Participation agreements with Managed Care Organizations (MCOs) overwhelmingly favor the MCO, not the provider of services. Even when an MCO offers reasonable payment terms, standard provisions found in a participation agreement typically permit an MCO to recoup payments made to a provider without notice, force a provider to accept low reimbursement levels in one product as a condition of participation in another, permit MCOs to unilaterally amend the contracts without obtaining the provider’s consent, and implement claims processing practices that deny timely payments for services, including short timeframes for submitting claims, denials of claims without sufficient explanation, and delayed payments.

Many health centers and behavioral health agencies mistakenly believe that they lack leverage with the MCOs to negotiate fair provisions in their participation agreements, overlooking legal protections available under state and federal law. In addition, many health centers and behavioral health agencies fail to position themselves to participate under value-based payment arrangements with MCOs, foregoing potential revenues streams.

This workshop is designed to assist health centers and behavioral health agencies negotiate favorable participation agreements with MCOs. FTLF attorneys will cover topics, including:

• Preparing for contract negotiations by identifying and assessing potential leverage points, such as regulatory leverage, market power, and competing on value;
• Evaluating managed care contracts using a team-based approach, considering an MCO’s operational and financial stability;
• Negotiating strategies and tips to make the most persuasive case;
• Federal laws and regulations that apply to payments to Federally Qualified Health Centers and to disclosures of confidential health information. 

Please Note: Attendance is limited to a small group of organizations to encourage discussion and focus on the exchange of ideas.