Page 1

Part D Compliance & Delegation Oversight Boot Camp August 20-21, 2019 • Park City, Utah The #1 source for critical content on audits and oversight to help maximize delegate relationships and achieve successful audits v10 dw 8.13.19


Get a comprehensive look at challenges to pass CMS audits from two critical topics - delegation oversight and compliance. Join RISE for in-depth peer discussions and 20 informative sessions offering expert advice on how to handle new CMS guidelines and regulations. Come with your peers to divide and learn more during two concurrent tracks covering delegation oversight and internal & external monitoring.

S E S S ION HI G HLI G HTS •

Interactive Session: Mock Audits 101—A Nuts & Bolts Crash Course

Delegation Oversight Track: Provider Preclusion List Implementation

• Auditing and Monitoring Track: Understanding the New CMS Financial Audit and the NowAssociated Penalties That Go with It

TOP RE A SONS TO AT TEND This year we are bringing in ten new speakers for a new and fresh perspective and a content packed four-hour workshop for new SNP Plans and those wanting an information refresher

2

1

2

3

Get an outline of the latest guidelines and protocols from CMS

Hear from plan sponsors about their CMS audits and what lessons they learned

Understand what your peers are doing to address similar challenges

4

5

Participate in training sessions that will prepare you for comprehensive delegation oversight

Learn about the latest strategies and penalties associated with new regulations regarding financial audits

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


OUR RENOWNED SPEAKING FACULTY Tammy Owens, Risk Management Audit Lead , Compliance & Risk Management HUMANA HEALTHCARE SERVICES

Koren Stevenson, JDDirector of Contracts And Compliance CENTER FOR ELDERS’ INDEPENDENCE

Ashley Smith, Manager of Pharmacy Services, Senior Care Options BOSTON MEDICAL CENTER HEALTHNET PLAN

Marita Nazarian Pharm.D., Director, Delegation Oversight L.A. CARE HEALTH PLAN

Richard Appel, Project Manager, Senior Segment CIGNA

Ana Handshuh, Principal, CAT5 STRATEGIES

Julie K Lappas, Attorney Hall, Render, Killian, HEATH & LYMAN, P.C.

Babette S. Edgar, Pharm.D., MBA, FAMCP, Principal, BLUEPEAK ADVISORS

Scott Fries, Executive Vice President Pharmacy Solutions PULSE8

Jeff Baker, Senior Consultant BLUEPEAK ADVISORS

Julie Moses, Compliance Monitoring Consultant BLUECROSS BLUESHIELD OF TENNESSEE

Robert Shelley, Principle LEAF HEALTH

Brian Wehneman, Director, Compliance and Risk Management | Healthcare Services HUMANA

Gail Blacklock, Director of Compliance INTER VALLEY HEALTH PLAN

Ryan Davis, Manager, Pharmacy Medicare Programs KAISER PERMANENTE

Pete Woelfel, Director of Business Development REVEALRX LLC

Jessica Vander Zanden, VP, Compliance and Audit NETWORK HEALTH

Dan Piessens, CEO REVEALRX LLC

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

3


WHO WILL ATTEND? This program is designed for senior leaders from Medicare, Part D and Commercial plans, and health care consultancies with responsibilities in the following areas: 01

07

Compliance

02 FDR Oversight 03 Pharmacy and Part D

Risk Management

08 Vendor/Delegation Management and Oversight

04 Internal/External Audit

09

05 Legal Affairs

10

Fraud, Waste & Abuse

06

11

Enforcement Compliance

Medicare Operations

Appeals and Grievances

Consultants and technology providers are also encouraged to attend.

RAVE REVIEWS

This was excellent information that many health plans should be aware of. Great variety of information for both days. Director Finance, Penn Medicine, University of Pennsylvania

Great speakers, very dynamic and knowledgeable. Compliance Officer, Abarca Health

Valuable information in a small group prone to conversation Pharmacy Director UM at HealthSun Health Plans

4

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


TUESDAY, AUGUST 20 7:30

Registration and Networking Breakfast

8:45

Chairperson’s Opening Remarks Ana Handshuh, Principal CAT5 STRATEGIES

9:00

Monitoring Your FDR: Meeting Contractual Obligations and Compliance Goals • Review Medicare Part D regulatory requirements to be included in new vendor contracts • Understand challenges for fulfilling contractual terms with vendors and how to address them • Discuss and share best practices to monitor and audit vendor performance and ensure contract terms are met Julie K. Lappas, Attorney HALL, RENDER, KILLIAN, HEATH & LYMAN, P.C.

9:45

CASE STUDY: A Delegated Model Health Plan and How to Effectively Manage FDR’s • Understand how Inter Valley uses committees to manage its FDR’s and how that benefits both organizations • Analyze obligations, goals and ascertain how to get there • Reviews processes to manage risk with FDR and establish a relationship so they listen to you and learn what to do when your vendor is evading your requests Gail Blacklock, Director of Compliance INTER VALLEY HEALTH PLAN

10:30

Networking Break

11:00

MA-PD Plans: Adjusting Approaches to Effectively Manage Part B and D Benefits • Review Regulatory Changes in Part B Program – Impacts for MAPD plans • Describe what programs plans are implementing as a result of the regulatory changes • Discuss the future of Part B and Part D – what’s next? Babette S. Edgar, Pharm.D., MBA, FAMCP, Principal BLUEPEAK ADVISORS

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

5


11:45

Proper Drug Benefit Adjudication • Understand what therapies should be focused on and hear examples of drugs within therapy categories that can move from B to D so that you know what therapies should be focused on • Understand regulatory loosening of B and D benefits and step therapy for Part B drugs • Analyze ways of managing part D excluded D vs E (excluded drugs) Brian Wehneman, Director, Compliance and Risk Management | Healthcare Services HUMANA

12:30 1:30

Networking Lunch

Outline of Administrative Requirements with the New CMS Guidelines and Protocols • Review new regulation about insurer approval of prescriptions totaling 90 or more morphine milligram equivalents (MME) per day, TBD and its recent change to a consultation between pharmacists and prescribers • Examine how to comply with challenges of newly required discussion between the pharmacist and the physician and how your organization may need to change relevant processes • Summarize requirements for Drug Management Programs for potential at-risk patients and examine ways it will affect your members Julie Moses, Compliance Monitoring Consultant BLUECROSS BLUESHIELD OF TENNESSEE

2:15

Understand New Guidance from CMS Regarding Opioids and How It Will Affect Your Current Policies and Procedures • Review policies to ensure new regulatory guidelines are in place for continued adherence • Understand new opioid utilization protocols and drug management programs that will need to be implemented • Review new changes to the OMS work from CMS and examine potential CY2021 impact to Medication Therapy Management Programs Ryan Davis, Manager, Pharmacy Medicare Programs KAISER PERMANENTE

3:00

6

Networking Break

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


3:30

INTERACTIVE SESSION: Mock Audits 101 — A Nuts & Bolts Crash Course • Review critical best practices for building and maintaining an effective mock audit program • Understand who needs to be involved and learn how to develop a culture that embrace compliance and audit-readiness • Analyze ways to master the basics of preparing flawless universe data to reduce the possibility of an infraction Ana Handshuh, Principal, CAT5 STRATEGIES

4:30

Champagne Roundtables Participate in an intimate conversation with your peers on one of the topics below. Facilitators will provide 5 discussion prompts for the group. Participants are encouraged to bring their own topics for a table discussion. Example topics: • Claims processing of vendors • Low income grievances regarding copays • Medication adherence • Rejected claims management • When and What to Delegate • PBM Contracting • Offshore Subcontractors Facilitators: Ashley Smith, PharmD, BCGP, Manager of Pharmacy Services, SCO BMC HEALTHNET PLAN Marita Nazarian Pharm.D. Director, Delegation Oversight L.A. CARE HEALTH PLAN Richard A. Appel, Project Manager, Senior Segment CIGNA Julie K. Lappas, Attorney, HALL, RENDER, KILLIAN, HEATH & LYMAN, P.C. Tammy Owens, Risk Management Audit Lead , Compliance & Risk Management, Humana, Pharmacy Solutions, HUMANA HEALTHCARE SERVICES Robert Shelley, Founding Principal LEAF HEALTH

5:15

Closing Remarks Ana Handshuh, Principal CAT5 STRATEGIES

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

7


5:30

Networking Cocktail Reception

WEDNESDAY, AUGUST 21 8:00

Registration & Continental Breakfast

9:00

Opening Remarks Ana Handshuh, Principal CAT5 STRATEGIES

DELEGATION OVERSIGHT Track Chair: Ana Handshuh 9:00

Provider Preclusion List Implementation – Ensuring Compliance in The Ever-Changing Regulatory Environment • Analyze and interpret the provider preclusion list • Review regulations and ways to communicate changes across organization and FDRs • Learn methods for managing implementation within your organization

9:45

10:30

8

AUDITING AND MONITORING Track Chair: Pete Woelfel Understanding the New CMS Financial Audit and the NowAssociated Penalties That Go with It • Review the purpose and recent changes of audit and how it differs from previous financial audits • Hear about details from Firstcare Health and what CMS auditors were looking for • Understand exception findings and corrective plans to better evaluate what you have in place

Richard A. Appel, Project Manager, Senior Segment CIGNA

Tammy Owens, Risk Management Audit Lead, Compliance & Risk Management, Humana Pharmacy Solutions HUMANA HEALTHCARE SERVICES

Reporting, Benchmarking and Analytics to Support Your FDR Oversight Program

Auditing and Monitoring Part D Coverage Determinations, Appeals, and Grievances (CDAG)

• Review systems to accurately report information and avoid CMS red flags • Analyze examples from clinical, financial and regulatory compliance programs • Understand how the data can be applied to other aspects of quality control

• Understand a CMS audit of CDAG and how to prepare for it • Review Vendor vs Health plan responsibilities during CMS audit • Define how CDAG monitoring impacts CPE audits

Scott Fries, Executive Vice President Pharmacy Solutions PULSE8

Marita Nazarian Pharm.D., Director, Delegation Oversight L.A. CARE HEALTH PLAN

Networking Break

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


11:00

Effective Resolution of Enrollee Grievances • Review new Appeals and Grievance guidance from CMS 2019 to ensure your organizations full compliance • Learn about ways for resolving every issue in the complaint • Review methods for ensuring correct classification of a compliant vs grievance

11:45

Review of Revised Tracer Formatting for Effective Documentation • Learn how to tell the complete story • Review revised CMS tracer format and new rules that no longer require demonstration of 7 elements • Analyze best practices for putting things in tracer form

Koren Stevenson, JD., Director of Contracts and Compliance CENTER FOR ELDERS’ INDEPENDENCE

Tammy Owens, Program Manager, Audit Intake HUMANA

Achieving Compliance and Privacy with Your Delegated Vendors

Changes in PBM Drug Manufacturer Audit for Drug Rebates

• Review how to analyze and implement comprehensive data sharing agreements • Learn about updates to BAA language • Review breach prevention protocols and what to do when there is a breach Jessica VanderZanden, VP, Compliance and Audit NETWORK HEALTH

• Review current Rebate Regulatory Status and the proposed rebate payment protocol and how it will affect drug prices • Learn about risk reserve and how to analyze likely Audit Parameters • Learn how to identify and avoid oversight challenges you may encounter to avoid prolonging problems in the future Robert Shelley, Founding Principal LEAF HEALTH

12:30

Networking Lunch

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

9


1:30

Handling CMS Memo’s – Effective Communication with PBM Regarding New Protocols

PANEL DISCUSSION : What Are You Doing to Monitor Internal Operations

• Learn best practices for handling and disseminating new information to FDRs • Understand ways to configure a system for new protocols • Review tactical plans for the logistics; time management, who is handling the memo and how to follow up with FDR

• Discuss how plans determine which areas to focus on and who conducts the internal monitoring • Review ways different departments conducting internal monitoring report their results to compliance/internal audit and other areas of the health plan where they’re may be overlap potentials? • Analyze where and how do you document your internal monitoring?

Ashley Smith, Manager of Pharmacy Services, Senior Care Options BOSTON MEDICAL CENTER HEALTHNET PLAN

Moderator: Dan Piessens, CEO REVEALRX Panelists: Jessica VanderZanden, Compliance Director NETWORK HEALTH Julie Moses, Compliance Monitoring Consultant BLUECROSS BLUESHIELD OF TENNESSEE Richard A. Appel, Project Manager, Senior Segment CIGNA

2:15

Auditing your PBM’s Prescription Drug Events (PDEs) • Analyze Chapter 9 requirements and apply them to PDE data • Is your PBM managing eligibility related rejections? • Understand CSCC operations related to PDE data and how it is interpreted • Review Vendor vs Health plan responsibility and how to provide the necessary oversight Jeff Baker, Senior Consultant BLUEPEAK ADVISORS

3:00

10

ROUND TABLES : Attendee Generated Content: Bring Your Own Topic • Connect and discuss on topics that did not make it onto the agenda • Explore knowledge and experience of peers and glean information you can take back home for implementation • Share findings amongst the group so you can hear what other people talked about and learn from their discussions

Closing Remarks

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


VENUE DETAILS

THE CHATE AUX DEER VALLE Y 7815 ROYAL ST PARK CIT Y, UT 8 4 0 6 0 (435) 65 8 -95 0 0 Nestled amidst the majestic Park City mountains, The Chateaux Deer Valley offers exemplary service and amenities for all guests, making it a popular year-round destination. At this Forbes Four-Star luxury property, guests take solace from the world and reconnect with nature. Mere steps from the worldrenowned Deer Valley Resort and a short ride to Historic Main Street, The Chateaux invites guests to experience everything our mountain town has to offer all year long. BOOK YO UR RO O M

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

11


CONFERENCE RATES EARLY BIRD RATE

STANDARD RATE

ONSITE RATE

Ends 6/28/2019

Ends 8/19/2019

HEALTH PLANS & HEALTH CARE PROVIDERS

$ 1,495

$ 1,695

$ 1,895

SERVICE PROVIDERS & CONSULTANTS

$ 1,995

$ 2,195

$ 2,395

GROU P DISCOU NTS ARE AVAIL AB LE Please contact Terrence Johnson at (704) 341-2647 or tjohnson@risehealth.org In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For information regarding refund, complaint and/or program cancellation policies, please visit our website: https://risehealth.org/the-fine-print/

HOW TO REGISTER

CALL

REGISTER ONLINE

MAIL

704.341.2647

risehealth.org/partdcompliance

Wilmington FRA 3420 Toringdon Way, Suite 240 Charlotte, NC 28277

(Click to Register Online)

Please write H558 on your check.

12

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


ACCREDITATIONS SATISFACTORY COMPLETION Learners must complete an evaluation form to receive a certificate of completion. Your chosen sessions must be attended in their entirety. Partial credit of individual sessions is not available. If you are seeking continuing education credit for a specialty not listed below, it is your responsibility to contact your licensing/certification board to determine course eligibility for your licensing/certification requirement.

PHARMACISTS In support of improving patient care, this activity has been planned and implemented by Amedco LLC and Rise Health. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation Statement – Amedco LLC designates this live activity for a maximum of 10.75 credit hours of knowledge -based contact hours for pharmacists. Learners should claim only the credit commensurate with the extent of their participation in the activity. NOTE to Pharmacists: The only official Statement of Credit is the one you pull from CPE Monitor. You must request your certificate within 30 days of the activity to meet the deadline for submission to CPE Monitor.

CPE CREDITS RISE is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org PROGRAM LEVEL: Basic ANTICIPATED CPE CREDITS: 12.5 credits RECOMMENDED FIELD(S) OF STUDY: Specialized Knowledge PREREQUISITES: None ADVANCE PREPARATION: None INSTRUCTIONAL DELIVERY METHOD: Group live LEARNING OBJECTIVES: Upon completing the course, participants will: • Participate in a Mock Audits 101 interactive session and learn critical best practices to maintain an effective mock audit program • Understand the latest strategies and penalties associated with new CMS financial audits • Gain advice on how to handle new CMS guidelines and regulations

For more information, visit our website: https://risehealth.org/the-fine-print/

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

13


THE CONFERENCE ORGANIZER

RISE is the premier community for health care professionals who aspire to meet the extraordinary challenges posed by the emerging landscape of accountable care and government health care reform. Recognized industry-wide as the number one source for information on risk adjustment and quality improvement within health care, RISE strives to serve the community on four fronts: networking, education, industry intelligence and career development. Through cutting-edge conferences, online courses, in-house training, webinars as well as an association comprised of over 2,500 members, RISE provides professionals with industry insights and critical information they need to stay ahead of the curve. RISE produces more than 30 conferences annually, focused on sophisticated topics and ample networking opportunities for thousands of executives from mid- to senior-level and C-suite. Our team of subject matter experts is often first to market with emerging topics and we pride ourselves on consistently delivering on top quality operations and logistics to produce a seamless event.

LE ARN M ORE AT RIS EHE ALTH .ORG

14

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019


SPONSORSHIP AND EXHIBIT OPPORTUNITIES Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a custom-designed networking event. To learn more about sponsorship opportunities, please contact Michelle Elam at 704.341.2393 or MElam@risehealth.org

GOLD S P ONSOR S

BluePeak Advisors assists health plans, pharmacy benefit management companies, pharmaceutical companies and health care alliance companies with Medicare Parts C and Part D operational and compliance issues. BluePeak consultants, with experience from CMS and the industry, perform many mock audits and CMS validation audits each year, assist with actual CMS audits onsite, design staffing plans and act as interim staffing, and assist with remediation efforts. Please visit us at www. bluepeak.com.

Pulse8 is the only Healthcare Analytics and Technology Company delivering complete visibility into the efficacy of your Risk Adjustment, Quality, and Pharmacy Benefit Management programs. We enable health plans and providers to eliminate waste and achieve the greatest financial impact in the Medicare Advantage, Medicaid, and ACA Commercial markets as well as with Value-Based Payment models for Medicare. Our advanced analytic methodologies and flexible business intelligence tools offer real-time visibility into member behavior and provider performance. Pulse8’s Illumin8 Active Intelligence™ platform offers a suite of uniquely pragmatic solutions that are powered by our patent-pending Dynamic Intervention Planning to deliver the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality.

T h e C h at e a u x D e e r Va l l e y | Pa r k C it y, U t a h

Click Here to Register

15


S ILVER S P ONSOR S

Reveal is a cloud based solution that combines claim, formulary, eligibility and reference data making claim review and research faster and easier than ever before. Reveal’s opioid review, transition management, paid and rejected claim matching and more help your team stay in CMS compliance and prepared for your next audit - Reveal is a state of the art tool no health plan should be without!

Pharmacy Synergistics brings together software engineers and pharmacists specializing in Medicare Part D regulatory compliance and Star measures. Our proprietary software reviews 100% of rejected, paid and transition claims daily to ensure your CMS approved formulary is adjudicating accurately. Our Star Ratings program couple clinical pharmacists with software solutions to provide a multi-modal high-touch plan of action including member, physician, and pharmacy outreach initiatives targeted to improve medication related quality measures. www.pharmacysyn.com

BRONZE S P ONSOR S

16

r i s e h e a l t h . o r g /p a r t d co m p l i a n ce

August 2 0 -21, 2 019

Profile for WilmingtonFRA

Part D Compliance & Delegation Oversight Boot Camp [H558]  

The #1 source for critical content on audits and oversight to help maximize delegate relationships and achieve successful audits. Get a com...

Part D Compliance & Delegation Oversight Boot Camp [H558]  

The #1 source for critical content on audits and oversight to help maximize delegate relationships and achieve successful audits. Get a com...