Program Agenda

Program Agenda

The planning committee has finalized the sessions and speakers for the program. The full agenda and faculty for the program are below. We will offer 37 in-depth sessions covering Part A and B; fraud and abuse, Medicaid, ancillary services, and more. In addition, 6 sessions will be offered on demand, where attendees can watch the presentation on their own time. The difference between the a live session and an on-demand session is the live sessions include an interactive speaker/attendee question and answer chat feature.

Continuing education credits (CLE, CPE, and CCB) are available for the sessions being presented on March 24-26, as well as for any on-demand sessions that you watch. 

Attendees can access program materials, continuing education information, and networking opportunities on the Attendee Website. This site is for attendees only and you must be logged in to access it.

Wednesday, March 24

11:00 am-12:00 noon EDT | Plenary Session

1. Medicare and Medicaid: A View from the Hill
Amy Hall, Staff Director, Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Stuart Portman, Health Policy Advisor, US Senate Committee on Finance

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

2. Medicaid Fundamentals
(Session was Pre-Recorded for the Fundamentals of Health Law Program, November 2020)
Caroline L. Farrell, Medicaid Attorney
Jeff J. Wurzburg, Norton Rose Fulbright US LLP

  • The Medicaid program and its program objectives
  • The statutory requirements for Medicaid programs
  • Medicaid's critical role in addressing the COVID-19 public health emergency
  • Different state approaches to Medicaid and Medicaid eligibility
  • The next era of the Medicaid program and reforms including the Healthy Adult Opportunity and work and community engagement requirements
  • The future: Ongoing litigation and contemplated reforms

3. Hot Topics in Fraud and Abuse
Robert Kaufman, Office of the General Counsel-CMS Division, US Department of Health and Human Services
Laura  F. Laemmle-Weidenfeld, Jones Day
Lisa Re, Assistant Inspector General for Legal Affairs, Office of the Inspector General, US Department of Health and Human Services
Alison B. Rousseau, Senior Counsel for Health Care Fraud, US Department of Justice

  • Recent developments in CMS’s program integrity efforts
  • Recent priorities and developments in HHS-OIG enforcement efforts
  • Recent enforcement activity by the DOJ under the FCA and criminal statutes

4. The 340B Program:  Overview, Compliance, and Looking Ahead
Eva Johnson, Eyman Associates PC
Barbara Straub Williams, Powers Pyles Sutter & Verville PC

  • The 340B drug discount program and key compliance issues
    • Patient definition, diversion, GPO prohibition
  • Interaction of the 340B program with Medicare and Medicaid
    • Duplicate discounts, state initiatives to obtain the benefit of 340B pricing, importance of the Medicare cost report in establishing registered sites, Medicare payment reductions for Status Indicator “K” 340B drugs
  • “Hot topics” related to the 340B program
    • Alternative dispute resolution regulation, manufacturer actions related to contract pharmacy
    • Implications of 340B-related litigation for provider appeals and administrative law more generally

5. The Road Ahead: What Telehealth Looks Like in 2021 and Beyond
Jacob Harper, Morgan Lewis & Bockius LLP
Shira N. Hollander, Senior Associate Director, Policy Development, American Hospital Association
Catherine Wong, Assistant Counsel, Mercy
Emily Yoder, Division of Practitioner Services, Hospital and Ambulatory Policy Group, Centers for Medicare and Medicaid Services

  • Impact of the COVID-19 PHE declaration on telehealth
  • How physicians, hospitals, and other stakeholders have responded
  • Off-ramps for telehealth coverage in 2021
  • Legislative and regulatory changes on the horizon

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

6. Mental Health, EKRA, and the Opioid Crisis
Lynn M. Barrett, Wachler & Associates, P.C.
Kimberly Brandt, Tarplin Downs & Young
Gary L. Cantrell, Deputy Inspector General for Investigations, Office of the Inspector General, US Department of Health and Human Services

  • Mental health issues focusing on individuals and entities impacted by the opioid crisis
  • What we know (and don’t know) about EKRA
  • CMS’s strategy to combat the opioid epidemic, including new Part B benefits for OTPs, Part D initiatives, and key guidance and flexibilities for state Medicaid programs
  • Latest trends and enforcement strategies in the fight against prescription opioid diversion and fraud


7. Addressing Social Determinants of Health
Michael McKnight, Senior Vice President of National Programs, Green & Healthy Homes Initiative

We all know about the social determinants of health and their importance. But how do we pay for them? This session will cover:

  • Payment models including value-based payments that are used in Medicaid and Medicare to pay for services that address the social determinants of health
  • How partnerships between health care payers and social service providers are developed
  • Common barriers to these models and how to overcome them
  • Policy recommendations to scale payment models that address the social determinants of health


8. PRRB Appeals—The View from the Board Chair
Clayton J. Nix, PRRB Chairperson, Office of Hearings, Centers for Medicare and Medicaid Services

  • Introduction of Board members
  • Board decisions
  • Jurisdiction
  • Hearings
  • Case inventory
  • Board initiatives
  • Electronic case tracking and filing
  • Evaluation of decision process
  • Observations from the Board


9. Who CARES how you spent CARES Act funds? The OIG: Be Prepared for CARES Act Audits
Jeffrey S. Cohen, Audit Director, Office of the Inspector General, US Department of Health and Human Services
Joseph Geraci, Husch Blackwell
Julie Sullivan, Greenberg Traurig LLP

The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated tens of billions of dollars for the Provider Relief Fund (PRF) to support health care providers affected by the COVID-19 pandemic. The HHS-OIG has included various CARES Act audit topics to its Work Plan, and providers should ensure their documentation is in order in anticipation of these audits. In this presentation, we will review the ground rules for the various Provider Relief Act funding distributions, and discuss what auditors may expect to see from various providers to determine that the providers complied with the terms and conditions for reporting and expending PRF funds.

  • The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated tens of billions of dollars for the Provider Relief Fund (PRF) to support health care providers affected by the COVID-19 pandemic. The HHS-OIG has included various CARES Act audit topics to its Work Plan, and providers should ensure their documentation is in order in anticipation of these audits.
  • What are the likely areas of focus for the OIG (and other federal auditors).
  • In light of the often confusing and changing sub-regulatory guidance provided by HHS, what factors will the OIG take into consideration when deciding on penalties.
  • How will the OIG audits differ from a Single Audit?
  • What are best practices for preparing for an audit?

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

10. Medicare Graduate Medical Education Reimbursement: Overview and Recent Policy Changes
Tim Johnson, Senior Vice President, Greater New York Hospital Association
Lori K. Mihalich-Levin, Dentons US LLP

  • Medicare payment for graduate medical education (GME)
  • The Hahnemann fallout and new program closure rules: Displaced Resident Status and Closed Hospital slot redistribution
  • Medicare rules regarding newly-accredited residency and fellowship programs
  • Medicare GME legislative changes included in Consolidated Appropriations Act, 2021ac

11. Legal Ethics: The Grey Zone—Ethical Issues In Between Compliance and Legal
Dawn R. Crumel, Managing Counsel, Legal Operations and Administration, Vanderbilt University Medical Center
Stella Ghattas, Children's National Health System
Kim Harvey Looney, K & L Gates LLP

  • Intersection of compliance and legal in protecting the organization
  • Communication and coordination issues when compliance and legal aren’t on the same page
  • The role of Rules of Professional Conduct in these situations
  • Reality of compliance making independent reports to the board
  • Hypothetical situations

12. Medicare Appeals: Soup to Nuts
Hon. McArthur Allen, Chief Administrative Law Judge, Office of Medicare Hearings and Appeals, US Department of Health and Human Services
Andrew B. Wachler, Wachler & Associates PC

  • In-depth explanation of the appeals process, what triggers the process, and what to expect at each stage
  • Strategic approaches and practical tips to consider and implement when appealing overpayment demands and claim denials through the changing Medicare appeals process
  • Overview and updates from OMHA’s new Chief Administrative Law Judge, including practical tips from OMHA ALJs
  • The interplay between audits, provider enrollment, and False Claims Act liability in today’s legal landscape
  • Significant reforms to the Medicare appeals process, including HHS rulemaking aimed at reducing the backlog of pending appeals and encouraging resolution of cases earlier in the appeals process

13. Current Issues in Medicaid Supplemental Payments and Financing
Barbara D. A. Eyman, Eyman Associates PC
Charles A. Luband, Dentons US LLP

  • Medicaid disproportionate share hospital (DSH) and other Medicaid non-DSH supplemental payments
  • Medicaid managed care directed payments
  • Medicaid waiver payments, including uncompensated care payments and delivery system reform incentive program payments
  • Medicaid financing (IGTs, CPEs, provider taxes, and the Medicaid Fiscal Accountability Rule (MFAR))

3:45-4:30 pm EDT

Interactive Networking and Engagement
Interact with your colleagues face to face in our facilitated small group discussions. (Pre-registration required)

Thursday, March 25

10:00-10:45 am EDT

Coffee and Conversations
Start the day by connecting with your colleagues over coffee (or tea). Attendees can choose between two Zoom Breakout Rooms: GME - Deeper Dive or Telehealth - Deeper Dive. Attendance is limited in each room, so sign up early!
(Pre-registration required)

11:00 am-12:00 noon EDT | Plenary Session

14. Updates on Medicare and Medicaid
Daniel J. Barry, Deputy General Counsel, US Department of Health and Human Services
Gregory E. Demske, Chief Counsel, Office of the Inspector General, US Department of Health and Human Services
Matt Salo, Executive Director, National Association of Medicaid Directors

  • What is going on now at HHS?
  • What’s on our mind at HHS OGC?
  • Reflections on the past year
  • OIG COVID-19 work
  • OIG Medicare and Medicaid priorities, trends, and highlights
  • OIG audits, evaluations, investigations, and enforcement actions

The entire experience of Medicaid Directors over the past year has been through one or more of the following lenses:

  • Pandemic
    • Supporting providers at the front line of the surge (Hospitals, LTSS facilities)
    • Supporting providers who have struggled to keep patients/appointments and ensuring that their business model survives the pandemic
    • Role of the Public Health Emergency Declaration
      • Disaster SPAs and waivers
      • Utilizing Emergency waivers to increase telehealth
      • FMAP and MOE and the eventual unwinding
        • Economic Downturn
        • Racial and Ethnic Disparities/Inequality

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

    15. Original Medicare DSH Payment—An Ongoing Saga
    Peter Bryce, Civil Division, US Department of Justice
    Serena M. Orloff, Trial Attorney, Civil Division, Federal Programs Branch, US Department of Justice
    Stephanie Ann Webster, Ropes & Gray LLP

    • DSH payment adjustment
    • Legal issues, including:
      • Medicare Part C days
      • Medicare Part A non-covered days
      • Section 1115 waiver days
    • Jurisdictional challenges/decisions and implications

      16. Medicare Litigation Update
      Mimi H. Brouillette, Associate General Counsel, Office of Legal Affairs Westchester Medical Center
      Melissa Hart, Office of the General Counsel, US Department of Health and Human Services

      • Past year’s significant Medicare reimbursement decisions issued by the federal courts as well as review of the relevant agency decisions at issue
      • Litigation topics including: Jurisdiction; scope of the administrative record; substantive and procedural challenges (e.g., notice and opportunity to comment, contrary to law, and arbitrary and capricious); and remedies (e.g., remand orders and injunctions)
      • Potential areas of future Medicare litigation implicated by the past year’s developments
      • How courts and the agency have addressed the full spectrum of issues that might be applicable in Medicare litigation, thus giving attendees a better understanding of the strengths and weaknesses of ongoing reimbursement issues


      17. Medicare Reimbursement for CAR-T and Allogeneic Stem Cell Transplant: Major Wins, Unknown Future Impact
      Jugna J. Shah, Nimitt Consulting Inc
      Mark Trusheim, Strategic Director, NEWDIGS, Visiting Scientist, Sloan School of Management Massachusetts Institute of Technology; President, Co-Bio Consulting

      • The new Medicare cost reimbursement model for donor cell acquisition costs and how hospitals can access it
      • Medicare payment methods for new technologies and what happens after they expire
      • The latest about Medicare CAR-T coverage, coding, and reimbursement
      • Near-term product pipeline and issues on the horizon
      • What other payers are doing for new technologies and what can Medicare can learn from them
      • Strategies for tackling tomorrow’s reimbursement challenges today

      18. The Changing Medicaid Program—A Panel of State Medicaid Directors
      Michael Cook, Liles Parker PLLC
      Karen Kimsey, Director, Virginia Department of Medical Assistance Services
      Lynnette R. Rhodes, Executive Director, Medical Assistance Plans, Department of Community Health

      • How the Medicaid program is changing in a particular state and nationally
      • Innovative features of the particular state's Medicaid program
      • How the COVID pandemic is affecting their various programs including budget and coverage issues

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

      19. How Much Deference Does CMS Get These Days?
      Sven Collins, Squire Patton Boggs
      Alisa B. Klein, Attorneys, Appellate Staff, Civil Division, US Department of Justice

      Recent Supreme Court decisions have altered the deference standards courts apply to agency actions.  This session will explore:

      • How those deference standards are playing out in the lower courts
      • What implications those deference standards have for providers and CMS
      • Which types of agency actions and circumstances are getting deference and which are not
      • How guidance on policymaking practices has been adapted to the new deference standards

      20. What’s Up Doc: Updates to Medicare Physician Fee Schedule and Part B Payments
      Cynthia Brown, Vice President, Government Affairs, American Medical Association
      Sidney S. Welch, Akerman LLP

      • Important updates and Implications from the 2021 Final Physician Fee Schedule
      • Trends and considerations for Part B reimbursement
      • Looking forward to 2021 and beyond–areas for input and consideration

      21. Uncompensated Care Reporting—Audits and Financial Assistance Policies
      Fred A. Fisher, Toyon Associates Inc
      K. Michael Nichols, PYA
      Mark Polston, King & Spalding LLP

      This presentation will cover the importance of reporting uncompensated care on worksheet S-10 of Medicare Cost report, and highlight emerging issues including:

      • Variations and consistencies from national S-10 audits
      • The impact of COVID-19 to Uncompensated Care
      • Takeaways from CMS' new proposed S-10 instructions
      • Uncompensated Care's relationship to Financial Assistance Policies
      • Frankenstein accounts-can an old account be brought back and reported as charity care?
      • Out of network as charity care-is this a measurement of low income?

      22. The Federal Health Policy Agenda in the Age of Coronavirus and the Biden Administration: A Look Ahead
      Eric Zimmerman, McDermott Will & Emery LLP
      The new President has a long health care policy wish list. Tackling COVID is priority one, but the President and Congress can chew gum and walk at the same time. Expect much more from the new Administration and Congress this year. This session will identify anticipated federal Medicare and Medicaid policy changes in 2021 and beyond, and assess how those changes could affect client strategies, budgets and transactions.

      • Telehealth
      • Rural
      • Surprise billing
      • Medicare payment
      • Medicaid waivers

      Thursday, March 25 continued

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

      23. Hospital Inpatient PPS AND OPPS Update
      Marc Hartstein, Principal, Health Policy Alternatives Inc.
      Alyssa Keefe, System Senior Vice President, Public Policy and Advocacy, CommonSpirit Health
      Katrina A. Pagonis, Hooper Lundy & Bookman PC
      Valerie Rinkle, Valorize Consulting LLC

      • FY 2021 payment adjustments and outlier threshold
      • Burden reduction: Supervision and documentation relief
      • New technology and CAR T-Cell therapy
      • Site of service and level of care issues and reimbursement
      • Low wage hospital policy and the area wage index
      • Uncompensated care and bad debt


      24. Overview of the SPRINT Rules
      (Session was Pre-Recorded from the Physicians and Hospitals Law Institute, February 2021)

      Robert K. DeConti, Assistant Inspector General for Legal Affairs, Office of the Inspector General
      Julie E. Kass, Baker Donelson Bearman Caldwell & Berkowitz PC
      Catherine A. Martin, Senior Technical Advisor, Centers for Medicare & Medicaid Services
      Jillian A. Sparks, Senior Counsel, Industry Guidance Branch, Office of the Inspector General
      Lisa Ohrin Wilson, Senior Technical Advisor, Centers for Medicare & Medicaid Services

      • Framework and terminology for value-based health care delivery and payment
      • New exceptions and safe harbors for “value-based arrangements”
      • Other new exceptions, safe harbors, and flexibilities
      • Policy clarifications to facilitate compliance efforts under the physician self-referral law


      25. PRRB Appeals—Current Challenges
      Christine M. Blowers, Director, Division of Systems & Case Management, Office of Hearings
      Leslie Demaree Goldsmith, Baker Donelson Bearman Caldwell & Berkowitz PC
      Lisa Ogilvie-Barr, Director, Division of Hearings and Decisions, Office of Hearings
      Owen Osaghae, Division of Provider Audit Operations, Centers for Medicare & Medicaid Services

      • OH CDMS overview and updates
      • Jurisdictional, procedural, and case management concerns
      • Avoiding pitfalls and applying best practices before the Board
      • Emerging trends


      Friday, March 26

      10:00-10:45 am EDT

      Coffee and Conversations
      Start the day by connecting with your colleagues over coffee (or tea). Attendees can choose between two Zoom Breakout Rooms: 340B- Deeper Dive or Medicaid Supplemental Payments - Deeper Dive. Attendance is limited in each room, so sign up early! (Pre-registration required)


      11:00 am-12:00 noon EDT | Concurrent Sessions

      26. Provider-Based Status, Under Arrangements, Enrollment, and Related Medicare Requirements
      Emily S. Lipkin, Centers for Medicare and Medicaid Services
      Andrew D. Ruskin, K & L Gates LLP
      Lawrence W. Vernaglia, Foley & Lardner LLP

      • Provider-based fundamentals
      • Updates on disputes surrounding payments for 340B drugs, site neutrality payment reductions, and mid-build application results
      • Changes in outpatient department reimbursement rules and waivers during the Covid-19 PHE, as well as considerations to transitions out of the PHE
      • Co-location rules and implications for treating patients during the pandemic and after

      27. Finding the Right Balance of Oversight of Health Care Organizations During a Public Health Emergency (PHE)
      Kathryn Spates, Executive Director, Federal Relations, The Joint Commission
      Cynthia F. Wisner, Associate Counsel, Trinity Health

      • Regulatory flexibilities during PHE
        • Benefits of flexibilities; any additional flexibilities needed; examples of some flexibilities that should be automatic during a PHE
      • Challenges with oversight during PHE
        • Maintaining oversight when there are flexibilities in place; preventing an unnecessary burden on health care organizations strained by a PHE
      • Examples of new safety considerations during PHE / Regulatory Flexibilities
        • COVID Screening; PPE shortages; patient privacy
      • Oversight changes during PHE
        • Use of virtual surveys; issues with virtual surveys (security, technology)


      28. The Changing Face of the Medicaid Program: A Review of Recent Trends in State Medicaid Waivers
      Leonardo Cuello, Director, Health Policy, National Health Law Program
      Ross D. Margulies, Foley Hoag LLP
      Marybeth Musumeci, Associate Director at the Program on Medicaid and the Uninsured, Kaiser Family Foundation

      • History and background of the Medicaid waiver process, as well as the current rules and constructs for waiver submissions
      • A comprehensive review of recent key State waiver requests and CMS approvals, including the Tennessee block grant waiver
      • Key policy and legal issues raised in light of recent waiver approvals by CMS, including ongoing legal challenges
      • What to look for under the Biden Administration–policy updates, guidance, and priorities

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

      29. It Don't Mean a Thing if It Ain't Got Jurisdiction: Jurisdictional Principles and Issues for Appeals Before the PRRB and the Federal Courts
      Jocelyn Beer, Supervisory Litigation Attorney, Office of the General Counsel, US Department of Health and Human Services
      Kenneth R. Marcus, Honigman LLP

      • Lessons learned in 36 years in "The PRRB Zone"
      • Recurring jurisdictional issues before the PRRB
      • Summary of recent judicial decisions


      30. New Price Transparency Rules
      Kelly Cleary, Akin Gump Strauss Hauer & Feld LLP
      Terri L. Postma, Medical Officer, Centers for Medicare and Medicaid Services

      • CMS’s Price Transparency Rule for Hospitals, which took effect January 1, 2021
      • Status of litigation challenging the Price Transparency Rule
      • Policy drivers of price transparency initiatives at the state and federal level
      • Related federal mandates aimed at empowering patients and purchasers of health care services, including CMS’ Transparency in Coverage Final Rule, ONC’s Interoperability and Information Blocking Final Rule, and the No Surprises Act


      31. Clinical Lab and Pathology in the Age of COVID-19
      Jesse  A. Berg, Lathrop GPM LLP

      This session will review a wide range of developments in clinical lab and pathology over the past few years. Topics to be covered include:

      • CMS and other agency flexibilities made available for clinical labs during the current Public Health Emergency, areas of CMS enforcement discretion and obligations placed on labs such as public health reporting requirements
      • HHS / FDA guidance on laboratory developed tests: what has happened in the past, where things are now and where they might be headed in the future, as well as an update on emergency use authorizations and PREP Act immunity
      • Medicare / Medicaid payment systems that govern clinical lab and pathology, including CARES Act / FFCRA developments, status of PAMA reporting and implementation, reference lab billing along with developments in commercial payor reimbursement such as pass-through billing and marking up clinical lab tests
      • Key CLIA concepts, such as proficiency testing rules, what constitutes inter-lab communication or intentional referrals as well as penalties for non-compliance, growth of direct-to-consumer testing, expanded access to test results as well as discussion of recent CLIA guidance and developments during Public Health Emergency
      • Other interesting laboratory concepts, such as co-location restrictions, how shared laboratories are treated under CLIA and Medicare principles; physician-based labs performing testing on patients from outside the group and distinguishing among different types of labs, such as hospital labs, independent labs and physician office labs and why that matters
      • Enforcement activities for lab and pathology, including developments under Eliminating Kickbacks in Recovery Act and other enforcement initiatives

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

      32. The Wages of Medicare are Complex: The Medicare Wage Index and Its Evolution
      Daniel J. Hettich, King & Spalding LLP
      Michael Treitel, Centers for Medicare and Medicaid Services

      After years of relatively static wage index policies, CMS enacted three new policies effecting the Medicare wage index in its 2020 Final Rule. Those policies were meant to address two of the more controversial aspects of the wage index: The calculation of a state’s rural floor, and the disparity between low and high wage index areas. These policies are themselves not without controversy, however. This session will discuss:

      • The mechanics of the Medicare wage index focusing on potential areas of confusion or controversy
      • Mechanisms for wage index reclassifications, including MGCRB reclassifications and urban to rural reclassifications
      • The impact of CMS’s new 2020 wage index policies in 2021 and beyond, including areas of dispute
      • The practical implications of CMS’s new policies on hospital decision-making


      33. Hot Topics in Provider Enrollment: The Hot Topics Are Really Hot This Year
      Louise M. Joy, Joy & Young
      Emily W. Towey, Hancock Daniel & Johnson PC
      Jeanne L. Vance, Salem & Green PC

      • New Medicare Enrollment Rule (taking Program Integrity to a new level-Dante?)
      • OPPS Validation Edit Activation (and Enrollment record Spring Cleaning)
      • Deactivation Rebuttals–(Don’t miss out; don’t mess up)
      • Retroactive Medicare Enrollment Revocations and Denials (WMD?)
      • Medicare Enrollment Appeals (Text book vs. real life)
      • Best Practices for maintaining Medicare Enrollment Compliance (Easter eggs throughout)
      • Medicare Enrollment for COVID-19 (It’s worth a shot!)


      34. Medicaid Litigation Update
      Garrett F. Mannchen, Office of the General Counsel, US Department of Health and Human Services
      Felicia Y. Sze, Athene Law

      • Litigation affecting Medicaid expansions and work requirements, lockouts, and other features in Medicaid waivers
      • Drug rebate program and rate setting litigation challenging CMS statutory interpretations
      • Recent state-court litigation
      • Significant Departmental Review Board decisions

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

      35. Tangoing with the Government in the CHOW Dance: Avoid Missteps with Medicare Changes of Ownership
      Judy Strobos, Assistant Regional Counsel, Office of the General Counsel, US Department of Health and Human Services
      Nesrin G. Tift, Bass Berry & Sims PLC

      • CHOW situations and their impact
      • Benefits and burdens of accepting v. rejecting automatic assignment of the Medicare provider agreement
      • Successor liability v. revenue gaps
      • Reimbursement impacts
      • Non-CHOW situations and their impact
      • A walk-through of hypothetical transactions


      36. Key Recent CMS Innovation Initiatives: Exploration of Policy and Legal Issues
      Troy A. Barsky, Crowell & Morning
      Margia K. Corner, University of California Office of the President

      • Key Initiatives: Medicare Shared Savings Program and Next Generation ACO Model, Radiation Oncology Model, Direct Contracting Model, Comprehensive Care for Joint Replacement Model
      • The legal authorities underpinning the development and evolution of these models
      • Practical implementation issues faced by health care organizations and practitioners as they adapt to these to new payment models
      • The common legal issues and concerns that arise in structuring participation in these Innovation Models
        • Fraud and abuse compliance
        • Participation in multiple models
        • Managing risk and state licensure


      37. Current and Emerging Issues in Rural Medicare Policy
      Ing-Jye Cheng, Director of Acute Care, Centers for Medicare & Medicaid Services
      Emily J. Cook, McDermott Will & Emery LLP
      Darci L. Graves, Office of Minority Health (CMS OMH), Centers for Medicare & Medicaid Services
      Sarah  Heppner, Policy Research Division Director, Federal Office of Rural Health Policy, Health Resources & Services Administration

      • Why rural providers and the policies that apply to them have implications for a broader audience
      • Recent updates/changes to rural provider payments–including payment changes and flexibilities related to the COVID-19 Public Health Emergency
      • Emerging regulatory issues as they relate to rural health care providers
      • Recent and forthcoming changes to geographic eligibility for rural health grant programs
      • New and innovative care delivery and payment models taking place in rural communities– including the new “Rural Emergency Hospital” (REH) provider type and the “Community Health Access and Rural Transformation” (CHART) model
      • Recent research into rural care delivery models


      On Demand Offerings

      (Available March 23, 2021)

      I. Fundamentals of Medicare and Medicaid Reimbursement: Part A and B
      (Session was Pre-Recorded for the Fundamentals of Health Law program, November 2020)
      Alison R. Hollender, Husch Blackwell
      Kevin Milne, Chief Counsel, Region IX, United States Department of Health and Human Services
      Felicia Y. Sze, Athene Law LLP

      • Medicare Governance: CMS and Medicare Contractors
      • Part A coverage and reimbursement
      • Part B coverage and reimbursement
      • How Parts A and B impact beneficiaries and providers/suppliers
      • Medicare Enrollment and Certification–How to do it and what to be aware of
      • Conditions of Participation and Payment–What you need to do to maintain enrollment and get paid
      • Medicare Impact on Health Care Transactions–How does Medicare impact health care transactions: CHOW/asset purchase v. CHOI/equity transfer
      • Keeping Medicare updated re provider changes
      • How to assist providers address Medicare questions–Where to research and how to interpret guidance
      • Brief COVID Medicare updates


      II. Fundamentals of Medicare and Medicaid Reimbursement: Part C and D
      (Session was Pre-Recorded for the Fundamentals of Health Law program, November 2020)
      Anthony H. Choe, AVP & Associate General Counsel, Inovalon Inc
      David E. Kopans, Jones Day

      • History of insurers and other third party payers
      • Survey of major federal and state laws
      • The commercial health insurance market
      • Medicare Parts C and D (Medicare Advantage and Prescription Drug Plan Programs)


      III. Primer on Researching Medicare and Medicaid Issues: Sources and Techniques
      Lindsay Goldberg, Office of the General Counsel - CMS Division, US Department of Health and Human Services
      Rachel Ludwig, Jones Day

      • Strategies for developing a research plan and tips for effectively and efficiently conducting research
      • Key primary and secondary sources for researching Medicare and Medicaid issues
      • Research tips for avoiding pitfalls
      • Practical considerations and real-life examples


      IV. A Peek Behind the Curtain: The Interactions of DOJ, OIG, CMS, and the HHS Office of General Counsel
      (Session was Pre-Recorded for the Fraud and Compliance Forum September 2020)
      Karen Schandler Glassman, Senior Counsel, Office of the Inspector General, US Department of Health and Human Services
      Janet S. Nolan, Deputy Associate General Counsel for Program Integrity, Office of the General Counsel, US Department of Health and Human Services
      Lisa Ohrin Wilson, Senior Technical Advisor, Centers for Medicare & Medicaid Services
      Laurie A. Oberembt, Senior Trial Counsel, US Department of Justice

      • An insider's perspective on how DOJ, OIG, CMS, and HHS Office of General Counsel (HHS OGC) interact during the course of investigations, litigation, review of self-disclosures, and other government work
      • The roles of each of the agencies in enforcing critical fraud and abuse laws, such as the federal Anti-kickback Statute the Physician Self-referral Law, and Medicare/Medicaid rules and regulations
      • Tips for providers during investigations and self-disclosures


      V. CMS/OIG Administrative Enforcement Risks and DAB appeals
      Julie Burns, Attorney, Office of the General Counsel, US Department of Health and Human Services
      Judith Pichler, Director, Appellate Division, Departmental Appeals Board, US Department of Health and Human Services
      Srishti Sheffner, Senior Counsel, Office of Counsel to the Inspector General
      Judith A. Waltz, Foley & Lardner LLP

      • Administrative enforcement: Case study with perspectives from CMS, OIG and the DAB
      • CMS–Revocations of Enrollment, including under the “Affiliates” Rule, and Collateral Consequences; COVID-19 related enforcement authorities (cease and desist orders for labs, CMPs, and enhanced reimbursement rates for testing timeliness)
      • OIG–CMP authorities, exclusion, and the role of the Fraud Risk Indicator
      • DAB–practice tips


      VI. Teaching Hospitals, COVID Waivers, and Cost Reporting Best Practices
      Christopher L. Francazio, PKFHealth LLC
      David J. Vernon, Hooper Lundy & Bookman PC

      • How COVID waivers impact Medicare payment for graduate medical education (GME)
      • Select GME topics will include: Bed counting, resident training location issues, and GME affiliation agreements
      • How COVID waivers impact other Medicare reimbursement principles pertinent to teaching hospitals
      • Select teaching hospital Medicare reimbursement topics will include: Teaching physician supervision, moonlighting, and physician time studies
      • Cost reporting best practices and processes for these select topics