Foley partners Judy Waltz, chair of the firm’s Health Care Practice Group, and Leah D’Aurora Richardson are speaking in the American Health Law Association’s (AHLA) Annual Meeting in San Diego, CA. Waltz is hosting the session “Evolving Expectations: Medicare Advantage Compliance for Plans and Providers,” and Richardson is speaking in the session “Getting Aligned: Structuring Strategic Affiliations for Community Providers.”
Evolving Expectations: Medicare Advantage Compliance for Plans and Providers
This session will cover:
- Whose job is Medicare Advantage (MA) compliance anyway? Differing expectations for plans and providers.
- What is new for plans?
- Operational impacts for providers including applicability of Fee-for-Service (FFS) guidelines, promoting social determinants of health, and living with prior authorizations.
- The impact of new government guidance: the Office of Inspector General (OIG) Compliance Guidance for Managed Care (expected); the 60-day Refund Rule (as revised effective Jan. 1, 2025).
- The changing environment for enforcement actions against plans and providers.
- Practical tips for aligning compliance programs with the new expectations.
Getting Aligned: Structuring Strategic Affiliations for Community Providers
This presentation will discuss strategic partnerships between community hospitals and regionally or nationally renowned programs and physician organizations, highlighting the following:
- Obtaining alignment between the community hospital and academic medical centers (AMCs)/physician organization in light of the benefits, challenges and ultimate partnership goals of both sides of the transactions.
- Common strategic partnership structure options and compliance/business risks of each option.
- Applicable regulatory considerations and guardrails to each strategic partnership structure.
- Approach to fair market valuation and key financial terms to ensure successful and compliant financial arrangement.
- Recent case studies of rural community provider affiliations, challenges encountered, and how the parties found solutions and ultimate alignment in the business terms.
CLE
AHLA applies for Continuing Education Credits for this conference and all of our conferences. Participants will be able to receive credits for sessions they attend in person and watch on demand.
CLE: The maximum number of credits available for IN-PERSON is 16.0 (including 2.0 of ethics) for a 60-minute state and 19.2 (including 2.4 of ethics) for a 50-minute state. Please note that the actual number of credits may vary from state to state.
Please Note: We are now working with ABA CLE for our CLE accreditation needs. Those who scan in and out of the conference each day will receive a personalized CLE affidavit from [email protected] following the conference. All inquiries should be directed to [email protected]
