Medicare Advantage Plan

AHA Conference Call Series

General Education Sessions

Session 1 – Background and Fundamentals  -- This session provided a grounding for the Medicare Advantage (MA) series.  It reviewed the history of Medicare managed care, types of MA plans, and the basics of MA payment, regulatory requirements and beneficiary protections.

Session 2 – Payment Issues for Providers  -- This session reviewed changes in how MA plans are being paid (such as competitive bidding, risk adjustment, and special payments for some MA plans) and the implications for providers.

Session 3 – Regulatory Issues for Providers -- This session reviews MA regulatory provisions that have special significance for providers, especially in sorting out the issues that need to be addressed through contracting.  Issues examined included Regional PPOs and Private-Fee-For Service plans, network issues, beneficiary notice requirements, and more.

Issues Unique to Small or Rural Providers

It is expected that MA plans will be available in many parts of the country for the first time, especially rural areas. Issues included those affecting “essential hospitals” and  “critical access hospitals”, payment considerations, and other matters specific to rural or small providers.

 

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