Health Exchanges: Proactive Legal Strategies for Providers
Navigating Managed Care Contracts Issues, Out-of-Network Provider Coverage, Reimbursement, and Potential Bad Debt Exposure
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide counsel for healthcare providers and MCOs with a review of the new health insurance exchanges—how they will work and their anticipated impact on providers. The panel will provide guidance for counsel to providers to assist clients now to adapt to the healthcare exchange environment.
Outline
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Exchanges basics
- Types of exchanges and exchange products
- Enrollees—who will obtain exchange coverage?
- Coverage on exchange plans
- The timeline to Jan. 1, 2014
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Provider risks and opportunities: bad debt and coverage
- Projected 2014 enrollment and the remaining uninsured
- Expanded safety net: exchange subsidies and Medicaid expansion
- Bad debt exposure
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Managed care contracting issues for providers
- Does a QHP need you? Network adequacy and essential community providers
- Are you already in? Broad base agreement language
- Tiered networks and the importance of steerage language
- QHP-specific terms and conditions
- Legally-required amendments
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Out-of-network providers: coverage and reimbursement
- Emergency services
- PPO products and OON cost-sharing
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Provider opportunities to facilitate enrollment
- Navigators, in-person assisters, and certified application counselors
- Open enrollment
- Special enrollment
- Grace periods
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Beyond 2014
- Transitioning from federal to state responsibility
- The SHOP Exchange
- Expansion of multi-state plans
Benefits
The panel will review these and other key questions:
- What are the legal risks and opportunities of health insurance exchanges for healthcare providers?
- How will the exchanges impact coverage and reimbursement for out-of-network providers?
- What are the key legal considerations for healthcare providers as the exchanges go into effect?
Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.
Faculty
Martin A. Corry
Director of Government Relations & Public Policy
Hooper Lundy & Bookman
He represents clients on health care matters before Congress and the Executive branch on legislative, regulatory and... | Read More
He represents clients on health care matters before Congress and the Executive branch on legislative, regulatory and administrative matters. He also provides strategic advice and counsel to clients on broad public policy and program goals as well as specific client business needs. He also was formerly the Special Assistant to the Administrator of the Centers for Medicare and Medicaid Services (CMS), where he assisted in planning, developing and implementing program initiatives related to healthcare financing and quality health care.
CloseKatrina A. Pagonis
Hooper Lundy & Bookman
Her practice focuses on the representation of health care providers in matters relating to health care reform, as well... | Read More
Her practice focuses on the representation of health care providers in matters relating to health care reform, as well as regulatory compliance more generally. She advises clients related to the Affordable Care Act and Health Insurance Exchanges. She provides strategic advice on managed care contracting and counsel on providers’ options to assist in outreach and enrollment activities. Her regulatory work covers issues in fraud and abuse, non-profit law, clinical trial agreements, privacy and licensure.
CloseJack Ebeler
Principal
Health Policy Alternatives
Before returning to HPA, he spent a year on the staff of the House Committee on Energy and Commerce, where he worked... | Read More
Before returning to HPA, he spent a year on the staff of the House Committee on Energy and Commerce, where he worked on health care reform. Before joining the House Committee staff, he was an independent consultant and served as vice-chair of the Medicare Payment Advisory Commission (MedPAC). He also served on several boards: Inova Health System in northern Virginia, Families USA, and the Health Care Services Board of the Institute of Medicine (IOM), as well as a number of advisory committees. Prior to that, he was president and CEO of the Alliance of Community Health Plans. In 1995 and 1996 he served in the U.S. Department of Health and Human Services as Deputy Assistant Secretary for Planning and Evaluation/Health and then as Acting Assistant Secretary for Planning and Evaluation.
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