Schedule

1380x420_20_NAME_w_header1.jpg

Schedule

The timeline for the program is below. We will offer 10 in-depth sessions covering contracting, antitrust, COVID's impact on policies, self-funded group health plans, and more. All sessions will be played during the scheduled time, which includes a live speaker Q&A. All sessions will be available to also watch on demand. Anything viewed on demand will not include a live speaker Q&A. 

Continuing education credits (CLE, CPE, and CCB) are available all sessions participants watch live and on demand. 


Thursday, November 5, 2020

(Pre-recorded presentations with live speaker Q&A)


11:00 am-12:00 noon EST
   

1. Federal Update and Political Environment on Health Care Policy
 Michael Kolber
Wendy Krasner
David Schwartz

  • Supreme Court preview: California v. Texas and Rutledge v. PCMA
  • Drug pricing administrative and legislative proposals
  • Health care nondiscrimination under ACA section 1557
  • Hospital and insurer price transparency rules
  • Value-based purchasing: Price reporting and antikickback implications
 
12:15-1:15 pm EST
   
2. Innovative Care Delivery and Vendor Arrangements–Regulatory and Contracting Discussion

Matthew Brown
Jeremy Earl

  • The trend towards virtual and home-based services
  • MA program regulatory framework for innovative models
  • The effect of COVID-19 and associated regulatory flexibility on innovative models
  • Contracting tips when implementing innovative models
  • Value- and risk-based contracting for innovative models

1:30-2:30 pm EST | Concurrent Sessions


3. How You Can Avoid State and Federal Antitrust Investigations and How to Manage Them When You Can't

Vic Domen
Dionne Lomax
Peter Mucchetti

  • The importance of having an antitrust compliance program and practical tips for implementing the program, including who and what should be covered
  • The latest guidance from the Department of Justice regarding the necessary elements of an effective compliance program
  • What steps organizations should take upon becoming involved in an antitrust investigation
  • Best practices for working with state and federal authorities during an investigation both as a target and third-party, including how to manage matters when multiple agencies are investigating the same issue



4. Seeking Clarity for Parity: A New Era for Parity Legislation, Litigation, and Enforcement

 Gerald (Jud) E. DeLoss
Todd Pearson
David Shillcut

The volume of new legislation, litigation, and regulatory enforcement regarding mental health and substance use disorder parity has exploded over the course of the past two years, but substantial confusion and debates persist regarding many of the most fundamental concepts. There is a significant need for health care attorneys with a sophisticated understanding of the structure and requirements of federal and state parity laws to assist stakeholders from all parts of the health care system strive to improve health care access and outcomes for individuals with mental health and substance use disorder needs.

  • Key developments among the sea changes to parity compliance and enforcement, with particular emphasis on the implications for provider contracting, utilization management, and pharmacy benefits
  • Legislative and regulatory developments
    • Current enforcement authority and approach by market
    • Federal legislation is proposed that would require health plans to develop and implement dedicated parity compliance programs
  • Litigation and regulatory enforcement
    • Significant enforcement actions and multi-million dollar settlements have recently made headlines in states across the country
    • Courts are dramatically expanding the conceptual framework and compliance requirements for health plans and coverage to adhere to national standards of care
    • Public and private litigation is pushing requirements for provider reimbursement rates and methodologies to adhere to parity requirements that are poorly defined in guidance and hotly disputed among stakeholders
  • Best practices for compliance
    • Ambiguities in guidance and differences in enforcement approaches across markets and regulators can pose challenges to demonstrating and determining compliance

2:45-3:45 pm EST | Concurrent Sessions

5. Legal Ethics: So You Want To Be A General Counsel? The Perils and Pitfalls
Kyle Kveton
Cory Tolliver

  • Recognizing who is the client in a corporate setting: The potential conflicts of interest inside and outside of litigation
  • Up-the-ladder reporting and gatekeeping: The lawyer’s duty to identify, report, and rectify violations of law
  • Legal v. business advice: What’s the difference and what’s privileged
  • The GC/in-house counsel as a participant in negotiations with third parties: The ethical limitations of doing so
  • The supervisory responsibility of GC/in-house counsel for the conduct and ethical compliance of retained counsel

3:45-4:30 pm EST
  
Virtual Networking Reception
Following the sessions, grab a drink, set up your virtual background, and hop on our Zoom Happy Hour(ish). Relax after a full day of learning and see and talk to your colleagues live!
(Pre-registration required).


Friday, November 6, 2020

(Pre-recorded presentations with live speaker Q&A)


10:00-10:45 am EST 
   
Coffee and Conversations

Start the day by connecting with your colleagues over coffee (or tea). Hosted by our Payers, Plans, and Managed Care Practice Group, virtual Zoom Rooms will be open based on a topic. More information on the topic will be available soon. (Pre-registration required)

    
11:00 am-12:00 noon EST
  
6. The Future of Health Care: How COVID-19 is Reshaping Health Care Delivery and Payment

Kate McDonald
Hemi D. Tewarson

  • The financial impact of COVID-19 on health care providers and the influence on emerging payment models
  • The outlook for telehealth and digital health as regulations change, sites of care shift, and payment arrangements adapt
  • Reinvigorated policy momentum for all-payer delivery system reform and expansion of government programs
  • Unique perspectives on how the pandemic will influence changes in Medicaid managed care, Medicare Advantage, and the commercial and self-funded markets
  • The debate over who will pay for surveillance testing

12:15-1:15 pm EST | Concurrent Sessions

7. Understanding the "War" Between Out-of-Network Medical Providers and Administrators/Insurers of Group Health Plans
Timothy R. Hargadon
Andrew J. Holly

Out-of-Network medical providers have filed hundreds of lawsuits seeking payment for medical services against group health plans and their administrators/insurers. That trend will very likely continue and even expand. This presentation will summarize the key legal and factual issues arising in these lawsuits, including:

  • Summary of the ERISA and state law claims raised in these lawsuits
  • The role of ERISA preemption as a defense
  • Procedural and substantive defenses and issues
  • Recoupment claims by group health plans/insurers against providers seeking the recovery of overpayments
  • Pre-litigation strategies for preparing for these lawsuits, including how to administer the ERISA administrative process

 

8. Medicare and Medicaid Legal Issues and Developments
Robert Belfort
Wayne Gibson
Ross D. Margulies

  • How MA plans can overcome regulatory obstacles to develop innovative models of home-based care
  • How MA plans can use increased flexibility on social determinants of health to more effectively manage benefits
  • The historical context of Section 1115 waivers and their role in the growth and expansion of Medicaid managed care
  • Key waiver approvals impacting the Medicaid managed care marketplace
  • Policy and legal issues raised in light of recent waiver approvals by CMS, including legal challenges

 


1:30-2:30 pm EST | Concurrent Session 1:30-2:45 pm EST | Concurrent Session
   

9. Self-Funded Group Health Plans–The 10 Golden Rules
David McFarlane
Ryan Temme

  • ERISA or Not?-What plans are covered? Inadvertently ERISA
  • Who's the ERISA fiduciary–Understanding various roles, rules, and risks
  • The ”Other” Applicable Laws–Tax, COBRA, GINA, HIPAA and many of their other friends
  • Benefit Claims Administration-Overview, identifying, and correcting errors
  • Missing Participants/Missing Employer–Finding folk, forfeitures, and abandonment. What happens when an employer goes under
  • MHPAEA–Plan sponsor and TPA roles and conflicts
  • DOL–Enforcement approach at the Plan Sponsor/TPA/insurer levels
  • COVID-19Extensions of time and modifications. What’s applicable, best efforts, and what to do now
10. There’s an API for That: EHI Interoperability and Access
Brian Hoyt
Marilyn Lamar
Kathy Roe

In May 2020, CMS published a final rule to promote electronic health information (EHI) interoperability and individuals’ access to their EHI via a health plan application programming interface (API). At the same time, ONC published a companion final rule, promoting EHI interoperability and prohibiting information blocking. These CMS and ONC rules will affect health plans differently as this session will review.

  • What history and purpose underlie the new CMS and ONC rules governing EHI interoperability, information blocking and API access to EHI?
  • Which rule requirements apply to health plans?
  • Which health plans are subject to those rule requirements and when?
  • What is an API and how does it work?
  • What standards govern the EHI health plans must make accessible to members through APIs?
  • What opportunities and challenges do these new rule requirements present health plans?