May 9, 2017 | Austin, TX
Coming Together...Caring for KIDS
8:30-10:00 am Legislative Update
Hear about the issues affecting pediatric providers that have merited the attention of the 85th Texas Legislature. What’s been gained, what’s been lost? How might the future of pediatric home care in Texas be forever changed? Speakers: Rachel Hammon, Executive Director, TAHC&H; Sarah Mills, MS, Director of Public Policy and Government Relations, TAHC&H; TAHC&H Lobby Team (1.5 clock hours Administrator/Alternate)
10:15-11:45 am Unraveling the Puzzle of Contracting with Managed Care
In an effort to bend the healthcare cost curve, the federal and state governments have implemented managed care programs for the Medicaid populations to achieve budget certainty. While these programs are operated through private managed care organizations (MCOs) that are at total financial risk for the Medicaid population, it is crucial that providers are knowledgeable about the interworking of MCO contracting. Topics covered to during the presentation will be:
• What are the incentives/factors that drive MCOs in managing their provider networks?
• What are the rights of MCOs in negotiating contracts with providers, and what are the rights of providers in negotiating with MCOs?
• What are MCOs looking for in contracts with providers incentive arrangements?
• Things those providers do that make MCOs not want to contract with them.
Speaker: Michelle “Missy” Apodaca, Attorney, Haynes and Boone, LLP (1.5 clock hours Administrator/Alternate)
11:45-1:00 pm LUNCH (included in registration)
1:00-2:30 pm Helping Your Client Navigate Medicaid Fair Hearings – Keys to Success
Increase the odds of success in a Medicaid Fair Hearing by using these helpful tips! This presentation will address the best practices and strategies to help your client succeed at a fair hearing. We will also cover information on DISABILITY RIGHTS TEXAS and how it can assist clients who have had their requests for medically necessary services denied or reduced. We will review the fundamentals of the fair hearing process: how an appeal is requested, what services are continued pending the fair hearing process, how to get authorizations for continued services pending the fair hearing process, important timelines, documents to present at the hearing, who can attend the hearing, what happens at the hearing, what you can do to help, and what happens if your client wins, or loses, the hearing? Speakers: Peter Hofer, JD, Disability Rights Texas; Terry Anstee, RN, JD, Disability Rights Texas. (1.5 Administrator/Alternate; 1.5 SWCEUs)
2:45-4:15 pm A Stitch in Time Saves Nine: Planning Ahead for the Inevitable IG Request for Records and What to Expect
If you are, or work for, a Medicaid provider in Texas, then you will receive a request for records from either the Texas Medicaid and Healthcare Partnership (TMHP) or Texas Health and Human Services Inspector General (HHS-IG). The important thing to understand is the process that generated the request, how the clinical documents will be reviewed, and how to prepare them to be sent. This session provides a panel discussion between an IG staff person, Medicaid provider and experienced attorney who works with providers in responding to clinical records requests. In addition to the preparation of records, we will discuss what happens after all of the hub-bub is over and records are delivered to the IG. Understanding this part of the process will help a provider troubleshoot their records and know what to expect in response from IG. Speakers: Debbie Weems, FACHE, Deputy IG, Medical Services; Kristen Robison, RN, Angels of Care Pediatric Home Health; Troy Brooks, JD, BrooksAcevedo (1.5 contact hours continuing education for nurses; 1.5 clock hours Administrator/Alternate)