Event

Medi-Cal Managed Care Finance 201: Inside the Rate-Setting Process
A deeper dive into the components, structure and implications of the rate-setting process

December 3, 2019
CalOptima
Orange

Registration is now closed.

Overview

The Medi-Cal managed care rate-setting process establishes the foundation on which local health plans provide services to 7.5 million Californians. How plans leverage this process can prove critical to their operational and financial success. 

Diving deeper into concepts introduced in the Medi-Cal Managed Care Finance 101 course, expert faculty will provide an in-depth look at the Medi-Cal managed care rate-setting process. Attendees will learn how rates are established, how the process is structured, the key components of the Rate Development Template (RDT) and implications for local plans’ day-to-day and strategic operations.

Topics for the course include:

  • Medi-Cal managed care rate-setting process — rate models, timeline and key players
  • A walkthrough of the RDT and how its elements play a critical role in plan operations
  • RDT data collection process and the important role of supplemental data requests
  • How your RDT submission sets the stage for rate negotiation with the State  
  • What may lie ahead for the rate-setting process  
  • And more …

*Note: The course is not designed to be a training on how to complete the RDT. The intent is to provide a closer look at the fundamental elements and considerations that factor into the RDT and the
rate-setting process as a whole.

Who should attend:
Plan staff working in finance, planning, data analytics, provider network, medical management and information technology. To get the most benefit from the course, interested individuals should have some level of knowledge and/or experience in plan financing, or perform functions that are connected to or impacted by plan financing.

Agenda

*May be subject to change

9:30 a.m. – Noon

The Rate Development Process: Context and Overview

  • Review of the rate-setting process — purpose, key players and their roles
  • Rate-setting environment for DHCS and plans
  • Overview of the different rate models
  • Role of risk adjustment, efficiency adjustments and countywide averaging in the rate model construct

Inside the Rate Development Black Box

  • Understanding the RDT — a walkthrough of key components, timelines
  • Data used in the rate development process and how it’s collected
  • Supplemental data requests — what they are and why they’re important

Noon – 1:00 p.m. | Hosted Luncheon

1:00 – 4:00 p.m.

Operational Implications & Revenue Maximization Strategy

  • How the organization as a whole can (and should) work to support the RDT process
  • The RDT and implications for plan operations
  • Using the RDT as a basis for rate negotiation with the State

Understanding Non-Federal Matching Revenue Streams

  • Identifying non-federal revenue streams and plans’ responsibilities under each program
    • Directed payments
    • Intergovernmental Transfers (IGTs)
    • Certified Public Expenditures (CPEs)
    • Provider and plan taxes/fees
  • How counties and plans are using these programs
  • Implications for plan revenue strategies

Site

CalOptima
505 City Parkway West
Orange, CA 92868

For attendees who will require overnight accommodations, discounted rooms are available at the DoubleTree by Hilton Hotel Anaheim – Orange County:

DoubleTree by Hilton Hotel Anaheim – Orange County:
100 The City Drive
Orange, CA 92868
(714) 634-4500
Note: To receive the discounted rate, mention CalOptima when booking.

Faculty

Meredith Wurden
Wurden Consulting


Meredith Wurden most recently served as the Director of Policy and Fiscal Strategy at Partnership HealthPlan of California where she was responsible for fiscal policy development and communication. Prior to joining PHC, Meredith worked for the state of California for nearly ten years. She also previously served as Assistant Deputy Director of Health Care Financing at the California Department of Health Care Services and with the California State Legislature covering health issues, including as a principal fiscal and policy analyst for the non-partisan California Legislative Analyst’s Office and as Deputy Director at the California Senate Office of Research. Meredith also worked at the federal Government Accountability Office.

Jonathan Freedman
Vice President
Health Management Associates


Jonathan Freedman works with plans, providers, associations, and governmental and non-governmental entities in the areas of public health, safety net health care, and public policy. His work focuses on strategic planning, public health improvement and transformation, and the health care safety net. Prior to joining HMA, Mr. Freedman held a variety of management and leadership roles at L.A. Care Health Plan and with the County of Los Angeles, and led a number of high-profile health- and health care-related initiatives.

Keenan Freeman
Chief Financial Officer
Inland Empire Health Plan


Keenan Freeman joined Inland Empire Health Plan (IEHP) as Chief Financial Officer in 2016. With nearly 30 years of professional finance experience, Mr. Freeman is responsible for the overall financial management of IEHP, its financial reporting and transparency, and for multiple plan financial functions including accounting, purchasing, capitation, cost recovery, risk management, and the coordination of fiscal and other operational audits.

Registration

Registration is now closed.

Registration Fees: $21.59 per registrant

Registration Details: The course will accommodate up to 80 participants. Each plan may elect to send no more than five (5) participants. If more than five individuals from a plan are interested in attending, they are encouraged to sign up for the waitlist. Waitlisted individuals will be admitted should space become available.

Registration Deadline: Registration closes Nov. 22 at 5:00 p.m. or once capacity is reached.

Registration Confirmation: Registrants will receive an email notification confirming their registration.

Special Accommodations: Please contact the LHPC Institute at institute@lhpc.org should you require special accommodations pursuant to the Americans with Disabilities Act.

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.