2019 Managed Care Compliance Conference

1. Don't Freak Out! You Can Survive Multiple CMS Audits at the Same Time-?Here's How

   2019 Managed Care Compliance Conference  | Presenter(s): Ryan Hayden, Rohit Gupta, Rezarta Molla  | January 29, 2020 

   • Payers can gain value from being better prepared and more productive, and can uncover greater operational insights when multiple audits occur at the same time

   • Payers can lower their risks by understanding how the same set(s) of data may impact multiple audits; scenario planning these impacts is a valuable activity

   • Payers can improve their performance by understanding how overlapping audits impact one another under the Medicare program

2. Stress is Stressful

   2019 Managed Care Compliance Conference  | Presenter(s): Cathy Bodnar, Lauren Tockey  | January 29, 2020 

   • Recognize and acknowledge that working in Compliance is incredibly challenging

   • Key strategies to identify and interpret work-tasks, the work environment, and the impact on self

   • Revitalize your compliance “mission” to strengthen your health plan’s compliance program

3. The State of Play for Mental Health Parity

   2019 Managed Care Compliance Conference  | Presenter(s): Tricia Beckmann, Amy Finley  | January 29, 2020 

   • Discerning the state of Mental Health Parity and Addiction Equity Act enforcement under the Trump Administration and avoiding traps for the unwary

   • The 21st Century Cures Act of 2016 called for stepped up enforcement and additional guidance; taking stock of what has been done to date, what’s missing, and what might be to come in terms of both state and federal responses

   • The intersections between mental health parity law and other coverage mandates and federal nondiscrimination rules

4. The WHO, WHY, and HOW of Delegation Oversight

   2019 Managed Care Compliance Conference  | Presenter(s): Christian Puff, Hayley Ellington-Buckles  | January 29, 2020 

   • WHO qualifies as an FDR and how to tell

   • WHY perform oversight; rules and regulations

   • HOW to do it; steps and best practices

5. GENERAL SESSION: The Parity Challenge - Compliance with a Complex Law

   2019 Managed Care Compliance Conference  | Presenter(s): Tim Clement  | January 29, 2020 

   • A family story about the impacts of mental health

   • Mental Health Parity and its impact on health plans

   • Parity risk areas and how to focus your compliance resources

6. Are You Just Checking the Box or Creating Effective Compliance Training?

   2019 Managed Care Compliance Conference  | Presenter(s): S. Leah Yoder, Shelley Segal  | January 29, 2020 

   • CMS’s expectations of effective training

   • Components of effective training

   • Catalysts for caring about training

7. How to Prepare for 2019 CMS Rule Change to Marketing Materials: ANOCs, EOCs, Summary of Benefits?-?Issues, Impact, Disclosures, and Audits

   2019 Managed Care Compliance Conference  | Presenter(s): Debbie Mabari, Hannah LaMere, Mike Turrell  | January 29, 2020 

   • CMS Expectations: Plans must verify that accurate and complete data is represented on materials; identify benefit changes year-to-year; reduce/eliminate erratas

   • Regulatory Changes: Allowing for e-materials means that plans need to be diligent on data presented to members; CMS’s distinguishing between e-communication and e-marketing materials may lead to more focus and scrutiny on these required materials

   • Audits and Best Practices: Audit issues; disclosed issues to CMS tied to CPE audit and pre-audit issue summary; beneficiary impact; tracer sample

8. Regulators Mount Up: How an Insurance Department Ensures Compliance with Managed Care Plans

   2019 Managed Care Compliance Conference  | Presenter(s): Rachel Chandler  | January 29, 2020 

   • What a Network Adequacy review for a Managed Care Plan entails

   • DOs and DON’Ts and PROs and CONs when submitting a Network Adequacy plan for review

   • Managed Care Compliance from the perspective of a State agency regulator

9. The Importance of Automating Your Monitoring and Auditing

   2019 Managed Care Compliance Conference  | Presenter(s): Pamela Cleveland, Megan Grifa  | January 29, 2020 

   • Do you know where your compliance risk is hiding?

   • How do you move your organization to complete risk identification without adding staff?

   • Why is a central compliance management solution critical for managing and mitigating risk?

10. The Rise of the Virtual Workforce: Compliance Role in Robotic Automation Governance

    2019 Managed Care Compliance Conference  | Presenter(s): Deana Rhoades, John Wells, Sherrie Ryder  | January 29, 2020 

    • With Operations and IT teams collaborating on an automation strategy, the role of Compliance in governance cannot be ignored

    • Robotic Process Automation is creating a team of virtual workers —  and an additional layer of oversight requirements

    • How Compliance can join Business and IT in development of a proper governance strategy

11. Understanding Recent Legislative Changes to Coordination of Benefits Practices for Medicaid and CHIP Programs

    2019 Managed Care Compliance Conference  | Presenter(s): Kristen Ballantine, Deborah Grier  | January 29, 2020 

    • An overview of recent and upcoming changes — due to legislative and regulatory activity at the federal and state levels — which will impact coordination of benefits function for Medicaid and CHIP programs and plans

    • Plan requirements, with a focus on operational compliance and impact on stakeholders

    • Targeted for Medicaid and CHIP plans

12. Are You Ready for a Department of Labor Audit?

    2019 Managed Care Compliance Conference  | Presenter(s): Amy Christen  | January 28, 2020 

    • Tips for health insurance issuers on how to prepare for a DOL audit of a group health plan

    • Tips for a health insurance issuer on how to work with the DOL and the group health plan sponsor to ensure the completeness of audit responses

    • Trends in DOL audits, including areas of focus under PPACA; HIPAA privacy issues that arise in the context of DOL audits; a checklist to track responses

13. Hot Topics in Managed Care Compliance

    2019 Managed Care Compliance Conference  | Presenter(s): Ann Beimdiek Kinsella, Sarah J. Lorance, Ann Greenberg  | January 28, 2020 

    • What’s on the priority list for compliance officers

    • Program strategies in a time of transformation in the industry

    • Sharing best practices and lessons learned

14. Detecting and Preventing Fraud, Waste, and Abuse

    2019 Managed Care Compliance Conference  | Presenter(s): Christina Matsiga  | January 28, 2020 

    • Review of requirements for providers participating in federal and/or state-funded health care programs to detect and prevent fraud, waste, and abuse

    • Examples of what constitutes fraud, waste, and abuse; and a look at some case studies

    • Possible strategies to identify— as well as prevent— fraud, waste, and abuse

15. GENERAL SESSION: CMS Compliance and Enforcement Update

    2019 Managed Care Compliance Conference  | Presenter(s): Kimberly Brandt  | January 28, 2020 

    • Patients Over Paperwork

    • Addressing the Opioid Epidemic

    • Program Integrity

16. A Phish Tale: Lessons Learned from a Successful Phishing Attack in a Managed Care Organization

    2019 Managed Care Compliance Conference  | Presenter(s): Jessica Vander Zanden, Angela Keenan  | January 28, 2020 

    • A Medicare Advantage Plan’s incident-response approach to a phishing attack that resulted in a HIPAA breach of over 500 individuals; lessons learned during and after the investigation

    • The obligations and complexities of the overall investigation; reporting to other entities such as the media, OCR, and CMS; the facets of an OCR breach investigation

    • Creative and effective post-breach training and communication strategies used by the plan, designed to reduce the likelihood of future breaches

17. Crisis Management for Really Busy People: Learn How to Implement an Efficient and Effective Crisis Management Program in Six Easy Steps

    2019 Managed Care Compliance Conference  | Presenter(s): Lee Painter, Ahmed Salim  | January 28, 2020 

    • Putting a crisis management plan in place doesn’t have to be difficult

    • Six straightforward steps to prepare for crisis events

    • Specific implementation and execution recommendations, including how to overcome obstacles and potential risks to success

18. Risk Adjustment Compliance and Operations: Building Meaningful Communications

    2019 Managed Care Compliance Conference  | Presenter(s): Nicole Martin, Dorothy DeAngelis  | January 28, 2020 

    • Bridging the gap between organizational compliance and risk adjustment compliance

    • Understanding and collaborating with risk adjustment operations in your organization; an example using PPO member to PCP attribution

    • Physician risk adjustment education compliance, internal planning vs external sharing, where do we draw the line?

19. Engaging Members through Advocacy and Outreach: Addressing Social and Clinical Needs to Minimize Health Disparities

    2019 Managed Care Compliance Conference  | Presenter(s): Joynicole Martinez  | January 28, 2020 

    • The unique programmatic structure for effective advocacy and outreach to hard-to-reach and hard-to-engage populations

    • Methods to connect members to culturally-relevant and socially-constructive resources and assist them as they navigate the system

    • Staff and multidisciplinary resources that are the most efficient

20. Not for the Faint of Heart: Preparing CMS Tracer Case Summaries

    2019 Managed Care Compliance Conference  | Presenter(s): Anne Crawford, Thomas Wilson, Mary Ann McLean  | January 28, 2020 

    • Key considerations when developing a tracer case summary, including a model template

    • Successful strategies for engaging business owners in presenting tracers

    • How to incorporate lessons learned from Plans that have been through a CMS CPE Program Audit

21. Federally Facilitated Exchange (FFE) Audits: Do You Know the Risk Areas?

    2019 Managed Care Compliance Conference  | Presenter(s): Steve Bunde, Dawn Guzik Stocker  | January 28, 2020 

    • Understand the FFE audit process and areas of focus

    • Learn about the FFE audit process

    • Identify FFE risk areas and remediation strategies

22. GENERAL SESSION: Combating Fraud, Waste, and Abuse in Managed Care

    2019 Managed Care Compliance Conference  | Presenter(s): Megan Tinker  | January 28, 2020 

    • Current trends, vulnerabilities, and developments

    • Update on recent FCA cases

    • Update on recent and planned OIG Audits and Evaluations

23. How Adequate Is Your Provider Network? Applying and Measuring Managed Care Provider Network Compliance Against the New 2018 Requirements

    2019 Managed Care Compliance Conference  | Presenter(s): Jennifer Tryder, Michael Walsh, Kimberly Hornik  | January 28, 2020 

    • Key transition strategies; moving forward from the 2002 Network Access Rule

    • Understanding CMS protocols, EQR requirements, and state exceptions for evaluating Network Adequacy standards

    • Best practice recommendations for evaluating and following network adequacy requirements under government-approved auditing standards

24. Managed Care Expansion in Medicaid and Medicare: Benefits, Challenges, and Compliance

    2019 Managed Care Compliance Conference  | Presenter(s): Denise Leard, Pam Felkins Colbert, Angela Brice-Smith  | January 28, 2020 

    • Understanding managed care private insurance plans vs. Medicare/Medicaid government plans

    • Challenges and benefits for beneficiaries and providers in managed care plans for Medicare/Medicaid

    • The culture clashes of government programs and private insurers

25. Managed Models: The Future of FDR Delegation-?Service Delivery, Service Responsibility, and Service Ability

    2019 Managed Care Compliance Conference  | Presenter(s): Richard Golfin III  | January 28, 2020 

    • Managed care in California, the nation’s largest Medicaid population

    • In California, health plans delegate clinical delivery and clinical services to non-administrative entities

    • Large Medicaid populations require innovative approaches to integrated delivery and population management