January 27, 2020
9:30 a.m. – 4:30 p.m.
The California Endowment
Sacramento

Registration is now closed.

Overview

Effective January 2021, the Department of Health Care Services will be carving in coverage of long-term care (LTC) — including skilled-nursing facilities, subacute facilities, pediatric subacute facilities and intermediate care facilities — to all managed care health plans. For plans that will newly manage the LTC benefit, thoughtful planning and preparation will be key to successful implementation.  

Taking on a new benefit is a complex and challenging task. This day-long seminar will provide the opportunity to learn from seasoned local plan leaders and industry experts who will present the critical elements of implementation, and share best practices and insights from their lessons learned in building a new LTC benefit. Attendees will take away important information and guidance to help inform plan strategies and approaches for implementing and administering the LTC benefit.

Designed specifically for local health plans that are newly acquiring the LTC benefit, the program will include discussion on the following topics:

• Developing and maintaining an LTC network
• Managing the LTC benefit
• Operational readiness
• Areas of concern and best practices
• And more …

Who should attend:
Staff from local health plans that are newly acquiring the LTC benefit and who will be participating in the implementation and ongoing operation of the benefit — particularly those who are part of contracting, provider relations, medical management and claims teams. 

Agenda

*May be subject to change

9:30 a.m. – Noon

Overview of the LTC Benefit

• What’s included in the benefit — services, types of facilities, levels of care
• Who’s eligible for the benefit and what issues may arise
• Managing members’ care
• Implications for health plans — financial, operational
• Challenges and opportunities for health plans

Developing & Maintaining Your LTC Provider Network

• Building a provider network and contracting considerations
  • Who are the impacted providers and what services do they offer?
  • Engaging prospective providers
  • What to consider when contracting with providers
  • Contracting mechanics
  • Provider training
• Maintaining and working with your network
  • Curating strong working relationships with providers
  • Ongoing provider training
  • Critical issues — billing and reimbursement, disputes 
• Developing and refining your capacity
  • Partnerships with provider facilities
  • Strategies for supporting member management

Noon – 1:00 p.m. | Hosted Luncheon

1:00 – 4:30 p.m.

Managing the Benefit & Member Care

• What to do before day one — identifying members and their needs, Treatment Authorization Request (TAR) process
• Utilization management (UM) requirements — criteria, time frames and more
• Claims — key components of a successful claims process
• Care management issues — institutionalized members, transitions of care

Operational Areas of Concern & Best Practices

• Areas of concern — eligibility issues, claims payment, transitions of care, provider transitions
• Reporting and monitoring — UM, quality, claims, compliance

Ask the Experts: Strategies for Implementation

• Structuring an implementation team 
• Key tasks and milestones
• Helpful lessons learned to consider in your planning

Faculty

Judy Cua-Razonable
Director, MLTSS
L.A. Care Health Plan

Donna Garrison, RN
UM, DC Planning Nurse, Long-Term Services and Supports
Santa Clara Family Health Plan

Donna Garrison is a Utilization Management and Discharge Planning Nurse at Santa Clara Family Health Plan (SCFHP) on the Long-Term Services and Supports (LTSS) team. In this role, Donna serves as the clinical liaison between skilled-nursing facilities and SCFHP’s internal departments. Donna works to assist providers and members with utilization management and safely transitions SCFHP members out of long-term care and into the community. She brings more than 25 years of experience as a Registered Nurse in the acute, sub-acute and skilled-nursing settings. 

Bradley Gilbert, MD
Consultant and former CEO of Inland Empire Health Plan

Dr. Bradley Gilbert has more than 30 years of experience in public health and managed care leadership. He most recently served as Chief Executive Officer at Inland Empire Health Plan (IEHP), a managed care plan serving 1.24 million members in California’s Riverside and San Bernardino Counties. Prior to IEHP, Dr. Gilbert served as the Director of Public Health/Health Officer for San Mateo and Riverside Counties, leading positive changes for public health care in those communities. He also has clinical and leadership experience in jail medicine and substance use disorder treatment center, as well as with Kaiser Permanente and private practice.

Richard Golfin, III
Compliance & Privacy Officer
CenCal Health

Richard currently serves as Compliance & Privacy Officer at CenCal Health/Santa Barbara San Luis Obispo Regional Health Authority. Most recently, Richard served as the Director of Delegation Oversight at Molina Healthcare of California, where he managed delegation to First-Tier and Downstream Related Entities across California in Medicaid and Medicare State Sponsored Programs, and the California Health Exchange. Richard is a lifelong teacher and learner, having served on the faculty in the College of Political Science at Ashford University, and as guest lecturer at the University of Southern California, Sol Price School of Public Policy. Richard is a sought after public speaker on health care compliance, delegation and public integrated delivery systems. Richard is committed to the fulfillment and successes of national public health initiatives, and honored by the opportunity to serve and provide Californians quality health care and improved access to services in Safety Net programs.

Peggy Hoover, RN
Senior Director, Health Services
Partnership HealthPlan of California

Peggy Hoover is a Registered Nurse with over 35 years of experience as an administrator in the managed care industry and in medical, surgical and pediatric nursing. As Senior Director of Health Services at Partnership HealthPlan of California (PHC), she is responsible for development and administrative oversight of PHC’s Care Coordination, Utilization Management and Cultural, Linguistics, and Health Education programs. Her leadership was instrumental in the preparation and success of the Health Services program through three PHC geographical expansions – from just three counties to a current 14-county service area. Most recently, she led PHC’s implementation of the Whole Child Model, the state-mandated transition of the provision of California Children’s Services care to designated managed care plans.

Samantha Huang
Manager, Provider Contracting Service Team
Inland Empire Health Plan

Samantha Huang manages the Provider Contracting Service Team within the Network Operations division of Inland Empire Health Plan. Samantha and her team are responsible for management and maintenance of the ancillary providers network, which includes but is not limited to hospitals, SNFs, DME and Home Health. The Team develops training materials, facilitates training and supports all ancillary provider needs. Samantha also oversees provider-initiated claim review requests and claim special projects. Samantha has 19 years of health care experience with both commercial and Medicaid plans, ranging from UM to provider services and contracting.

Alma Palafox
Director of Claims Administration
Community Health Group

Alma Palafox is the Director of Claims Administration at Community Health Group (CHG) and has nearly 15 years of experience in the health care industry on both the provider and health plan side. Prior to her work at CHG, Alma served in the hospital setting in the revenue cycle department where she worked on billing and reimbursement issues. She has experience in both the Medi-Cal and Medicare lines of business.

Irene Walsh
Provider Network Associate
Santa Clara Family Health Plan

Irene Walsh is a Provider Network Associate at Santa Clara Family Health Plan (SCFHP) and is part of the Long-Term Services and Supports (LTSS) team. In this capacity, she serves as the primary liaison between skilled nursing facilities, SCFHP internal departments and community partners. She offers LTSS providers support with operations, provider relations, troubleshooting and outreach. Irene brings more than 25 years of experience in health plan operations, quality, training and program development.

Site

The California Endowment
1414 K Street, Suite 100
Sacramento, CA 95814

Registration

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

Registration Fees: $30 per registrant

Registration Details: The course will accommodate up to 70 participants. Each invited plan may elect to send 11 participants. If more than 11 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 Jan. 22 at 5:00 p.m. or once capacity is reached.

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

Presentation Materials: Presentation materials will be made available electronically only via the program resource web page that will be provided to confirmed registrants. Attendees are encouraged to download the materials in advance to their mobile device or print a copy to bring to the event. 

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.