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The Medicaid Managed Care Proposed Rule: Digesting the Details and Implications 
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On May 26, 2015, CMS released a Proposed Rule containing the first proposed revisions to the Medicaid Managed Care program’s regulations in more than 12 years. When these proposed revisions are finalized, they will have broad-reaching effects on state Medicaid programs nationally as well as the plans, providers, and companies that serve Medicaid plans or Medicaid providers either directly or indirectly.

Medicaid is the largest government payer, supplying coverage for approximately 70.5 million Americans and providing the core source of financing for safety-net hospitals and health centers that serve low-income communities, as well as nursing homes and community-based long-term care facilities. Approximately 74 percent of Medicaid enrollees received services through managed care plans, and Medicaid Managed Care enrollment is expected to grow as Medicaid expansion through the Affordable Care Act (“ACA”) continues.

Through its proposals, CMS seeks to modernize managed care in Medicaid and the Children’s Health Insurance Program (“CHIP”) to reflect changes in managed care delivery systems. Also, the Proposed Rule would better align the rules governing Medicaid managed care and CHIP with the rules applying to Medicare Advantage and the requirements for qualified health plans sold through the “Exchange markets.”  Comments on the Proposed Rule are due to CMS by 5:00 p.m. ET on July 27, 2015.

Several of the more significant impacts of the Proposed Rule include updated network adequacy standards for all types of Medicaid Managed Care entities, the application of medical loss ratio (“MLR”) requirements to Medicaid Managed Care entities, setting actuarially sound capitation rates, expanded quality-of-care requirements, appeals and grievances, beneficiary enrollment protections, Managed Long-Term Services and Supports (“MLTSS”), state monitoring and information standards, primary care case management, and third-party liability. The Proposed Rule MLR requirement on Medicaid Managed Care plans mandates at least 85 percent, similar to the requirements applicable to commercial plans in the exchange markets.

This session will address the relevant details of the Medicaid Managed Care Proposed Rule, as well as highlight key implications of the major provisions for stakeholders, and what overall level of revisions might be expected with issuance of the Final Rule.

Please join us Wednesday, July 22nd, 2015 at 2:00 PM Eastern as Bob Atlas, President and Strategic Advisor with EBG Advisors and Helaine Fingold, Senior Counsel, Health Care and Life Sciences with Epstein Becker Green provide a one hour briefing on The Medicaid Managed Care Proposed Rule - Digesting the Details and Implications.
Learning Objectives
Participants will be able to:
  1. Review detailed relevant provisions of the Medicaid Managed Care Proposed Rule.
  2. Consider the various implications for stakeholders regarding major provisions of the Proposed Rule.
  3. Understand the process and overall level of revisions that might be expected with issuance of the Final Rule.
  4. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Legal & Regulatory Executives and Staff
  • Government Program Executives and Staff
  • Medicaid Operations Executives and Staff
  • Transformation, Innovation and Integration Executives and Staff
  • Medical Directors
  • Network Management Executives and Staff
  • Provider Contracting Executives and Staff
  • Accountable Care Executives and Staff
  • Managed Care Executives and Staff
  • Network Management Executives and Staff
  • Planning and Strategic Executives and Staff
  • Business Development Executives and Staff
  • Business Intelligence Staff
  • Other Interested Parties

Attendees would represent organizations including:

  • Medicaid Health Plans
  • Hospital Systems
  • Provider Networks
  • Accountable Care Organizations
  • Medical Groups
  • Other Providers
  • Government
  • Pharmaceutical Organizations
  • Consulting Organizations
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
The Medicaid Managed Care Proposed Rule: Digesting the Details and Implications
  Individual Registration Fee: $195. webinar flash drive with video syncing slides and recorded audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event brochure.
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Bob Atlas

Robert F. Atlas
President and Strategic Advisor
EBG Advisors

  Bob Atlas is President of EBG Advisors, Inc. He serves as an executive consultant on strategy, policy analysis, program development, and performance improvement for health care providers, payers, policymakers, investors, and others. Mr. Atlas has more than three decades of experience as an advisor to leaders in the health care industry and the public sector.
Since 2013, Mr. Atlas has served as advisor on Medicaid reform to North Carolina’s Secretary of Health and Human Services. He facilitated the deliberations of a governor-appointed Medicaid Reform Advisory Group and coordinated the production of a report to the General Assembly on proposed changes to the program, which emphasized the need to move away from fee-for-service to a value-based approach.
Previously, Mr. Atlas was Executive Vice President and Chief Operating Officer of Avalere Health, as well as President of The Lewin Group. Mr. Atlas has led engagements on managed/accountable care, aiding many states and health plans in implementing Medicaid managed care programs.

After receiving an M.B.A. in Health Administration and Finance from The University of Chicago Booth School of Business, Mr. Atlas served as a commissioned officer in the U.S. Public Health Service. He worked in Medicare’s Health Standards and Quality Bureau and the Office of Health Maintenance Organizations.

Helaine I. Fingold

Helaine I. Fingold
Senior Counsel, Health Care and Life Sciences
Epstein Becker Green


Helaine Fingold is a Senior Counsel in the Health Care and Life Sciences practice, in the Baltimore office of Epstein Becker Green. She has more than 20 years of broad health law and regulatory experience, including prior government experience in both the legislative and executive branches of the federal government.

Ms. Fingold advises on issues involving the Medicare Program Parts A, B, C, and D, Medicare Innovations, Medicare Dual Eligibles, Medicaid, and Veterans' health care programs. She counsels on issues related to products offered on public and private health insurance exchanges and related health insurance reform issues, and provides interpretative and practical advice regarding oversight and compliance requirements of the Medicare Advantage and Medicare Prescription Drug programs. She also advises on the development of business arrangements to assure compliance with federal and state fraud and abuse laws; and counsels companies on legislative and regulatory strategies involving government health programs including health insurance reform.

Prior to rejoining the firm, Ms. Fingold worked at the Center for Medicare & Medicaid Services' ("CMS's") Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group. As both a Senior Technical/Policy Lead and as the Acting Director, Rates & Benefits Branch, Division of Plan Management, Ms. Fingold was responsible for defining and interpreting requirements relating to the qualification of qualified health plans and stand-alone dental plans in both state and federally-facilitated exchanges, oversight of these plans, essential health benefits, and market-wide cost sharing limitations.

From 2004 to 2012, Ms. Fingold worked in a range of capacities at CMS with responsibility for areas of the Medicare Advantage program, including plan application review and approval, application denials and appeals, contracting, plan surveillance, oversight, and marketing. She also is experienced in the Medicare Advantage and Prescription Drug audit and sanction process.

Ms. Fingold began her professional career as an attorney in the Office of the General Counsel of the Department of Health and Human Services assigned to CMS's predecessor agency on legal issues arising under Medicare Parts A and B and Medicaid. Ms. Fingold then was a team lead within Office of Research and Demonstrations at CMS's predecessor agency, working on Medicaid waiver and Medicaid demonstration programs. She later spent two years as a health care attorney in the DC office of Epstein Becker Green. Ms. Fingold left the firm to serve as General Counsel for the Medicare Payment Advisory Commission before rejoining CMS in 2004.

Ms. Fingold received her J.D. from the Northeastern University School of Law and her B.A. from the University of Massachusetts. She is admitted to the Bar in the state of Maryland.

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