- What the New Medicaid Managed Care Regulations Mean for Health Plan Quality and Performance MeasurementJune 17, 2015Wednesday, June 17, 2015 1:00 p.m. EST — The proposed Medicaid managed care regulations released last month by CMS include fundamental changes in the way quality and performance is measured among health plans in state-sponsored programs. The rules seek to align quality and performance measures with existing government programs like Medicare Advantage, institute a quality ratings system, support a variety of performance improvement projects, and increase the role of external quality review. During this webinar, HMA experts will outline the proposed quality rules and discuss the implication for states, Medicaid managed care plans and other stakeholders.
- Thursday, May 28, 2015 at 3 p.m. EST – The wait is over. CMS has finally released a new set of proposed Medicaid managed care and CHIP regulations – the first major update of federal rules for health plans in state-sponsored programs in more than a decade. The changes seek to align Medicaid managed care regulations with those of other government-sponsored programs, while at the same time fostering innovation, transparency, quality and financial viability. Like all such rules, details matter. And at more than 650 pages, these proposed rules have a lot of details to digest. It will take weeks – if not months – to fully understand the ins and outs of the new regulations. However, an initial read reveals several important themes likely to dramatically impact Medicaid managed care going forward. During this webinar, HMA experts will provide a “first take,” with initial thoughts and reactions to key components of the new regulations. This will be the first in a series of webinars that will fully explore the implications of the new rules in the weeks and months ahead.
- Minimum MLRs and Rate Setting Requirements: Implications of the Proposed Medicaid Managed Care RegulationsJune 16, 2015Tuesday, June 16, 2015 at 3 p.m. EST — Among the most important changes in the proposed federal Medicaid managed care regulations released last month are those involving medical loss ratios and rate setting requirements for health plans in state-sponsored programs. The rules dramatically expand federal oversight of the entire rate setting process – including a shift to actuarial certification of specific rate cells and the establishment of an 85% MLR threshold. During this webinar, HMA experts will discuss the proposed changes to the rate setting process and the implications for states, Medicaid managed care plans, and other stakeholders. Speakers: Eileen Ellis, Managing Principal, HMA Steve Schramm, Managing Director, Optumas
- Thursday, May 28, 2015 at 1 p.m. EST — New York has by far the most ambitious Delivery System Reform Incentive Payment (DSRIP) Program in the nation. The program has a clear focus on full health system transformation and payment reform. The state will invest $6.4 billion to incentivize collaboration among health care providers, social service providers, and community-based organizations to dramatically alter the way health care is delivered to Medicaid recipients. The primary goal: a 25% reduction in avoidable hospital use over five years. Getting there will require huge investments in community-based care, improvements in key quality metrics like hospital readmissions, and the continued shift from traditional fee-for-service payment models to value-based care. During this webinar, you’ll hear from Health Management Associates Principal Denise Soffel, PhD, who has been on the front lines in helping New York plan, develop, and implement its DSRIP initiative.
- April 30, 2015Thursday, April 30, 2015 at 1 p.m. EST – The U.S. Supreme Court last month limited the ability of healthcare providers to file lawsuits against state Medicaid programs over the adequacy of provider payment rates. The court’s decision in Armstrong v. Exceptional Child Center is good news for states looking to rein in Medicaid costs. But many fear it will be bad news for Medicaid beneficiaries, who may struggle to find access to quality care if providers refuse to participate in the program because of insufficient payment rates. Enforcement of Medicaid’s promise to provide high-quality health care to the poor now falls largely in the lap of CMS, whose enforcement tools may not be up to the task. During this webinar, you will hear an analysis of the possible real-world implications of this decision – for providers, beneficiaries, states and Medicaid managed care plans. Learning Objectives: • Understand the key arguments on both sides of the issue and why the court ruled the way it did. • Assess the most likely outcomes of the ruling. • Gain an understanding of the tools available to CMS to enforce the payment rate and network adequacy requirements of Medicaid. • Find out whether providers and beneficiaries have other avenues for addressing insufficient payment rates. • Learn how the ruling may impact Medicaid managed care plans, which are paid by a growing number of states to provide access to care for Medicaid beneficiaries and which contract directly with providers to do so. Confirmed Speakers: Meghan Linvill McNab, JD, Krieg DeVault Leah Mannweiler, JD, Partner, Krieg DeVault Kathy Gifford, JD, Managing Principal, Health Management Associates Catherine Rudd, JD, Senior Consultant, Health Management Associates
- March 12, 2015Thursday, March 12, 2015 at 1 PM EST – The time for culturally responsive health care is now. Not only is it the right thing to do, but key elements are mandated by the federal CLAS standards (Culturally and Linguistically Appropriate Services). There is also a strong business case for culturally responsive health care; it drives patient satisfaction, helps improve outcomes, and brings a degree of economic viability to what is essentially an unfunded mandate. Unfortunately, many healthcare organizations find themselves either unfamiliar with the standards or lagging in the development and implementation of strategies for full compliance. During this webinar, Health Management Associates Principal Dr. Jeff Ring will make the case for socially responsive health care and show your organization how to take the necessary steps to make it work for your patients and your organization.