Session 5
November 16, 2022
11:00 a.m. – 12:30 p.m., PT

Registration is now closed.

Overview

Under CalAIM, all Medi-Cal managed care plans will be required to begin operating a Dual-Eligible Special Needs Plan (D-SNP) by January 2026. Given the significant lead time needed for planning, development and implementation, the time is now for local plans to assess, analyze and evaluate their operational readiness. 

Join the LHPC Institute for a multi-part webinar series that will walk through many of the fundamental components of planning for, implementing and operating a D-SNP. Expert presenters, led by Athena Chapman and Khoa Nguyen, will share state and federal requirements, review upcoming timelines, offer lessons learned from the Coordinated Care Initiative (CCI) and Cal MediConnect (CMC), and discuss important operational considerations for local plans as work gets underway. Attendees will also gain insights and perspectives from fellow local plans with experience serving Medicare duals.

Who should attend:
Local health plan staff across all departments who will be involved in the planning, development, implementation and ongoing operation of the plan’s Dual-Eligible Special Needs Plan.

Sessions 1 & 2 Agendas

Session 1: D-SNP 101: A Primer for Medi-Cal Managed Care Plans
Oct. 12, 2022 | 11:00 a.m. – 1:00 p.m., PT 
Presenters: Athena Chapman; Anastasia Dodson, DHCS; Tiffany Huyenh-Cho, Justice in Aging; Kerry Branick & Gretchen Nye, Centers for Medicare & Medicaid Services

• D-SNPs — introduction and overview
• Medicare vs. Medicaid/Medi-Cal
• Overview of Medicare in California
• State and federal policies and requirements
• Lessons learned and best practices from Cal MediConnect 
• Medicare dual eligible overview and consumer experience
• Implementation resources and timelines for Medicare Medi-Cal Plan (MMP) D-SNPs

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Session 2: Medicare Covered Services, Care Management & the Model of Care
Oct. 26, 2022 | 11:00 a.m. – 12:30 p.m., PT 
Presenters: Khoa Nguyen; Heidi Arndt, Consultant; Dr. Chris Esguerra, Health Plan of San Mateo; and Steven Chang, Sr. Director Care Management, L.A. Care Health Plan

• Demographic profile and health status of California dual eligible beneficiaries
• Benefits and services that Medicare D-SNPs must cover, as well as optional services and interactions with Medi-Cal covered services
• Key elements of the Model of Care (MOC)

Sessions 3-5 Agendas

Session 3: Medicare Financing, the Bid Process, & Provider Network and Reimbursement
Nov. 2, 2022 | 11:00 a.m. – 12:30 p.m., PT 
Presenters: Khoa Nguyen; Mike Engelhardt, Health Management Associates; Keenan Freeman, Inland Empire Health Plan; and Trent Ehrgood, Health Plan of San Mateo

• Annual Medicare bid process — key timelines and materials to submit to CMS for review and approval each year
• How CMS pays Medicare Advantage health plans for each enrolled beneficiary — key components that can significantly impact financial feasibility
• Provider network adequacy requirements and reimbursement options — strategies to impact access and quality of care

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Session 4: Medicare STARS and Risk Adjustment
Nov. 9, 2022 | 11:00 a.m. – 12:30 p.m., PT 
Presenters: Khoa Nguyen; Heidi Arndt; Noreen Koizumi & Gabriela Rubalcava, Community Health Group; and Lyndsey Beets, Inland Empire Health Plan

• Medicare 5-Star quality rating system
  • Key measures and calculation methodology
  • How scores are used for marketing
  • Adjusting CMS payments to Medicare health plans
• Medicare risk adjustment program
  • Key program principles and methodology
  • Examples of how risk scores impact health plan revenue
• Potential challenges and opportunities for performance improvement

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Session 5: Member Outreach, Sales and Marketing, & Enrollment
Nov. 16, 2022 | 11:00 a.m. – 12:30 p.m., PT 
Presenters: Khoa Nguyen; Heidi Arndt; Chelsea Byom, Santa Clara Family Health Plan, Linda Lee, CalOptima; Lisa Steward & Luis Coronel, Inland Empire Health Plan

• Medicare communications and marketing guidelines for prospective and current enrollees
  • Key definitions
  • Examples of model marketing materials — Annual Notice of Change (ANOC) and integrated Medi-Cal-Medicare member materials
• Medicare enrollment options available to duals and health plan approaches for sales and marketing
  • Options for default enrollment
  • Use of agents or brokers
  • Role of the provider network

Faculty 

Athena Chapman
President
Chapman Consulting LLC

Khoa Nguyen
Chief Executive Officer
KN Consulting LLC

Heidi Arndt
Consultant

Lyndsey Beets
Quality Improvement Facilitator II
Inland Empire Health Plan

Kerry Branick
Deputy Director, CMS Medicare-Medicaid Coordination Office  
Centers for Medicare and Medicaid Services

Chelsea Byom
Vice President, Marketing, Communications & Outreach
Santa Clara Family Health Plan

Steven Chang
Sr. Director Care Management
L.A. Care Health Plan

Anastasia Dodson
Deputy Director, Office of Medicare Innovation and Integration
Department of Health Care Services 

Trent Ehrgood
Chief Financial Officer
Health Plan of San Mateo

Mike Engelhardt, MBA
Managing Director, Regional Managed Care Organizations
Health Management Associates

Chris Esguerra, MD
Chief Medical Officer
Health Plan of San Mateo

Tiffany Huyenh-Cho
Senior Staff Attorney
Justice in Aging 

Linda Lee
Executive Director of Medicare Programs
CalOptima

Gretchen Nye
Health Insurance Specialist
Centers for Medicare and Medicaid Services

Registration

NOTE: Health plan staff interested in participating should adhere to their respective plan’s process for LHPC Institute event registration where applicable.

Fees (per connection)
Session 1                                $90
Sessions 2-5                           $75 per webinar
Full series                               $350
Plan series registration^        $500
^ Select this option if plan staff will view the webinars communally on-site. Plans with multiple sites must register each site separately and identify whom at each site should receive the webinar access information upon registering. When registering, please enter unique email addresses for each additional site as the system may not allow duplicate logins.​​

Registration Confirmation: Registrants will receive two sets of emails — a registration confirmation email and separate emails that contain access information for the webinar(s). 

Participating in the Webinar: You will only need a computer with an updated web browser (Google Chrome, Microsoft Edge, Mozilla Firefox or Safari are recommended). Participants may opt to listen to the webinar via telephone or device. 

Cancellation Policy: Cancellation notification must be submitted in writing to institute@lhpc.org seven or more days prior to the course date. Refunds will not be given after that date. Substitutions are encouraged. Payment will be due for registered individuals that do not attend or participate in the event, and for which a cancellation notice is not received.