Schedule

Caroline L. Farrell, Attorney, Office of the General Counsel, US Department of Health and Human Services
Jeff J. Wurzburg, Norton Rose Fulbright US LLP

• Session description to follow

Alison Hollender, Husch Blackwell LLP
Kathryn Moore, Bradley Arant Boult Cummings LLP

• Session description to follow

Jesse Berg, Lathrop GPM LLP
R. Ross Burris, Polsinelli PC
Hilary L. Isacson, Assistant General Counsel I, Legal & Risk Services, Sutter Health

• This session will provide an update on key changes affecting Medicare and Medicaid reimbursement that occurred during 2024, including the following:
• New or expanded policy initiatives, such as behavioral health and social determinants of health, implementation of Medicare’s second round of the Drug Price Negotiation Program, CMS’ revised guidance on Rural Emergency Hospitals, continued shifts in telehealth coverage and use of artificial intelligence
• Update on alternative payment models, including updates on the GUIDE (Dementia Care) Model, Oncology Care Model, AHEAD Model, Organ Transplant Access Model, and Final Rule on Appeal Rights for Changes in Inpatient to Observation Status
• Review of key hospital, physician, and other federal provider / supplier payment rules from the 2024 rulemaking cycle, as well as the Mental Health Parity final rule, final changes to Medicare Advantage and actions to remedy underpayments in the 340b drug discount program
• Developments in enforcement and program integrity, including efforts to crack down on improper reimbursement for skin substitutes, new compliance guidance for skilled nursing facilities, updated CMS-855A disclosure requirements, Medicare Advantage marketing issues, the revised overpayment rules, and the future of civil monetary penalties after Jarkesy
• Evolution of AI and digital health regulation from CMS and other agencies
• Reimbursement rule challenges after Loper Bright

Asha B. Scielzo, AHLA President
Emily J. Cook, Planning Committee Chair

Robert K. DeConti, Chief Counsel to the Inspector General, Office of the Inspector General, US Department of Health and Human Services

• Session description to follow

Eric Zimmerman, McDermott Will & Emery

• Session description to follow

Karen S. Kim, Athene Law
Dave Yoder, Founder, Medicare Regulatory University

• The hospital cost report, for those not familiar with the form
• The flow of the report, a fundamental understanding of cost-based reimbursement calculations, and how cost reporting disputes result in a large volume of administrative appeals, as well as federal court litigation
• An overview/primer of the appeals and litigation process for cost report disputes
• Timely updates relating to the home office cost report as well as discuss appeals relating specifically to the home office form, wage index, and UC DSH

Timothy P. Blanchard, Blanchard Manning LLP

• A brief review of the Fundamentals
• Medicare Coverage Policies: NCDs and LCDs
• Claims Processing, Overpayment, and Administrative Sanction Risks
• Medicare Advantage Issues
• False Claims and Health Care Fraud Implications

Bradley Cunningham, Lead Policy and Regulatory Analyst, Association of American Medical Colleges
Andrew D. Ruskin, K&L Gates LLP

• Graduate medical education fundamentals
• Optimizing use of opportunities to expand FTE caps
• Protecting a hospital against establishment of a low per-resident amount
• Proper determination of the available bed count
• Status of litigation in relation to all these reimbursement concepts
• Policy considerations under the new administration

Michelle Webb, Senior Practice Attorney, Ascension
Vivian Wozniak, Vice President & Senior Counsel, Texas Children's Health Plan

• Session description to follow

Kelsey Bagheri, Principal Counsel, UC Legal – Office of the General Counsel, University of California
Christine Johnson, Davis Wright Tremaine

• Background
• Policy debates and financial impacts
• Commercial payer conflicts
• What’s next

Marti Arvin, Chief Compliance and Privacy Officer, Erlanger Health
Joseph A. Dickinson, Kaufman & Canoles

• Session description to follow

Kyle Brierly, Athene Law
Garrett F. Mannchen, Office of the General Counsel, US Department of Health and Human Services

• Session description to follow

Richelle Marting, Marting Law LLC; Director of Managed Care Contracting for North Kansas City Hospital

• Session description to follow

• Session description to follow

Jonathan Mason, Moss Adams LLP
Stephanie A. Webster, Ropes & Gray LLP

• Session description to follow

Nina Adatia Marsden, Hooper, Lundy & Bookman, PC
Judy Strobos, Attorney, Department of Health and Human Services, Office of General Counsel

• Session description to follow

Sarah E. Mutinsky, Eyman Associates PC
Anne O'Hagen Karl, Manatt Phelps & Philips LLP

• Session description to follow

Laura Laemmle-Weidenfeld, Jones Day

• Session description to follow

Marc Hartstein, Principal, Health Policy Alternatives, Inc.
Katrina Pagonis, Hooper, Lundy & Bookman PC

• Session description to follow

Susan Banks, Holland & Knight, LLP
B. Scott McBride, Morgan, Lewis & Bockius LLP

• Session description to follow

Kevin D. Smith, Acting Chair, Provider Reimbursement Review Board,Centers for Medicare & Medicaid Services

• Introduction of Board members
• Board decisions
• Jurisdiction
• Hearings
• Case inventory
• Board initiatives
• Board Rules and mandatory electronic filing
• Evaluation of decision process
• Observations from the Board

Susannah Gopalan, Feldesman Leifer LLP

• Session description to follow

Bryan Hull, Washington Counsel, Division of Legislative Counsel, American Medical Association
Sidney Welch, Bradley Arant Boult Cummings LLP

• Session description to follow

Emily J. Cook, McDermott Will & Emery LLP

• The laws and regulations outside of the 340B Statute that 340B Covered Entities need to understand
• Example scenarios of arrangements requiring review under the 340B Statute and other federal and state laws will be presented and analyzed
• Applicable requirements and penalties for violation
• Examples of the following arrangements, among others: Alternative distribution, provider-based rules, management agreements, and medication therapy management models

Margia K. Corner

• Session description to follow

Charles A. Luband, Dentons

Medicaid is a program jointly financed by the federal government and the states. The financing rules that specify how the federal government will and will not match the non-federal share is a case study in federalism and has shaped the Medicaid program’s structure. This session focuses on Medicaid financing issues, including but not limited to the bulleted items below.

• Federal Financial Participation and the Federal Medical Assistance Percentage
• Permissible sources of the non-federal share
• Disputes and ambiguities regarding intergovernmental transfers and provider taxes
• Provider Tax waivers and hold harmless issues

Lisa A. Hathaway, Staff Vice President, Associate General Counsel Centene Corporation
Kathy Roe, Managing Attorney and Co-Founder Health Law Consultancy

In this environment, Medicare Advantage Organizations need to evolve and CMS is making sure MAOs do by demanding ever more from their performance. This session will focus on CMS’s expanding expectations of MAOs by addressing:

• Quality—evidenced by evolving measures and measurement for the Star Ratings program
• Benefits with value—manifested by enhanced requirements for supplemental benefits
• Utilization management practices—demonstrated by new interoperable FHIR-based APIs, annual health equity analysis mandates and use of artificial intelligence by MAOs
• Updates for supplemental benefits, ending of VBID, dual eligible special needs plans and transitions & ending of Medicare-Medicaid Plans, and changes to medical loss ratios

Pam D'Apuzzo, VMG Health
Mitchell Surface, Maynard Nexsen, PC

• Uptick in Providers (MD/QHP) opting out of Medicare and implementing the concierge practice model (i.e., cash only practice)
• Provider options with respect to his/her relationship with Medicare (participating, non-participating, or opt-out Provider)
• What it means to be a Provider (and a patient of a Provider) that has opted out of Medicare
• Common reasons why Providers opt out of Medicare • FAQs related to opting out of Medicare

Melissa D. Hart, Office of General Counsel, US Department of Health and Human Services
Daniel J. Hettich, King & Spalding LLP

• Leveraging the perspective and experience of both a private practice Medicare reimbursement litigator and a DOJ litigator, this session will cover:
• The past year’s significant Federal court cases or decisions affecting Medicare reimbursement, including Advocate Christ v Becerra, the Medicare DSH case currently pending before the U.S. Supreme Court
• Issues particularly pertinent to Medicare litigation such as agency deference post-Chevron, jurisdiction, substantive and procedural challenges, and remedies
• What recent decisions and tell us about the strengths and weaknesses of ongoing Medicare reimbursement appeals
• Potential areas of future Medicare litigation implicated by the past year’s developments

Laura Laemmle-Weidenfeld, Jones Day

• Session description to follow

Judge McArthur Allen, Chief Administrative Law Judge, HHS Office of Medicare Hearings and Appeals
Judge Christopher Randolph, Deputy Chair, HHS Departmental Appeals Board
Deborah Samenow, DLA Piper LLP (US)

• Legal framework/guidance for Medicare Appeals
• Lifecycle of an Appeal
• Update from the Office of Medicare Hearings and Appeals
• Update from the Medicare Appeals Council/DAB
• Case example
• Special Issues–Impact of Loper Bright/Corner Post

Susan Feigin Harris, Norton Rose Fulbright US LLP

• Session description to follow

Colin P. McCarthy, Kaufman & Canoles, PC

• Session description to follow

Kathy Ghiladi, Feldesman Leifer LLP

• Session description to follow

Kelsey Bagheri, University of California
Christine Johnson, Davis Wright Tremaine

• Background
• Policy debates and financial impacts
• Commercial payer conflicts
• What’s next

James M. Daniel, Hancock, Daniel & Johnson, PC
Chad Mulvany, Forvis Mazars

• Session description to follow

Lisa Orhin Wilson, Senior Technical Advisor, Centers for Medicare and Medicaid Services
Albert W. Shay, Morgan Lewis & Bockius LLP

• Using hypothetical scenarios, this advanced-level presentation will provide new insight into some of the “basic” concepts fundamental to the physician self-referral law
• Connecting the dots between various pieces of governmental guidance, the speakers will explore topics including remuneration, referrals, the in-office ancillary services exception, and “one-off” issues that can prove challenging to ensuring compliance with the physician self-referral law
• The speakers welcome your questions in advance of the panel, and will do their best to incorporate them into the presentation
• Audience participation is encouraged!

Hope Levy Biehl, Davis Wright Tremaine LLP
Ryan Thurber, Polsinelli PC

• Session description to follow

Richelle Marting, Marting Law LLC; Director of Managed Care Contracting for North Kansas City Hospital

• Session description to follow

Jonathan Mason, Moss Adams LLP
Stephanie A. Webster, Ropes & Gray LLP

• Session description to follow

Scott Gold, Forvis
Vacheria T. Keys, Director, Policy & Regulatory Affairs, National Association of Community Health Center

• Session description to follow

Timothy P. Blanchard, Blanchard Manning LLP

• A brief review of the Fundamentals
• Medicare Coverage Policies: NCDs and LCDs
• Claims Processing, Overpayment, and Administrative Sanction Risks
• Medicare Advantage Issues
• False Claims and Health Care Fraud Implications

Bradley Cunningham, Lead Policy and Regulatory Analyst, Association of American Medical Colleges
Andrew D. Ruskin, K&L Gates LLP

• Graduate medical education fundamentals
• Optimizing use of opportunities to expand FTE caps
• Protecting a hospital against establishment of a low per-resident amount
• Proper determination of the available bed count
• Status of litigation in relation to all these reimbursement concepts
• Policy considerations under the new administration

Michelle Webb, Senior Practice Attorney, Ascension
Vivian Wozniak, Vice President & Senior Counsel, Texas Children's Health Plan

• Session description to follow

Margia K. Corner

• Session description to follow

Michael H. Cook, Liles Parker PLLC

• Session description to follow

Julie Burns, Office of the General Counsel, US Department of Health and Human Services
Judith A. Waltz, Foley & Lardner LLP

• Session description to follow

Zubin Khambatta, Holland & Knight
Praveen Mekala, Assistant Vice President, Networ Finance, WMCHealth Network
K. Michael Nichols, University of Illinois Hospital and Clinics

• Session description to follow

Marc Hartstein, Principal, Health Policy Alternatives, Inc.
Katrina Pagonis, Hooper, Lundy & Bookman PC

• Session description to follow

Melissa D. Hart, Office of General Counsel, US Department of Health and Human Services
Daniel J. Hettich, King & Spalding LLP

• Leveraging the perspective and experience of both a private practice Medicare reimbursement litigator and a DOJ litigator, this session will cover:
• The past year’s significant Federal court cases or decisions affecting Medicare reimbursement, including Advocate Christ v Becerra, the Medicare DSH case currently pending before the U.S. Supreme Court
• Issues particularly pertinent to Medicare litigation such as agency deference post-Chevron, jurisdiction, substantive and procedural challenges, and remedies
• What recent decisions and tell us about the strengths and weaknesses of ongoing Medicare reimbursement appeals
• Potential areas of future Medicare litigation implicated by the past year’s developments

Victoria M. Corke, Attorney, US Department of Health and Human Services, CMS Division
Erin E. Hertzog, Manatt Phelps & Phillips LLP

On August 16, 2022, President Biden signed into law the Inflation Reduction Act of 2022 (IRA)—the law’s “Prescription Drug Pricing Reform” provisions represent the most significant changes to Medicare payment for drugs and biologicals in decades

• Among other provisions, the law authorizes the Medicare program to negotiate prices for certain Medicare-covered drugs, and requires manufacturers that raise their drug prices faster than the rate of inflation to pay a rebate to Medicare and reduces Part B coinsurance for these drugs for people with Medicare
• The law also contains several other provisions intended to reduce out-of-pocket expenditures for Medicare beneficiaries for drugs and certain vaccines
  • CMS’ ongoing implementation of the IRA’s Prescription Drug Pricing Reform provisions for initial price applicability year (IPAY) 2026 and beyond
  • The key statutory provisions, timelines, and the steps CMS has taken to implement them to date, with a primary focus on the drug price negotiation provisions
  • Legal considerations for pharmaceutical companies, pharmacies, and providers as a result of the changes under the IRA, and how those changes will affect patients in the coming years

Christine Blowers, Director, Division of Systems & Case Management, Office of Hearings, CMS
Leslie Demaree Goldsmith, Bass Berry & Sims
Lisa Ogilvie-Barr, Director, Division of Hearings & Decisions, Office of Hearings, CMS

• OH CDMS overview and updates
• Jurisdictional, procedural, and case management concerns
• Avoiding pitfalls and applying best practices before the Board
• Emerging trends

Bryan Hull, Washington Counsel, Division of Legislative Counsel, American Medical Association
Sidney Welch, Bradley Arant Boult Cummings LLP

• Session description to follow

Emily J. Cook, McDermott Will & Emery LLP

• The laws and regulations outside of the 340B Statute that 340B Covered Entities need to understand
• Example scenarios of arrangements requiring review under the 340B Statute and other federal and state laws will be presented and analyzed
• Applicable requirements and penalties for violation
• Examples of the following arrangements, among others: Alternative distribution, provider-based rules, management agreements, and medication therapy management models

• Session description to follow

Susan Banks, Holland & Knight, LLP
B. Scott McBride, Morgan, Lewis & Bockius LLP

• Session description to follow

Pam D'Apuzzo, VMG Health
Mitchell Surface, Maynard Nexsen, PC

• Uptick in Providers (MD/QHP) opting out of Medicare and implementing the concierge practice model (i.e., cash only practice)
• Provider options with respect to his/her relationship with Medicare (participating, non-participating, or opt-out Provider)
• What it means to be a Provider (and a patient of a Provider) that has opted out of Medicare
• Common reasons why Providers opt out of Medicare • FAQs related to opting out of Medicare

Zubin Khambatta, Holland & Knight
Praveen Mekala, Assistant Vice President, Networ Finance, WMCHealth Network
K. Michael Nichols, University of Illinois Hospital and Clinics

• Session description to follow

Colin P. McCarthy, Kaufman & Canoles, PC
Daniel J. Hettich, King & Spalding LLP

• Session description to follow

Kathy Ghiladi, Feldesman Leifer LLP

• Session description to follow

Hope Levy Biehl, Davis Wright Tremaine LLP
Ryan Thurber, Polsinelli PC

• Session description to follow