Modernizing Medicaid Managed Care: Navigating CMS' Long-Awaited and Overhauled Proposed Regulations
Calculating Medical Loss Ratio, Complying with Network Adequacy Standards, Setting Capitation Rates, and More
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide healthcare counsel with an in-depth review of the Centers for Medicare & Medicaid Services’ (CMS) newly proposed regulation revision that overhauls Medicaid managed care. The panel will analyze who will be impacted—and how, and addresses the likelihood of the rule being adopted and expected challenges. The panel will also address what counsel needs to do now regarding compliance that could be impacted if/when the rule is adopted.
- The proposed regulations
- Medical loss ratio standards
- Provider network adequacy standards
- Actuarially sound capitation rates
- Other key changes
- Who will be impacted and how
- Likelihood of the proposed rule being adopted and expected challenges
- What counsel needs to do now regarding compliance that could be impacted if/when the rule is adopted
The panel will review these and other key issues:
- How does the proposed rule change MLR, network adequacy standards, and capitation rates?
- What are the potential compliance impacts under the proposed rule?
- What are the costs and risks to healthcare providers and other stakeholders?
- What types of challenges can be expected?
J. Peter Rich
McDermott Will & Emery
Mr. Rich practices almost exclusively in the healthcare field, advising hospitals, medication groups, and health plans,... | Read More
Mr. Rich practices almost exclusively in the healthcare field, advising hospitals, medication groups, and health plans, as well as health industry clients. He has formed and restructured many types of managed care organizations, including ACOs, other types of physician-hospital organizations and similar integrated healthcare delivery systems, as well as HMOs and other types of health plans.Close
McDermott Will & Emery
Ms. Tschumi focuses her practice on general health matters. She previously served as an analyst at the Center for... | Read More
Ms. Tschumi focuses her practice on general health matters. She previously served as an analyst at the Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). She was the principal author of the legal waiver agreement between CMS and the State of Maryland for a new state-wide all-payer approach for hospital reimbursement. She formulated policy related to Medicare’s participation in state-led payment and delivery system reform models, and developed legal and programmatic components of Medicare ACO and advanced primary care medical home models.Close