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Key Sessions

Karen Matsuoka, Ph.D.

Driving Quality Improvement for Medicaid Beneficiaries through Managed Care

Center for Medicaid and CHIP Services Centers for Medicare & Medicaid Services

08:45 09:00 (15 mins)

Symposium A: Medicaid Managed Care 101

Chairman’s Opening Remarks

  • Clay Farris - Senior Healthcare Executive, Mostly Medicaid

09:00 09:30 (30 mins)

Symposium A: Medicaid Managed Care 101

An Overview of Managed Care Transitions

Look at different states currently transitioning to Managed Care for part or all their populations and how the implications of policy change and general uncertainty is affecting states transitioning to managed care models.


  • Alexander Shekhdar - Vice President, Federal and State Policy, Medicaid Health Plans of America (MHPA)

09:30 10:00 (30 mins)

Symposium A: Medicaid Managed Care 101

Government Accountability Office: Update on the Managed Care Landscape

  • Carolyn Yocom - Director, Health Care Team, U.S Government Accountability Office (GAO)

10:00 10:30 (30 mins)

Symposium A: Medicaid Managed Care 101

MegaReg Program Updates: One Year Out

  • Alexander Shekhdar - Vice President, Federal and State Policy, Medicaid Health Plans of America (MHPA)

09:15 09:30 (15 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

Chairman’s Opening Remarks

  • Jennifer Babcock - Vice President for Medicaid Policy & Director of Strategic Operations, ACAP

09:30 10:00 (30 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

The Business Case for SDOH

  • Jean McGuire, Ph.D. - Professor of Practice, Health Sciences Department, Northeastern University

10:00 10:30 (30 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

CASE STUDY: The 80% of Care Gaps Health Plans Aren't Addressing

By moving past traditional sick care and exploring ways to address insecurities in food, education, housing, child care and other basal needs, Passport works to address needs across the social spectrum. This presentation will share some best practices and early lessons learned from Passport’s programs to address high risk populations.

  • John Burich - Chief Strategy Officer, Passport Health Plan

10:30 11:00 (30 mins)

Main agenda

Grand Opening & Networking Reception in MMCC Hall

11:00 11:30 (30 mins)

Main agenda

Driving Quality Improvement for Medicaid Beneficiaries through Managed Care

  • Karen Matsuoka, Ph.D. - Chief Quality Officer Director, Division of Quality and Health Outcomes, Center for Medicaid and CHIP Services Centers for Medicare & Medicaid Services

11:35 12:05 (30 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

Problem Solving for Social Determinants of Health Challenges in Rural Populations

  • Kenneth Beutke - President, OSF Saint Elizabeth Medical Center

12:05 12:35 (30 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

CASE STUDY: SDOH - Being Part of the Solution

There is a significant impact that SDOH have on a person’s overall health and wellbeing. 

Hear how Geisinger has expanded its Population Health team to include Community Health Assistants with a primary focus on key barriers preventing access to quality health care including transportation, housing, and food insecurity.  Learn about Geisinger’s demonstrated impact and key partnerships developed.

  • Stacey Souchak - Director, Health Choices, Geisinger Health Plan

12:35 13:05 (30 mins)

Symposium B: Addressing Social Determinants of Health (SDOH)

CASE STUDY: Initiatives for Ensuring Affordable Housing for Vulnerable Populations in Medicaid

Housing is a health issue and Health is a housing issue. Learn about social determinants of health and how health system and providers can partner with housing providers to decrease community costs of high utilizers and increase housing stability. University of Pittsburgh Health System (UPMC) and Community Human Services (CHS) have partnered for 6 years and work collaboratively on this issue.

  • Jeremy Carter - Chief Housing Officer, Community Human Services

11:35 12:05 (30 mins)

Symposium A: Medicaid Managed Care 101

Provider Enrollment and Screening Meets Credentialing – Where States are Headed

The Affordable Care Act (ACA) substantially changed the requirements for screening and enrollment of Medicaid providers.   Providers must be placed into categories of risk; Limited, Moderate, and High.  There are new requirements for periodic background and sanction checks, facility site visits, fees, and many other tasks.  Another complicating factor is the role of Medicaid Managed Care Organizations (MCOs) in this process.  While MCOs typically have responsibility for provider credentialing, it is often separate from screening & enrollment, creating redundancy and confusion for stakeholders.  A number of States have begun to combine the Credentialing process with Medicaid Screening & Enrollment.  This presentation will explore what states are doing and the implications for Medicaid Programs, MCOs, and Providers.

  • J.P. Crouse - Vice President, Business Development, Maximus

12:05 12:35 (30 mins)

Symposium A: Medicaid Managed Care 101

Ensuring Your Value – Building and Maintaining Excellence, Efficiency and Profitability in the Managed Care Landscape

  • Sarah Adelman - Vice President, New Jersey Association of Health Plans

12:35 13:05 (30 mins)

Symposium A: Medicaid Managed Care 101

The Impact of Fraud Waste and Abuse on Managed Care Health Plans

  • Jennifer DePaul - Director, Special Investigations Unit, Anthem

14:05 14:15 (10 mins)

Symposium A: Medicaid Managed Care 101

Chairman’s Welcome Back

  • Clay Farris - Senior Healthcare Executive, Mostly Medicaid

14:15 14:45 (30 mins)

Symposium A: Medicaid Managed Care 101

CASE STUDY: Program Integrity - Effective Compliance Program to Detect and Report Fraud, Waste and Abuse

  • Learn about the structure of one plan's Compliance Program incorporating the 7 elements of an effective program.
  • Analyze a Case Study on One Plan's Fraud, Waste and Abuse detection methods including bringing on and managing a Special Investigations Unit.
  • Hear Tips and Techniques from a Compliance Officer on what terms should be included in contracts with Delegated Vendors and Providers to promote compliance and integrity.
  • Ryan Tyrrell Lipinski - Compliance Officer, Cook County Health and Hospitals System

14:45 15:15 (30 mins)

Symposium A: Medicaid Managed Care 101

Don’t Say The F$#*D Word & Other Tips to Strengthen Program Integrity and Compliance in a Mega Reg World

  • Deonys de Cárdenas, RN, JD - Director of Compliance, Department of Compliance, Select Health of South Carolina

15:45 16:15 (30 mins)

Symposium A: Medicaid Managed Care 101

Problem Solving for Systems Issues in Transitioning Your Medicaid Populations to Managed Care

  • Laura Hopkins - President, Amerigroup Kansas

13:05 14:05 (60 mins)

Main agenda

Networking Luncheon

14:05 14:15 (10 mins)

Symposium C: Medicaid Long Term Services and Supports (MLTSS)

Chariman's Opening Remarks

  • Camille Dobson - Deputy Executive Director, Former Senior Policy Advisor, National Association of States United for Aging and Disabilities, Centers for Medicare & Medicaid Services

14:15 14:45 (30 mins)

Symposium C: Medicaid Long Term Services and Supports (MLTSS)

Managed Long Term Care Services and Supports: Examining Payment Structures and CMS Oversight

  • Susan Barnidge - Assistant Director, U.S. Government Accountability Office (GAO)

15:45 16:15 (30 mins)

Symposium C: Medicaid Long Term Services and Supports (MLTSS)

CASE STUDY: Transitioning Medicaid LTSS to Managed Care: Challenges, Opportunities and Lessons Learned

  • Kelli Todd, MPH - Program Manager, Iowa Managed Care Ombudsman Program, Iowa Department on Aging

16:15 16:45 (30 mins)

Symposium C: Medicaid Long Term Services and Supports (MLTSS)

Minnesota's Approach to MLTSS Compliance with the Mega-Reg

The State of Minnesota's Senior Health Options program includes a comprehensive long term care benefit and is one of the country's oldest integrated programs for Medicare and Medicaid enrollees. Learn how Minnesota is approaching the new focus on home and community based service provider enrollment, network adequacy and quality outlined in the Medicaid managed care regulations

  • Gretchen Ulbee - Manager Special Needs Purchasing, Health Care Administration, Minnesota Department of Human Services

15:15 15:45 (30 mins)

Main agenda

Networking & Refreshment Break

16:15 16:45 (30 mins)

Symposium A: Medicaid Managed Care 101

ACA and ACHA: Which Path Forward?

  • Hector De La Torre - Executive Director, Transamerica Center for Health Studies

16:45 17:15 (30 mins)

Symposium A: Medicaid Managed Care 101

Improving Patient Outcomes Through Medicaid Health Home

Harbor has a 5-year history of providing home health services to adults with severe persistent mental illness and children with severe emotional disturbances, helping them coordinate their physical and mental health, long term care, and social service needs. The program has had positive impact on emergency visits, general and psychiatric hospitalizations with reduction in costs and increase in client outcomes.

  • Steve Benjamin - Senior Vice President Clinical Services, Harbor Behavioral Health

16:45 17:15 (30 mins)

Symposium C: Medicaid Long Term Services and Supports (MLTSS)

Building LTSS Partnerships: Community Organizations, Managed Care Organizations and the Ever-Changing Environment

  • Erica Anderson - Senior Director, National Association of States United for Aging and Disabilities

17:30 18:30 (60 mins)

Main agenda

Cocktail Reception