Medicaid Managed Care Final Rule: Calculating Medical Loss Ratio, Complying With Network Adequacy Standards and More
Recording of a 90-minute CLE webinar with Q&A
This CLE webinar will provide healthcare counsel with an in-depth review of the Centers for Medicare & Medicaid Services’ (CMS) final regulations that overhaul Medicaid managed care. The panel will analyze who will be impacted—and how—and discuss the key components of the rule. The panel will also address what counsel needs to do to ensure compliance.
- The final regulations—key components
- Medical Loss Ratio
- Actuarial soundness
- Continued authorization of “pass-through” payments for a limited time
- Benefit flexibility, network adequacy/accessibility
- Integration of LTSS
- Provider screening and enrollment
- Other provider program integrity provisions
- Who is impacted and how
- Best practices for compliance
The panel will review these and other key issues:
- How does the final rule change MLR, network adequacy standards, and capitation rates?
- What are the potential compliance impacts under the final rule?
- What are the costs and risks to healthcare providers and other stakeholders?
Freeborn & Peters
Ms. Dorman-Rodriguez is the leader of her firm's Healthcare Practice Group. She has diverse experience as... | Read More
Ms. Dorman-Rodriguez is the leader of her firm's Healthcare Practice Group. She has diverse experience as a healthcare attorney representing insurers, providers, and other healthcare entities. Most recently she served as the Senior Vice President, Chief Legal Officer, and Corporate Secretary at Chicago-based Health Care Service Corporation (HCSC), which operates BlueCross and BlueShield plans in Illinois, Montana, New Mexico, Oklahoma and Texas. At HCSC, she was responsible for providing legal advice and consultation on such issues as federal and state regulatory implementations, litigation, mergers and acquisitions, corporate governance and compliance. She oversaw HCSC’s legal strategy during a period of unprecedented turbulence in the healthcare industry and helped the company navigate the regulatory and business upheaval associated with the passage of the ACA.Close
Susannah Vance Gopalan
Feldesman Tucker Leifer Fidell
Ms. Gopalan focuses on health care litigation and regulatory counseling, with a distinct focus on Medicaid... | Read More
Ms. Gopalan focuses on health care litigation and regulatory counseling, with a distinct focus on Medicaid and the new coverage options under the Affordable Care Act. She has extensive experience negotiating Medicaid waivers and managed care arrangements, and advises clients on Medicaid and Medicare reimbursement and compliance issues. She works with health centers, local governments, primary care associations, and the National Association of Community Health Centers on Medicaid and Medicare policy issues and administration. She also counsels health care providers on their responsibilities as Exchange network providers and as Navigators supporting the enrollment of uninsured individuals.Close
Hooper Lundy & Bookman
Ms. Sze is a recognized expert in Medicaid and Medicare reimbursement matters, focusing on both the managed care and... | Read More
Ms. Sze is a recognized expert in Medicaid and Medicare reimbursement matters, focusing on both the managed care and fee-for-service programs. She advises healthcare providers, including hospitals, clinics, post-acute providers, pharmacies, durable medical equipment suppliers, and others, on a wide array of compliance and reimbursement matters and in disputes with managed care entities and government payors. She regularly reviews, revises and negotiates managed care contracts with a focus on those using alternative payment models.Close