Handouts

Monday, December 8

8:30 – 9:30 am
General Session: Hot Topics from the Centers for Medicare and Medicaid Services
Kim Brandt, Director of Program Integrity,
Centers for Medicare & Medicaid Services

Handout

9:45 – 10:45 am
Linking Compliance and Performance: How Part D Quality Measures Relate to Plan Performance?
Cynthia Tudor, Medicare Drug Benefit Group, Centers for Medicare & Medicaid Services

Handout

• Examine CMS’ process for quality measurement and
  plan monitoring
• Identify trends in quality measurement over time
• Address CMS’ monitoring protocol
• Identify possible changes in CMS’ measurement and
  monitoring processes

11:00 am – Noon
Breakout Sesions

101 Beneficiary Complaints: How to Respond to Appeals, Grievances, and Redeterminations
Thomas Delegram, Deloitte & Touche LLP
John Valenta, Senior Manager Health Sciences, Regulatory & Capital Markets Consulting, Deloitte & Touche, LLP

Handout

• Gain a detailed understanding the Medicare Part D Appeals & Grievances process as well as other processes related to Part D Plan Sponsors’ responsibilities in responding to beneficiary complaints
• Gain a detailed understanding of the CMS Medicare Advantage (MA), MA-PD and PDP Audit Guide data elements related to Appeals & Grievances, Determinations and Redeterminations
• Developing a detailed understanding of the Medicare Part D Reporting Requirements related to Appeals & Grievances, Determinations and Redeterminations

102 Fraud, Waste and Abuse: Medic Reporting
Brian Ripes, Director of Compliance Operations, CVS
Caremark

Handout

• Responding to MEDIC Requests
• MEDIC Referrals
• Recommended Best Practices

12:00 – 1:00 pm
Networking Lunch

1:00 – 2:00 pm
Breakout Sesions

201 Marketing Brokers & Agents
Bob Rabecs, Counsel, Hogan & Hartson LLP

Handout

• CMS requirements for marketing of Part D plans
• Problems identified by CMS
• Increased scrutiny and recent developments
• Plan oversight and education of brokers

202 Employer Group vs. Individual Plan Issues
Amy Hafey, Senior Counsel, Legal and Government Relations, Kaiser Permanente
Robert Raffel, Director, Group Medicare Sales and Account Management, Kaiser Permanente
Sheila Rankin, Vice President, National Medicare Administration, Kaiser Permanente

Handout

• Application of CMS rules and guidance
• Employer group issues related to low income subsidy
• Creditable coverage
• Part C reporting requirements and group market
• Retiree drug subsidy
• Employer’s perspective

2:15 – 3:15 pm
Breakout Sesions

301 Integrating Internal Auditing and Compliance in the Medicare Part D Environment
Scott Robinson, Senior Internal Auditor, CareFirst BlueCross BlueShield

Handout

• Internal Audit and Compliance: a cooperative effort
• Two years into the program: knowing what your greatest challenges are
• Prioritizing audits
• Remaining flexible enough to re-prioritize as issues arise

302 Price/Program Transparency
Dorothy DeAngelis, Managing Director, Huron Consulting Group

Handout

• Learn CMS and OIG audit plans related to ensuring Part D program price transparency
• Learn how your plan can protect itself by conducting proactive audits of key business partners (PBMs, Pharma manufacturers, and pharmacies)
• Obtain insights on important new CMS guidance regarding Part D drug cost reporting and audit ramifications

3:30 pm – 4:30pm
Breakout Sesions

401 What Plan Sponsors Need to Know about Pass‑Through PBM Contracting
Lori Sanchez, Account Executive, The Burchfield Group
Greg Bigwood, Consultant, The Burchfield Group, St. Paul, MN

Handout

• Business and oversight implications of pass-through and traditional (“lock-in”) PBM arrangements
• Contracting strategies and the associated audit and oversight requirements
• General PBM oversight requirements, including Fraud, Waste and Abuse

402 CMS Audit Readiness
Brian Ripes, Director of Compliance Operations, CVS Caremark

Handout

• Preparing for a CMS audit.
• Overview of the CMS audit process
• Best practices

4:30 – 6:00 pm
Networking Reception