Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

Description: Learn more about recent updates to the Bermuda Market and how this may impact current and future market players. This session will cover the Bermuda reserving and capital requirements and how the recent Bermuda Consultation Paper may impact the industry. At the end of the session, you will have a better understanding of the status of the proposed changes, the implications and general observation of the industry reactions.

Description: This is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: Centers for Medicare & Medicaid Services (CMS) launched the GUIDE model, which represents a significant step forward in improving dementia care nationwide. Those with deep expertise in dementia recognize that family caregivers are the most powerful frontline defense to improve care for people living with dementia. It is thus not surprising that the GUIDE model specifically requires the inclusion of the family caregiver in the care team.

Description: In this session, we will address the current landscape of the standalone Medicare Part D market and the challenges to its sustainability. Specifically, we will discuss some headwinds for plan sponsors due to the Inflation Reduction Act and future considerations for prescription drug plan (PDP) benefit design and pricing.

Description: The article describes the sessions that the SIPF section sponsored - Paid Family Leave and Medicare and Medicaid Update. The Paid Family Leave session described what it is and what states it is currently in and how it is being implemented. The Medicare and Medicaid update gave the attendees the most up to date news about what is going on at the Federal level.

Description: In this session, participate in a mock negotiation of a typical value based contract taking on the role of either provider or payer and solving for the various negotiation challenges, objections, risk mitigations, data requirements, etc. from either party. Attendees will learn best practices and ideal tools and workflows to engage in when supporting VBC negotiations and gain insights into the typical challenges to equitable and agreeable terms.

Description: The 2020 ERISA Advisory Council of the Department of Labor had a project on Considerations for Recognizing and Addressing Participants with Diminished Capacity. I delivered testimony to the ERSIA Advisory Council on this topic in September 2020. This article summarizes some key points from the testimony and also offers ideas for how employers can help employees and retirees deal with these issues. There are two different audiences that employers deal with as a result of diminished capacity – the individuals whose capacity is diminished, and those who help them.

Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

Description: The cell and gene therapy marketplace is quickly evolving and continues to grow as a risk concern for governments, health plans, stop loss insurers and reinsurers. In this webinar, we discuss currently approved tissue, cell and gene therapies, the near-term pipeline, uptake considerations, case management processes, plan document and contract considerations, risk mitigation processes and programs, and network considerations.