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Dual Eligibility: Impacts on Providers


Product Code - lgn24
Speaker(s): Robert L. Roth, Hooper, Lundy & Bookman, P.C.; Mark E. Reagan, Hooper, Lundy & Bookman, P.C.; Marsha Simon, Ph.D., Simon & Co., LLC
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The reorganization of the Centers for Medicare and Medicaid Services (CMS) focuses specifically on those enrolled both in Medicare and Medicaid, commonly called the "dually-eligible." According to CMS, the goal of the Medicare-Medicaid Coordination Office "is to make sure Medicare-Medicaid enrollees have full access to seamless, high quality health care and to make the system as cost-effective as possible." To that end, that Office "works with the Medicaid and Medicare programs, across Federal agencies, States and stakeholders to align and coordinate benefits between the two programs effectively and efficiently" and partners "with States to develop new care models and improve the way Medicare-Medicaid enrollees receive health care."

The results, so far, are stunning. Looking at one state, California's plan is to move all Medi-Cal beneficiaries to managed long-term care through contracting with health plans beginning in January 2013. At the same time, the State is proposing to CMS that it also be allowed to administer the Medicare benefits of the "dual-eligible" population through these managed care arrangements in as many as ten counties beginning in January 2013. These dramatic changes will not only alter the way in which long-term care facilities are paid in the future, it will also significantly change the way in which facilities receive referrals for patients. Attending this program will assist those involved with long-term care facilities in understanding these coming changes as well as how to best position themselves for successfully navigating this new world of payment and referral relationships.

Educational Objectives:

• Understand the legal authorities that apply to CMS and the states with regard to addressing the dually-eligible.
• Learn about particular actions taken by CMS and various states.
• Understand the potential impact on different provider types, including hospitals, long-term care facilities, home health agencies, physicians, and DME companies.

Who would benefit from attending this program?

Health care professionals working at long-term care facilities; counsel who advise these professionals; payers; in-house attorneys; compliance officers; medical practice administrators.

Program Level: Intermediate

Robert L. Roth, Hooper, Lundy & Bookman, P.C.; Mark E. Reagan, Hooper, Lundy & Bookman, P.C.; Marsha Simon, Ph.D., Simon & Co., LLC

Robert L. Roth, Hooper, Lundy & Bookman, P.C.
Robert L. Roth, a partner with Hooper, Lundy & Bookman, P.C., in Washington, D.C., advises clients on matters arising under Medicare and Medicaid, focusing on payment, compliance, and licensing issues. A former senior attorney for the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), and a former Assistant Attorney General for the State of Maryland, Mr. Roth represents a wide range of clients on federal and state regulatory and business matters. He also represents clients in litigation at the state and federal trial and appellate court levels, as well as before state and federal administrative tribunals, including the Provider Reimbursement Review Board.

Mr. Roth represents providers and other clients throughout the country on matters such as reimbursement, overpayment refunds/disclosure, and coordination of benefits. He also actively counsels clients on complying with the issues surrounding all aspects of the Medicare/Medicaid programs, including the Medicare Secondary Payer (MSP) statute. Ranked by clients and peers as one of the leading health care attorneys in Washington, D.C. by Chambers USA, Mr. Roth was described as “zealous and committed” and as “stand[ing] out as having second-to-none knowledge of Medicare Secondary Payer issues.”

A frequent speaker and author on health law topics, Mr. Roth serves on the Advisory Board of Bloomberg BNA’s Health Law Reporter and Medicare Report and the CCH Medicare & Medicaid Guide. He has been teaching “Legislation” as an Adjunct Professor of Law at the University of Baltimore School of Law since 1984. In 2008, he served as a member of the Curriculum Review Committee for the Beazley Institute for Health Law and Policy at Loyola University Chicago School of Law. Mr. Roth earned an undergraduate degree from Lehigh University in history and Latin and J.D. from Syracuse University College of Law.

Mark E. Reagan, Hooper, Lundy & Bookman, P.C.
Mark E. Reagan is the managing partner and head litigator of the San Francisco office of Hooper, Lundy & Bookman, P.C., the largest full-service law practice in the country dedicated solely to the representation of health care providers.

Throughout his legal career, Mr. Reagan has represented long-term care facilities, hospitals, physician groups, home health agencies, hospices, medical product suppliers, trade associations, and other health-related entities in California and in numerous other states. His practice is devoted to counseling, litigation and trial and appellate work, before administrative agencies and all courts, with an emphasis on health care issues, including long term care, managed care, health care fraud and elder abuse, licensing and certification, Medicare and Medicaid, false claims, anti-trust, unfair competition, workers’ compensation reimbursement, risk management and corporate compliance. He frequently testifies before the California State Legislature on these and other health-related matters and assists clients with legislation and regulatory enactments.

Mr. Reagan has handled numerous Medicare and Medicaid reimbursement/audit matters on behalf of health care providers and has assisted his clients in obtaining recoveries in excess of $300 million. He earned a J.D. from Loyola Law School, Loyola Marymount University and a B.A. in Economics and Communication from Stanford University.

Marsha Simon, Ph.D., Simon & Co., LLC
Dr. Simon is an expert in legislative strategy, nonprofit management, and public policy research, with over 20 years of experience, including nearly a decade working for the United States Senate. She served as senior committee staff to Senators Edward M. Kennedy, Tom Harkin, and Robert C. Byrd, advising them on public health and welfare policy, as well as on the budget and appropriations processes. These staff positions included minority staff director for the Senate Appropriations Committee's Subcommittee on Labor, Health, and Human Services, Education and Related Agencies for Senator Tom Harkin; and chief policy advisor for Budget and Health Policy for the Senate Committee on Health, Education Labor, and Pensions for Senator Edward Kennedy. Senator Harkin is now chair of the Appropriations Subcommittee, as well as of the Health, Education, Labor, and Pensions Committee that is responsible for public health measures, including biomedical research and food and drug law.

In addition to her experience working for the U.S. Senate, Dr. Simon has managed government relations for diverse health, income security, and welfare stakeholders, including for the Jefferson Consulting Group, a lobbying and federal business development firm; the American College of Obstetrics and Gynecology; and public interest groups, including Families USA, the Food Research and Action Center, the Housing Assistance Council and Rural America (now the Community Transportation Association of America). Dr. Simon served on Barack Obama's health advisory committee during his presidential campaign. She also served as a policy advisor on Governor Howard Dean's campaign and drafted his long-term care platform. She was also a member of the Clinton Administration's National Task force on Health Care Reform.

Dr. Simon earned a Ph.D. and an M.S. in political science from the Massachusetts Institute of Technology. In addition to her work at Simon & Co., Dr. Simon is also an adjunct professor in the Department of Health Policy at George Washington University.

This program is CLE-credit eligible.

If you have further questions regarding a specific state or how to file for CLE credit, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the Legal and Business CLE Accreditation Coordinator.

Hardship Policy
Bloomberg BNA offers a hardship policy for any attorney earning less than $30,000 per year. If an attorney wishes to take advantage of this option, he or she must do so in writing and also provide proof of hardship. If approval is granted, a discount of 50% off the full registration price of the program will be awarded.


Questions
For more information about Mandatory or Minimum Continuing Legal Education (MCLE) requirements, visit the American Bar Association website at http://www.abanet.org/cle/mandatory.html.

• Bloomberg BNA Subscriber - OnDemand format $199

• Non-Subscriber - OnDemand format $249

• CD recording of program $199 (Subscriber and Non-Subscriber)

 

Registration for Legal & Business programs is simple. You may either visit the registration page to register -or- call 1-800-372-1033, Option 6, and refer to the date and title of the program. Lines are open Monday through Friday from 8:00 a.m. to 8:00 p.m. ET.