Medicaid Managed Care: Compliance Under New Program Rules, Waiver Initiatives and Future Changes as Yet Unknown
Recording of a 90-minute CLE webinar with Q&A
This CLE course will guide healthcare counsel on federal Medicaid managed care requirements and state level demands on participating managed care organizations. The panel will also discuss compliance with the law and potential changes to Medicaid managed care under the current administration.
Outline
- Compliance with Medicaid managed care final rule
- Medical loss ratio
- Actuarial soundness
- Authorization of “pass-through” payments
- Provider screening and enrollment
- Provider integrity
- State demands and new care management models
- Impact on MCOs
- Impact on providers
- Impact on patients
- Potential changes to Medicaid managed care
Benefits
The panel will review these and other high priority ssues:
- The final rule’s changes to MLR, network adequacy standards and rules for setting capitation rates
- Addressing compliance challenges under the Medicaid managed care regulations
- Changes implemented by the current administration and expectations for the future
Faculty

Clifford E. Barnes
Member
Epstein Becker & Green
Mr. Barnes is Co-Chair of the firm's Health Plan Compliance Group. He has been employed by the firm for over 35... | Read More
Mr. Barnes is Co-Chair of the firm's Health Plan Compliance Group. He has been employed by the firm for over 35 years and represents providers, including hospitals, hospital systems, nursing homes, home health, hospice, ancillary service companies; managed care companies, concentrating in Medicare and Medicaid; and nonprofit associations. Mr. Barnes is the Co-Founder of Medicaid Health Plans of America Inc., and currently serves as Vice Chair of the Accountable Care Organization Task Force of the American Health Lawyers Association. He counsels healthcare providers and payors on issues related to mergers, acquisitions, joint ventures, and various forms of contracting, including accountable care organization arrangements, international transactions, antitrust issues, fraud and abuse, and compliance programs Mr. Barnes serves as general and special counsel for post-acute providers, including nursing home, home health, and long-term acute care facilities. He also serves as general and special counsel for managed care companies, including Medicare and Medicaid health plans, and for nonprofit associations, including Medicaid Health Plans of America and the National Medical Association, among others.
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Michael A. Dowell
Partner
Hinshaw & Culbertson
Mr. Dowell practices in the areas of healthcare, regulatory and corporate law. With more than 30 years of experience,... | Read More
Mr. Dowell practices in the areas of healthcare, regulatory and corporate law. With more than 30 years of experience, he represents clients in a variety of sectors within the healthcare industry, including federally qualified health centers, health plans, PPOs, HMOs, Medicaid Managed Care Plans, Medicare Advantage Plans, PACE Programs, employer self-insured plans, pharmacy benefit managers, pharmaceutical manufacturers, retail pharmacies, long-term care pharmacies, specialty pharmacies, compounding pharmacies, mail order pharmacies, wholesale drug distributors, hospitals, health systems, long-term care providers, physician organizations, management companies, and ancillary service providers. Mr. Dowell counsels clients in a variety of corporate and contractual transactions, including M&As, joint ventures, affiliations, licensing, financing and services-related transactions. He also advises clients in federal and state fraud and abuse matters, compliance program development, governmental audits and investigations, Medicare, Medicaid, HIPAA and data privacy, meaningful use of electronic medical records, licensing, healthcare reform delivery models, concierge medicine, and managed care law.
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Helaine I. Fingold
Member
Epstein Becker & Green
Ms. Fingold has more than 20 years of broad health law and regulatory experience, including prior government experience... | Read More
Ms. Fingold has more than 20 years of broad health law and regulatory experience, including prior government experience in both the legislative and executive branches of the federal government. She advises on issues involving the Medicare Program Parts A, B, C and D, Medicare Innovations, Medicare Dual Eligibles, Medicaid, and Veterans' healthcare programs. Ms. Fingold counsels on issues related to products offered on public and private health insurance exchanges and related health insurance reform issues; provides interpretative and practical advice regarding oversight and compliance requirements of the Medicare Advantage and Medicare Prescription Drug programs; advises on the development of business arrangements to assure compliance with federal and state fraud and abuse laws; and counsels companies on legislative and regulatory strategies involving government health programs, including health insurance reform. Prior to rejoining the firm, Ms. Fingold worked at the CMS' Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group.
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