Speakers Designed For Shipping Information Written Materials Print an order form: If you do not wish to place your order online, click here to download a printable order form (PDF file), then submit your order via fax or mail, as directed on the form.

Order Now (Secure Site) CD and Printed Materials ($329) Pub code: C8A03T MP3 file ($329) Pub code: C8A03F View Cart

In an unexpected turn of events, Congress passed year-end legislation that leaves Medicare Advantage (MA) payment rates intact but precludes new Special Needs Plans from the entering the market and bars existing SNPs from expanding their service areas after Jan. 1, 2008. For plans that intended to offer a new SNP or to expand their SNP service areas in 2009, this leaves big questions about filing, developing, launching and marketing alternate products with benefit designs to accomplish most of the same objectives.

For plans that had filed Notices of Intent for 2009 for private-fee-for-service products as “placeholders” that they didn’t expect to use in light of Congress considering both abolition of “deeming” for PFFS networks and cutting up to $50 billion in payments from MA plans, they now must decide whether to convert those placeholders into actual applications. But they must make those decisions by March. Moreover, they must do this knowing that the physician payment cut “fix” that Congress adopted at year’s end is good for only six months and the State Children’s Health Insurance Program (SCHIP) extension for just three months. This leaves the likelihood that Congress will pass another Medicare bill in the first half of 2008, perhaps after the due date for plan bids, that could alter the treatment of MA plans substantially.

Meanwhile, the unexpectedly short six-month fix to the physician pay cut itself has implications for MA and PFFS plans, in particular, since many health plans reimburse providers according to Medicare fee schedule.

Two of the nation’s top Medicare Advantage experts explain what the changes created by the December law actually mean for you and your partners’ product strategies, benefit designs, and application filings, and what you should do in light of this. They provide detailed strategies in such key near-term decision areas as:

• How should you use the new law — and current Medicare Advantage climate — to alter your product strategy and benefit designs, while still meeting the March deadline for applications for 2009?
• What should you do now if you have an existing Special Needs Plan? What steps should you take if you are looking to get into the SNP market?
• What should you do about current and planned PFFS products in light of the inaction on PFFS in the December law and the most likely scenarios for additional legislation in the first half of 2008?
• What Medicare legislation is Congress likely to approve by the end of June — including on payments to Medicare Advantage plans — and what steps should you consider to prepare for this next round of congressional action? 
• What is Congress likely to do in the upcoming next phase of legislation on Medicare physician reimbursement, and what may it mean to your contracting and deeming strategies?

Speakers

JOHN GORMAN is CEO of Gorman Health Group, LLC, the leading consulting firm specializing in Medicare and Medicaid managed care and Part D. Before starting his company in 1996, Mr. Gorman served as assistant to the director of HCFA’s Office of Managed Care under two directors. Prior to that, he was staff director for U.S. Rep. John Conyers Jr., then chairman of the House Government Operations Committee. Mr. Gorman specializes in strategic planning and business development for the health care industry, with particular emphasis on federal programs and regulation.

JEAN LeMASURIER is director, Employer Group Practice at Gorman Health Group, LLC. She joined GHG after a 30-year career with CMS and its predecessor, most recently as senior advisor for the Employer Policy and Operations Group in CMS’s Center for Beneficiary Choices. In that role, Ms. LeMasurier provided leadership on policy and operations issues related to implementation of the 2003 Medicare reform law. Before that, she spent six years as the acting director/deputy director of the Health Plans Benefits Group in the Center for Beneficiary Choices, responsible for purchasing and regulatory oversight of Medicare managed care services.

Moderator: Jim Gutman, vice president and executive editor at Atlantic Information Services, Inc.

Designed Especially For

• Health plan CEOs, CFOs, chief operating officers, product development and marketing executives, market researchers, provider network and contracting managers, government relations and compliance executives, and pharmacy directors.

• Directors of managed care contracting at provider organizations.

• Federal and state government officials.

• Pharmaceutical company executives and marketers.

• Executives of pharmacy benefit management companies.

• Attorneys, actuaries, and consultants.

Written Materials