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MA peer discussion regarding the CMS proposed rule – comments due April 6!

Event Date: 3/10/2020

Event Overview

Wednesday, 3/10/2020
1:30 PM CST – 2:30 PM CST (60 minutes)
Hosted by: SheppardMullin

This event is hosted on our BigMarker platform

Comments on the proposed rule are due by April 6th, and CMS introduced particularly meaty topics for consideration this year.  Join your Alliance peers for an interactive, round table discussion, to share what your MA leadership is considering for comment submissions, and to hear from other MA leaders from Alliance member plans across the country.  The call will be moderated by Christine Clements, Partner with Sheppard Mullin, and a presenter at the Alliance’s recent MA Product Design Fly-In in Dallas.  Come ready to discuss comment opportunities including these key areas:

  • Network adequacy: What sources of information should CMS consider when creating standards? What additional specialties are appropriate for telehealth? Challenges specific to outpatient dialysis
  • Secondary Specialty Tier: How does your Part D plan view the proposals regarding specialty tier drugs and how to structure cost sharing?
  • D-SNP look-alikes: Does the absence of data sharing and care coordination requirements for D-SNP look-alikes disadvantage beneficiaries? Should the proposed rule be extended to all states? 
  • Beneficiary real time benefit tools: What do you think about the proposed adjustment to Jan 1, 2021? What information do you think should be included on the beneficiary RTBT? Is the proposed beneficiary RTBT unnecessary in light of other information and tools that plans already make available to their members?
  • Eligibility of ESRD beneficiaries for MA starting CY2021.  What are the challenges MAOs will face enrolling and providing coverage to this population, which MAOs have limited experience covering?  How can CMS help MAOs with these challenges?
  • Changes for all SNPs: CMS is soliciting comments on the extension of new care management and MOC requirements for C-SNPs to all SNPs 
  • Additional telehealth benefits: Should all MA plan types be allowed to offer ATBs through non-contracted providers and treat them as basic benefits under MA?
  • Reinsurance: CMS solicits comments generally on its reinsurance proposal as well as the $10,000 threshold

This call is an interactive, round table discussion and we encourage health plans to assemble their MA leaders and come prepared to share what your leadership is considering submitting during the comment period.


 

Audience

MA leaders with responsibility for your MA health plan’s product design, network development and management, financial and quality performance.


 

Ask your peers a question or share a resource anytime through the Alliance discussion forum

You can visit the discussion forum and post a question anytime. It's only available to Alliance members, so you question is private and secure. When submitting a question, you can select which topics your question is related to. Individuals who have indicated in their Alliance profile they are interested in those topics and are opted in to discussion forum emails will receive your question. You can also add an attachment to your question or reply, making this tool another great resource for sharing best practices with your peers.

 


 

 

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Documents
3/10/2020

Recording: MA peer discussion regarding the CMS proposed rule – comments due April 6!
Christine Clements, Partner with Sheppard Mullin, moderates a roundtable discussion with MA leaders on what they are considering for comment submissions on the proposed rule due by April 6th.

2/11/2020

CMS draft call letter: Analysis, expectations and implications
Sheppard Mullin shares an analysis and implications of the CMS draft call letter during the MA Product Design and Implementation Fly-in held in February 2020.

Attendees

Below is a list of all delegates registered to date for this event

  • Benjamin Aragon
  • ALLIANCE MEMBER
  • Manager of Product Development at Sharp Health Plan
  • Nicole Beadle
  • ALLIANCE MEMBER
  • Manager, Medicare Compliance at Paramount Health Care
  • Elizabeth Benz
  • ALLIANCE MEMBER
  • Vice President Quality and Clinical Integration at Network Health
  • Marty Cerier
  • ALLIANCE MEMBER
  • Director Regulatory Audits and Investigations at Health Alliance Plan (HAP)
  • Tammy Chadd
  • ALLIANCE MEMBER
  • Compliance Manager at IU Health Plans
  • Kevin Chi
  • ALLIANCE MEMBER
  • Assistant Compliance Counsel at Central Health Plan of California
  • Michelle Coberly
  • ALLIANCE MEMBER
  • Vice President, Medicare at Physicians Health Plan
  • Jacqueline Crews
  • ALLIANCE MEMBER
  • Director, Public Policy & Benefit Contracts at AvMed
  • Shawn Dewers
  • ALLIANCE MEMBER
  • Chief Executive Officer at Central Health Plan of California
  • Jodi Digmann
  • ALLIANCE MEMBER
  • Medicare Compliance Analyst at Medical Associates Health Plans
  • Rory Donohue
  • ALLIANCE MEMBER
  • Vice President Actuary at Network Health
  • Stephanie Hadcock
  • ALLIANCE MEMBER
  • Manager, Medicare Operations at Capital District Physicians' Health Plan (CDPHP)
  • Anthony Hansen
  • ALLIANCE MEMBER
  • Sr. Medicare Compliance Coordinator at Providence Health Plan
  • Valerie Headrick
  • ALLIANCE MEMBER
  • Health Care Services Accreditation & Compliance Manager at Providence Health Plan
  • Erin Heckethorn
  • ALLIANCE MEMBER
  • Director of Operations and Program Management at FirstCarolinaCare Insurance Company
  • Susan Herbert
  • ALLIANCE MEMBER
  • Director, Health Plan Integration & Development at AdventHealth (FHHS)
  • Elizabeth Heying
  • ALLIANCE MEMBER
  • Counsel & Compliance Manager at Medical Associates Health Plans
  • Karen Hoffmann
  • ALLIANCE MEMBER
  • Director of Operations at Medical Associates Health Plans
  • Merry Humm
  • ALLIANCE MEMBER
  • Medicare Compliance Specialist at Providence Health Plan
  • Mary Ingram
  • ALLIANCE MEMBER
  • Actuarial Services Director at Western Health Advantage
  • Elizabeth Jurkowski
  • ALLIANCE MEMBER
  • Medical Records Review Manager at Health Alliance Medical Plans
  • Joleen Katula
  • ALLIANCE MEMBER
  • Interim Compliance Officer at HealthTeam Advantage
  • Denise Lucas
  • ALLIANCE MEMBER
  • Configuration and UM Pharmacy Supervisor at Physicians Health Plan
  • Jonathan Moody
  • ALLIANCE MEMBER
  • Director of ACA Products and Government Affairs at Quartz Health Solutions
  • James Moore
  • ALLIANCE MEMBER
  • Compliance and Product Management Coordinator at Providence Health Plan
  • Ana Novas
  • ALLIANCE MEMBER
  • Manager of Quality/Accreditation and Credentialing at AvMed
  • Anna Rasmussen
  • ALLIANCE MEMBER
  • Strategy and Product Lead at Network Health
  • Ted Regalia
  • ALLIANCE MEMBER
  • VP Pharmacy Benefits at Network Health
  • Laura Reinsch
  • ALLIANCE MEMBER
  • Director Care Management at Network Health
  • Denise Roach
  • ALLIANCE MEMBER
  • Compliance Consultant at IU Health Plans
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • Clifton Schmidt
  • ALLIANCE MEMBER
  • Medicare Compliance Officer at SelectHealth
  • Kathryn Serenbetz
  • ALLIANCE MEMBER
  • Principle, Insurance Products at Avera Health Plans
  • Kelly Simpson
  • ALLIANCE MEMBER
  • Business Analyst at Providence Health Plan
  • Kelly Skifton
  • ALLIANCE MEMBER
  • Assistant Vice President, Compliance & Government Regulatory Operations and Privacy at Quartz Health Solutions
  • Michael Spicer
  • ALLIANCE MEMBER
  • Vice President, Product at Capital District Physicians' Health Plan (CDPHP)
  • Shelley Veal
  • ALLIANCE MEMBER
  • Executive Director Network Development at AdventHealth (FHHS)
  • William Yee
  • ALLIANCE MEMBER
  • Assistant Compliance Counsel at Central Health Plan of California
  • Holly Zorz
  • ALLIANCE MEMBER
  • Quality Improvement Team Lead, Medicare at Paramount Health Care
Speakers