Q: Your team recently attended and presented at the Medicaid Innovations conference in Orlando. What was a hot topic there?

A: At this conference and others we’ve attended recently, “operational compliance” is a buzzword we’ve heard a lot.

Historically, health plans’ compliance departments and operations departments have functioned as two separate entities, often in silos. “Operational compliance” supports the idea that compliance should be a functional part of operations, especially when it comes to quality oversight dictated by CMS. The industry is anxiously awaiting CMS’s release of new guidance in the form of a Medicaid Managed Care Manual, for which many health plans are not prepared.

This ties directly to the panel on which I presented, along with Cody Consulting’s Brad Boyer, Mike Turrell, CEO of Ultimate Health Plans, and Ray Hanley, President and CEO of Arkansas Foundation for Medical Care. Our topic, “Federal Government Oversight of Medicaid at the State Level and How Health Plans Can Prepare,” addressed the direction regulators are headed with Medicaid oversight from CMS and how to plan for that.

Deb Mabari, CEO & Founder