Federal Law Governing Medicare Advantage Plans and Medicaid Managed Care Plans

Medicare Advantage Plans (“MAPs”) and Medicaid Managed Care Plans (“MMCPs”) have become an important part of the lives of DME suppliers. Approximately 70% of Medicaid patients are covered by MMCPs, while approximately 39% of Medicare beneficiaries are covered by MAPs. These percentages will continue to increase. Working with MAPs/MMCPs is frustrating for suppliers. MAPs/MMCPs are heavy handed on a number of fronts. And so DME suppliers quite naturally ask what the federal laws are that govern MAPs/MMCPs. On the one hand, federal laws governing MAPs/MMCPs are quite extensive. However, only a small portion of the federal laws pertain to the relationship between the MAPs/MMCPs and the providers/suppliers that serve the patients covered by the plans. Much of the law is aimed to (i) protect covered lives and (ii) set minimum requirements for coverage, networks, complex reimbursement mechanisms. This program will discuss the federal laws that govern MAPs and MMCPs. Equally as important, this presentation will discuss how these laws affect DME suppliers as they provide services to patients covered by MAPs and MMCPs.
Learning Objectives:
1. The attendee will be able to discuss the laws and other regulatory guidance applicable to MAP and MMCPs.
2. The attendee will be able to describe a supplier’s rights and responsibilities under a MAP and MMCP
3. The attendee will better understand how to work with MAPs and MMCPs.