Managed Care Contracts: Medicare and Medicaid Considerations for Providers
Reimbursement and Delegation Challenges, Key Provisions, and Anticipating Areas of Dispute

Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Thursday, May 18, 2023
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
-
This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will provide healthcare counsel with a roadmap for drafting and negotiating managed care contracts on behalf of providers. With a focus on Medicare and Medicaid contracts, the panel will discuss current trends in contract negotiations, critical provisions in the agreements, and strategies for resolving common areas of dispute.
Faculty

Mr. Bassman focuses his corporate litigation practice on advising healthcare and other clients in both general trial and dispute resolution as well as antitrust litigation and counseling. He has significant experience serving as lead counsel in litigation across the U.S., resolving complex matters as efficiently as possible in his representation of healthcare providers, third-party payors, and life sciences companies in payment disputes, antitrust issues, managed care contract negotiations, and termination and regulatory challenges. Mr. Bassman has also represented many clients outside of healthcare in antitrust litigation and counseling.

Mr. Sullivan concentrates his practice in healthcare and insurance law, with a particular emphasis on the intersection of healthcare finance and delivery. He regularly represents and counsels health plans and healthcare providers in regulatory compliance and filings, and alternative financial models for healthcare delivery, including Organized Delivery Systems, Accountable Care Organizations, Multiple Employer Welfare Arrangements, and health system equity ownership or participation in insurance organizations. As Assistant Commissioner of the New Jersey Department of Banking and Insurance from 2010-2014, Mr. Sullivan oversaw the Office of Life and Health during a period of fundamental change in both the healthcare and insurance sectors. This encompassed the implementation of the Affordable Care Act and the Dodd-Frank Wall Street Reform and Consumer Protection Act; the emergence of alternative financial models for health care delivery, including CO-OPs, ACOs, and health system equity ownership or participation in insurance organizations; and the transition to electronic health records and implementation of the ICD-10 mandate.
Description
Over the past few years, the changes in healthcare have driven fundamental changes in the relationship between providers and MCOs and introduced new approaches to managed care contract negotiations. Negotiating favorable rates and terms in this new environment is more challenging than ever.
Among the changes is the increasing shift to Medicare and Medicaid managed care. Many states are expanding Medicaid-managed care to contain healthcare costs and implement value-based payment initiatives. In addition, state Medicare populations are increasingly enrolling in Medicare Advantage.
Providers continue to grapple with reimbursement and new value-based payment arrangements, delegation, and addressing contract provisions required by Medicare, among other things. Counsel negotiating managed care contracts must carefully consider complex arrangements and anticipate potential areas of dispute. Counsel must also take steps to minimize potential exposure for the provider for nonperformance of obligations under the contract.
Listen as our authoritative panel of healthcare attorneys offers best practices for providers negotiating managed care contracts. With a focus on Medicare and Medicaid contracts, the panel will examine current trends in contract negotiations, key contract provisions, and ways to address common areas of dispute.
Outline
- Managed care contracting: current legal trends
- Medicare and Medicaid managed care contracts
- Practical tips for negotiating key contract provisions
Benefits
The panel will review these and other essential questions:
- How have the changes in healthcare and the shift to Medicare and Medicaid impacted the negotiation of managed care agreements?
- What are some proven approaches for providers' counsel in negotiating favorable provisions in managed care contracts?
- What are the most commonly disputed issues during contract negotiations and practical approaches for resolving them?
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