Webinars

Session I

A Focus on Regulations: Analyzing Trends in Utilization Management

  • Date: April 6, 2016
  • Description: This session  examined the evolution of utilization management (UM) programs and related medical management functions over the past three decades with a detailed overview of how UM programs are regulated. Among other issues, speakers  highlighted the impact of the Affordable Care Act and other regulatory reforms on the ways that health plans make “medical necessity” determinations and how the appeals process works when a “denial” of care or adverse benefit determination is made. In addition, the presentation  reviewed the scope, licensure requirements, reviewer qualifications and the ways in which UM services are often integrated into a “care coordination” approach to managing patients. The session also  examined liability issues associated with the “corporate practice of medicine.”
  • Speakers:
    • Julie O’Brien, BSN, RN, MS, President, AliCare Medical Management
    • Garry Carneal, JD, MA, Founder, RegQuest
    • Catie Spivey, JD, Senior Legal Counsel, RegQuest (moderator)
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Session II

Navigating Nuances in Regulatory and Market Trends

  • Date: May 24, 2016
  • Description: As consumers take on a more active role in their health care decisions, the importance of external review (ER) has grown. However, compliance with state and federal ER laws can be a nuanced endeavor. In this informative session, industry leaders  examined ER regulatory requirements and focused on the important part these regulations play in consumer protection and ensuring appropriate care is provided for patients, and oversight of health plans. In addition, an analysis of the differences between state law and the NAIC Uniform Model Act was reviewed.
  • Speakers:
    • Tom Naughton, President, Health Division for MAXIMUS Federal
    • Gib P. Smith, Executive Director, NAIRO
    • Garry Carneal, JD, MA, Founder, RegQuest
    • Catie Spivey, JD, Senior Legal Counsel, RegQuest (moderator)
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Session III

Mental Health Parity: Achieving Equality in Care

  • Date: April 28, 2016
  • Description: With the adoption of the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (MHPEA), much attention has been focused on the integration of mental health and substance use disorders into mainstream medicine. This session focused on the legislation passed since 2008 designed to increase compliance with the federal law and to strengthen state laws, common violations and tracking efforts, and looked to the future. The presenters also touched base on the importance of Americans understanding their rights under parity laws and how to take action if their behavior health treatment is being unfairly restricted.
  • Speakers:
    • Julie O’Brien, BSN, RN, MS, President, AliCare Medical Management
    • Garry Carneal, JD, MA, Founder, RegQuest
    • Catie Spivey, JD, Senior Legal Counsel, RegQuest (moderator)
View Webinar