Description: Similar to how states had made adjustments to their capitation rates to reflect acuity adjustments caused by the onset of the pandemic, states will need to modify the rates to reflect the unwinding since utilization patterns and average acuity per enrolled member will change. When the continuous coverage requirements set forth by the COVID-19 Public Health Emergency (PHE) ended, Medicaid-managed care programs across the country adopted various approaches to phasing out maintenance of effort (MOE) as a result of changes to the PHE-era continuous eligibility requirements. Phasing out the MOE requirement will ultimately result in members who no longer meet eligibility requirements losing their Medicaid coverage. Further, states are facing a wide variety of circumstances and are implementing diverse approaches to the MOE phase-out. This topic will be of significant interest to all actuaries and stakeholders of the capitation rate development process for Medicaid-managed care programs. Join us as we discuss the operationalization of the PHE unwind while referencing the SOA's research project which models the effects of the unwinding on Medicaid eligibility and population costs. You will learn about the various approaches that different states have adopted to manage the unwinding process, which will be instrumental for accurately pricing managed care rates.

Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: Help consumers understand their rights in health care and understand how technology is embedded into the health care industry. On top of that, you will also hear about topics related to professionalism. During this webcast, you will learn about: ▪ An overview of the health insurance market ▪ Health care provider billing and contracting ▪ Recent trends with insurers and health care providers ▪ Identify areas of excessive billing and fraud ▪ The impacts of technology on billing practices ▪ An understanding pharmacy benefits, including discounts and rebates

Description: "Informal caregiving is far more costly than many people realize. And not just in the immediate future. Current demographic trends suggest that caregiving will become even more necessary and costly as the Baby Boomers continue to age and require more support and services. In 2022, the SOA engaged Milliman, Inc. to conduct an analysis of the need for informal caregiving and its impacts on employees, employers, and other stakeholders. The purpose of this research was to educate stakeholders, policymakers, and other interested parties on the realm of informal caregiving, as well as how the challenges associated with providing informal care of all kinds might be addressed. Discover key findings and themes from the research project, as well as stories highlighting the various forms this role can take, and solutions currently being developed around the country. An open discussion on ways our profession can impact this growing need with the work we do every day in our respective roles will also be included."

Description: Explore the findings from the research paper recently released by Milliman and the SOA, highlighting the growing need for support of informal/family caregivers. We will discuss both quantitative and qualitative data that illustrates not only the cost and burgeoning need, but the mental/emotional stressors that come along with this work.

Description: While states face a wide variety of circumstances and have implemented diverse approaches to the MOE phase-out, we revisit the conversation to discuss emerging experience across stakeholders as we examine the operationalization of the PHE unwinding as it relates to this major disruptor in the distribution of the healthcare enrollment.

Description: The SOA has been interested in financing of long term care for many years. As part of this interest, they approved a state-based research effort in the chosen location of Minnesota. Join authors of the research as they present their findings . The research effort looked at stakeholder responses in Minnesota to several designs that would create a state-based catastrophic long-term care insurance program. The conceptual work was based on efforts by Cohen, Feder and Favreault using the DYNASIM model created by the Urban Institute. Catastrophic coverage would be provided after a variable waiting period based on income. Private resources, including long-term care insurance, would be expected to cover the front end. (Persons on Medicaid would continue to have their gap coverage provided by that program).

Description: The regulatory and market dynamics of the ACA's second decade are more predicable than the first. Come hear the latest information from industry experts on the emerging trends in ACA marketplaces. You'll also discover an understanding about emerging federal and state policy that will have pricing and financial implications. Finally, you'll get to learn what actuaries need to know to be well prepared for actuarial practice in the ACA's second decade. Key learning objectives include: - Comprehending the historical dynamics in the ACA's first decade which will shape the future - Understanding the changing national premium landscape for 2024, the 11th year of ACA marketplaces - Having a strong grasp on how the ACA's second decade will differ from the first from an actuarial perspective

Description: "During the pandemic there has been provider burn out, early retirement, hospital consolidation, and lack of staff in step down facilities. It is taking longer to get appointments. Take a look at the impacts of this andat how this can affect quality ratings in Medicare. You can also explore meeting quality incentives in Medicaid and how the current requirements for these plan to say they have adequate networks. Will the provider shortage have an effect upon actuarial rate certifications? If so, how? Are there any forecasts for how long this shortage will last? What are the impacts to care giving to the Seniors and Medicaid beneficiaries as well as plan design changes? Those who are intermediate level Medicaid and Medicare actuaries are encouraged to attend. By attending this session, you will be able to: Have a good understanding of the current Medicare and Medicaid situation and its impacts Understand strategic ideas of how to keep quality of care and access to care available"

Description: As we entered 2014, actuaries became familiar with three risk stabilizing mechanisms in the early years of the ACA marketplaces, colloquially known as 'the 3Rs'. As we enter 2024, there is renewed focus on rating compliance and risk adjustment. Speakers will highlight pricing considerations when determining cost-sharing reduction premium loads as well as related issues pertaining to risk adjustment and metal tier pricing.