Ohio Association of Rehabilitation Facilities

Presents

Managing Medicaid Managed Care in Physical Medicine & Rehab

Mt. Carmel East Siegle Center for Continuing Education
Columbus, Ohio

Friday, April 27, 2007
9:00 am – 4:00 pm

5. 25 Continuing Education Credits Available

Presenters From
Medicaid Office/Bureau of Managed Health Care, Ohio Dept of Job & Family Services
Ohio Association of Health Care Plans
Medicaid Managed Care Plan Providers (Insurance Companies)

MMC Plan Provider Relations Information Booths

Who Should Attend
PM & Rehab Directors & Managers
Physical, Occupational and Speech Therapists
Admissions Staff
Billing Department Staff

SCHEDULE

Friday, April 27, 2007

9:00 am – 9:45 am
Registration Open

9:00 am – 9:45 am
Continental Breakfast

9:45 am – 12:00 pm
Morning Session

Medicaid Office, ODJFS
Kelly McGivern, President & CEO, Ohio Association of Health Plans

Overview of Medicaid
History of Managed Care
Background
Where we are now
How it works

Prompt Pay Law Review
Enrollment
Who's in, Who's Out
State Contracts with Health Plans
Care Management
How the Benefits Work

2008-2009 Forecast –-Medicaid expansion? Reduction? State Budget?

12:00 pm – 12:45 pm
Lunch on Your Own

12:45 pm – 4:00 pm
Afternoon Session

Ohio Health Plans Panel Discussion (All Eight Invited)
AMERIGROUP Ohio
Anthem
Buckeye Community Health Plans
CareSource
Molina Healthcare of Ohio
Paramount Advantage
Unison Health Plan of Ohio
WellCare of Ohio

Admissions – What are the Steps?
Prior Authorization/Pre-Certification Process for Acute, Skilled, Outpatient
Recertification Process for Acute, Skilled, Outpatient
How to Get Through a Recertification
Care Management
Case Management
Submitting Claims
Claims Processing
What Gets Paid for Relative to Various Levels of Care?
How are Claims Paid?
Frequently Cited Denials and How to Avoid
Appeals Process

2:45 pm – 3:00 pm
Break

3:00 pm – 4:00 pm
Question/Answer Period

ABOUT THE PRESENTERS

Christiane Pepe, ODJFS Bureau of Managed Health Care (Medicaid), holds Master of Gerontological Program Administration from Miami University, Oxford, Ohio, and a Master of Social Work from The Ohio State University. She has served as an Ohio Medicaid administrator since 2003, implementing aged, blind and disabled community programs. She previously administered nursing home and home care services for older adults, Medicare Advantage programs for United HealthCare of Ohio and Anthem Blue Cross/Blue Shield and served as a member of the full-time research staff at Miami University's Scripps Gerontology Center. Pepe recently joined the Bureau of Managed Health Care, and leads the Program Research and Provider Support unit.

Rafiat Eshett, MPA, ODJFS Bureau of Managed Health Care (Medicaid), is a senior program administrator in the Regulatory Unit, Contract Administration Section. Eshett has 23 years experience working with the ODJFS with approximately 13 years experience working on Medicaid managed care programs. She currently leads the Regulatory Unit which is responsible for contract development, production of consumer guides, the oversight of federal and state requirements to assure managed care program compliance and the intake and resolution of provider complaints. Prior to her current position, Eshett worked on care management initiatives and Medicaid programs related to home and community based waivers, transportation and mental health. Eshett received a bachelor's degree in Urban Planning from Michigan State University, East Lansing and a Masters in Public Administration degree from The Ohio State University, Columbus, Ohio.

Kelly McGivernis the president and chief executive officer of the Ohio Association of Health Plans and has served in this capacity since January 2000. OAHP is the statewide trade association dedicated to advocating access to a variety of affordable health care benefits for all consumers in Ohio. The association was founded in 1980 and represents health insurance companies that provide health care benefits to over six million Ohioans. In this role, she is responsible for overseeing the operations of the association, which include organizing lobbying and regulatory efforts on issues of importance to the health insurance industry. McGivern previously served as a government affairs executive with the Ohio Chamber of Commerce for eight years. In this capacity she was responsible for formulating legislative positions on behalf of Ohio's business community and advocating on behalf of the 6,000 member businesses. Mrs. McGivern began her career in politics in the Ohio Senate where she served as a legislative assistant to then Senator Gary C. Suhadolnik, who chaired the Senate Energy, Natural Resources and Environment Committee and the Senate Insurance, Commerce and Labor Committee.

OVERVIEW

Target Audience
Physical Medicine & Rehab Departments/Hospital and Free Standing Facilities, VPs, Therapy Managers, Physical & Occupational Therapist, Speech Therapists, Admissions, Registration, and Billers

Focus Area
Medicaid Managed Care Process ("Ins and Outs")
Payments for Rehab Services and Reimbursement Process and How to Avoid Denials

Exhibits
MMC exhibits will be staffed with provider relations representatives.

Sponsorship and Exhibit Opportunities
Sponsoring and exhibiting are opportunities to build relationship while marketing your company to a highly targeted audience of rehabilitation facility professionals. Opportunities to sponsor and exhibit are still available. Call the OARF Executive Office at (614) 221-9933.

ADMINISTRATIVE INFORMATION

Continuing Education Credits
Approval by Occupational Therapy Section of the OT/PT/AT Board for Occupational Therapists: 5.25 CEUs pending
Approval by Ohio PT Association for Physical Therapists: 5.25 CEUs pending

Certificated of attendance will be distributed at the conclusion of the seminar for paid participants only.

Cancellation & Refund Policy
Registration cancellations prior to April 15, 2007 will incur no penalty. Cancellations from April 15 – April 22 are subject to a $25.00 cancellation fee. Cancellation notices must be sent in writing to the OARF Executive Office. No refunds will be made on cancellations made after April 22 due to committed funds and forfeited fees cannot be applied to future meetings due to IRS reporting requirements.

Substitutions from within the same organization are permitted at no additional cost if received by April 15. All substitutions must be in writing and accompanied by a completed registration form.

Americans with Disabilities Act
The facility complies with the provisions of ADA. If you need additional assistance, please contact the OARF at least 14 days in advance.

Disclaimer
If OARF cannot hold the 2007 Seminar Series meeting due to acts of God, war, government regulations, disaster, civil disorder or curtailment of transportation facilitating other emergencies making it inadvisable, illegal, or impossible to provide the facilities or to hold the meeting, each prepaid attendee will receive a copy of the annual seminar handouts and any other materials that would have been distributed. Fixed seminar expenses will be paid from the pre-registration funds. Remaining funds will be refunded to pre-registrants. OARF is not responsible for any other costs incurred by pre-registrants in connection with the seminar.

The views and opinions expressed by presenters are their own and do not necessarily represent those of OARF. OARF disclaims any responsibility for the use and application of information presented at this meeting.

SEMINAR LOCATION

Mt. Carmel East Siegel Center for Continuing Education Auditorium
6100 E. Broad Street
Columbus, Ohio
(614) 234-6000

Hotel Options
The following is a link Columbus area hotels for overnight accommodations while attending the seminar:

http://columbus.citysearch.com/find/section/columbus/hotels_visitors.html

Directions
Mount Carmel East is located on Columbus' east side, at the intersection of E. Broad Street and I-270.

Take I-270 to Exit 39
Take eastbound exit towards Newark
Turn right at the first traffic light (Hart Lane)

Parking
All parking is free.

REGISTRATION

Registration Fees

Registration fee includes training materials, continental breakfast, and beverage breaks for each participant.

The preferred method for registration is the online secured registration form on tihs website. Registrations will be accepted on the official registration form only. Photocopies of the form are acceptable. Acceptable methods of payment are check, money order, MasterCard, or VISA. No purchase orders accepted. Registrations must be pre-paid.

A confirmation of registration will be sent upon receipt of the paid registration. Registrations will be accepted on a first-come, first-serve basis and the seminar may sell-out at any time. Therefore, we highly encourage you to confirm your registration with OARF before making travel arrangements.

Registration Fees

On or Before April 15

(Early Fee)

After April 15

(Regular Fee)

OARF Member

$175 Per Person

$200 Per Person

Non Member

$225 Per Person

$250 Per Person

To Register

Online

$$Link|https://www.tcslabs2.com/cgi-bin/PRIMA/tcsPRIMA2.pl?Action=DisplayUserMenu&UID=OARF,65439|Secured Online Registration|0$$

STEP 1: Registering online is easy! On the Login page, either Login using your email address and password OR select Need to set up a new account? and enter your email address and click Login. From that page, create your account by entering your Login & Password Information, Contact Information, and communication preferences. For first time registrants, once you completed that information, you will be directed to the User Menu. For returning members and registrants, select the Menu Item: Register for an Upcoming Event.

STEP 2: To register, you will only need to access #2 of the menu items - Register for an Upcoming Event. Use this link toregister for upcoming events. Click on Managing Medicaid Managed Care in Physical Medicine & Rehab Seminar to register for the event.

Step 3: At the bottom of Step 2 you will have the option to register an additional attendee or add a spouse/guest. If you select this option, you will be routed to Step 2 again to add another person. Once you have added all additional individuals, you will be routed to Step 4.

Step 4: You will be shown a receipt stating the event(s) you selected, as well as your fees. The fees shown are according to your membership status, i.e. member/non-member, etc. If you register after the early registration deadline, your total shown will be the regular registration fee.

Fax
If you are paying for your registration with a credit card, fax the registration with payment information to (614) 221-2335. Click $$Link|http://209.235.219.116/content/forms/OARF_brochure.pdf|here|0$$ to download the registration form (PDF, 236k).

Mail
Send your completed registration form with payment to:

OARF Payment Processing Center
PO Box 71-4559
Columbus, OH 43271-4559

Contact OARF at (614) 221-9933 with questions.