Critical Contract Issues
in
Medicaid Managed Care
Mid-Atlantic Region
October 29-30, 1998
Downtown Club
Public Ledger Building
150 S. Independence Hall West
Philadelphia, Pennsylvania
Southwest Region
November 16-17, 1998
Utah Law and Justice Center
645 South 200 East
Salt Lake City, Utah
Sponsored by
American Bar Association
Section of Public Contract Law
in cooperation with
George State Law School
Critical Contract Issues in
Medicaid Managed Care
If you're involved in Medicaid managed care as a Contractor, Health Care Professional, Procurement Official or Lawyer, here are just some of the issues you must know that are covered in this two-day program:
_ Federal and State criteria to become a Medicaid managed care contractor
_ Recurring contract administration issues
_ Alternative contract and payment models
_ Fraud initiatives
_ Payment issues
_ Enrollment of special needs populations
At each of the two convenient locations, the program will focus on the procurement and implementation issues in the various States in that region.
Special guest speakers include officials from the various states who will address the issues associated with their States’ implementation of Medicaid managed care, along with other experts in Medicaid managed care including:
_ Sara Rosenbaum and Phyllis Borzi, George Washington Center for Health Policy Research, authors of "Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts"
_ Judith Fader, Professor, Institute for Health Care Research and Policy, affiliated with Georgetown University Medical Center, expert in dual-eligibles
_ James M. Verdier, Senior Fellow, Mathematica Policy Research (invited)
_ Bruce Greenstein, Health Insurance Specialist, HCFA Seattle Regional Office (invited)
PROGRAM
Day 1 –
Overview and The Procurement
7:30 a.m. to 8:30 a.m.
Registration
8:30 a.m. to 9:30 a.m.
Overview
_ Federal waiver authority to implement Medicaid managed care
_ Implementation of managed care
_ National and Regional Trends
9:45 a.m. to 10:30 a.m.
The Procurement: Contract Provisions (State Agency Specifications)
_ Population group eligibility
_ Provider network and performance requirements
10:30 a.m. to 10:45 a.m.
Break
10:45 a.m. to 12:00 noon
State and Federal Contracting Requirements
_ Data collection
_ Reporting and confidentiality requirements
_ Quality assurance
_ Quality of care
_ Accreditation requirements
_ Geographic coverage of program
12:00 noon to 1:30 p.m.
Lunch Break (No seminar sponsored lunch scheduled)
PROGRAM
1:30 p.m. to 3:15 p.m.
More on State and Federal Contracting Requirements
_ Payment and capitation rate setting methodologies
_ Alternative benefit packages, terms and conditions, including physical health benefits, mental health benefits and long term health benefits
3:15 p.m. to 3:30 p.m.
Break
3:30 p.m. to 5:00 p.m.
Rules, Regulations and Evaluation
_ Applicability of state and federal procurement requirements
_ Requirements of other state agencies, including insurance departments, social and health services agencies
_ Contract negotiations
PROGRAM
Day 2 –
Contract Management Issues and
Projected Trends
9:00 a.m. to 10:15 a.m.
Critical RFP/Contract Clauses
_ State’s boilerplate language
_ Reinsurance and stop-loss
_ COB and third party liability recovery
_ Indemnification and hold harmless
_ Termination
_ Medical necessity
_ Scope, duration and frequency of coverage
10:15 a.m. to 10:30 a.m.
Break
10:30 a.m. to 12:00 noon
Contract Management
_ Fraud detection activities
_ Remedies and sanctions
_ Role of the Attorney General
_ Contract renewal and non-renewal
12:00 nooon to 1:30 p.m.
Lunch Break (No seminar sponsored lunch scheduled)
1:30 p.m. to 3:00 p.m.
Projected Trends
_ Enrollment of special needs populations
_ Capitation risk adjustment
_ Alternatives to traditional risk-based models for rural areas
3:00 p.m. to 3:15 p.m.
Break
3:15 p.m. to 4:30 p.m.
More on Projected Trends Followed by
Open Question-and-Answer Session between Audience and Program Speakers
PROGRAM PLANNING COMMITTEE
Stephanie Pontzer Gilson, Program Chair
Miller & Chevalier, Chartered
Program Faculty:
Anne M. Jacobs
Greg S. Bingham
Tucker Alan Inc.
Jessica C. Abrahams
Dorothea Powell-Woodson
Miller & Chevalier, Chartered
Jonathan C. Cramer
McManus, Schor, Asmar & Darden, LLP
David C. Hammond
W. Bruce Shirk
Powell, Goldstein, Frazer & Murphy, LLP
Justin D. Simon
Dickstein Shapiro Morin & Oshinsky, LLP
Stanley R. Soya
Piper & Marbury, LLP
Karen Vagley
Melissa Muroff
McCurdy Group
Donald J. Kissinger
PHP Healthcare Corporation
Alexander J. Brittin
McKenna & Cuneo, LLP
Frank M. Rapoport
Pepper Hamilton LLP
CLE CREDIT
Accreditation has been requested for this program from every state (including California and Pennsylvania) with mandatory continuing legal education (MCLE) requirements for lawyers. Please be aware that each state has its own rules and regulations, including its definition of "CLE." Attorneys seeking to obtain MCLE credit in Pennsylvania are required to pay state accreditation fees directly to the PACLE. Please be prepared to remit payment to the PACLE ($2.00 per credit hour or any portion thereof) after the program. Certificates of attendance will be available at the conclusion of the program for both attendees and speakers. If you have questions about the number of credit hours granted by each state, you may call 312-988-6217, starting 2 to 3 weeks before the program.
CANCELLATION POLICY
Registrants who must cancel will receive a full refund if a written cancellation is received five business days before the scheduled seminar. Requests should be sent to the Section of Public Contract Law’s office, 750 North Lake Shore Drive, Chicago,IL 60611-4497, or faxed to 312-988-5688. Substitutions may be made at any time.
If you complete a registration form and fax it to the office listed on the registration application, the transaction is considered a firm commitment and you will be expected to pay the registration fee even if circumstances prevent you from attending the conference.
NO refunds will be made unless the request is received 5 business days before the program.
HOTEL INFORMATION
Room reservations for out-of-town attendees should be made directly with a hotel of choice. Listed below are the names and phone numbers for hotels nearest the program facilities in each of the cities listed:
Philadelphia
Omni Hotel, 4th & Chestnut St, 215-925-0000
Holiday Inn, 4th & Arch Sts, 215-923-8660
Sheraton Society Hill, One Dock St, 215-238-6000
Penn View Inn, Front & Market Sts, 215-922-7800
Salt Lake City
Little America, 500 South Main St, 801-363-6781
SPECIAL AIRLINE DISCOUNTS
If you fly Delta Air Lines, United Airlines, or USAirways to this program, you can receive 5% or more off restricted fares and at least 10% off coach and first class fares. To receive a discount, you or your travel agent must call the number listed below and mention the corresponding ABA reference number. You can also call Direct Travel, the official ABA travel agency, at 1-800-929-3544 for reservations.
_ DELTA AIR LINES – 1-800-241-6760
Reference # E0001
_ UNITED AIRLINES – 1-800-521-4041
Reference # 507SZ
_ USAirways – 1-800-334-8644
Reference # 21900057
REGISTRATION APPLICATION
Send directly to:
Stephanie Pontzer Gilson
Miller & Chevalier, Chartered
655 Fifteen Street, N.W., Suite 900
Washington, DC 20005-5701
202-626-5816 – Fax: 202-628-0858
Please register the following person for the ABA Public Contract Law Section program on Critical Contract Issues in Medicaid Managed Care on the following date:
_ Philadelphia: October 29-30
_ Salt Lake City: November 16-17,
Registration Fee *:
_ $225 Government Employee
_ $275 Member of Sponsoring or Cooperating Organzations
_ $350 Non-Member
Name
Please print or type
Firm/Agency/
Company
Address
City, State, Zip
Telephone Number
Fax Number
Enclosed is my check, payable to the AMERICAN BAR ASSOCIATION/PCL, for $ .
* Registration fee includes all scheduled coffee breaks and a bound manual of speakers' written presentations.