Legal and Ethical Issues In Managed Care
(Now available: the Summary Book from this seminar series)
All seminars are free for members of The Coalition of Voluntary Mental Health Agencies, Inc. and any agency in contract with the New York City Department of Mental Health, Mental Retardation and Alcoholism Services. For all others the seminars cost $100 each.
I. September 7, 1999
Topic: An Introduction to Managed Care Contracting for Behavioral Healthcare Providers
Overview: The seminar will provide a general outline to managed are contracting. Basic contract provisions will be examined including: responsibilities of the provider and the managed care organization (MCO); records; resource management; communication with clients; credentialing; payment and other general parts of the contract. The focus will be on assisting the provider in negotiating a contract with a managed care organization.
II. October 12, 1999
Topic A: Medical Necessity: How is it Defined and Who Decides What is Medically Necessary?
Topic B: Legislative Developments Relating to Mental Health Parity
Overview: This seminar will examine two important areas of concern to consumers and providers. Topic A will present the
concept of medical necessity and examine how it is put into practice and used to determine the level of service available to clients. Topic B will review developments in legislative efforts to accomplish parity between behavioral health and healthcare as it relates to coverage and payment.
III. November 9, 1999
Topic: Confidentiality, Communication and the Client in Managed Care Programs
Overview: The seminar will focus on the issues relating to confidentiality of clinical records and other information in a managed care environment. Presentation and discussion will focus on electronic records, managed care computer files, communication with managed care case managers, and communications with clients.
IV. December 7, 1999
Topic: Utilization Review and Resource Management: How to Use the MCO's Grievance and Appeals Process to Your Best Advantage
Overview: The seminar will outline utilization review and resource management processes in managed care and focus on appeals and grievance procedures.
V. January 11, 2000
Topic: Risk Sharing and Payment Mechanisms in Managed Care
Overview: This seminar will describe the various ways that managed care organizations share financial risk with providers. The focus will be on assisting providers to develop payment arrangements and choose among the different financial reimbursement mechanisms.
VI. February 8, 2000
Topic: Ethics and the Risk of Professional Misconduct and Malpractice
Overview: The seminar will examine selected issues relating to professional misconduct, malpractice and ethics in managed behavioral healthcare practice. The focus will be on models of risk management which help resolve ethical dilemmas and minimize risks to the clinician and provider.
VII. March 7, 2000
Topic: Federal and State Laws Which Impact on Providers in Managed Care
Overview: The seminar will focus on laws such as ERISA, Prompt Pay Laws and the New York State Managed Care Act that play a
significant part in how managed care organizations are structured and how they deal with providers and clients.
VIII. April 4, 2000
Topic: Patients' Bill of Rights
Overview: The seminar will review existing and proposed legislation at both the State and
Federal governments which related to consumer rights in managed care
All seminars will be held at the:
Community Service Society
105 East 22nd Street, Conference Room 4A
New York, NY 10010
Time: 9:30am - 12:30pm
The Legal Series will be presented by Lawrence K. W. Berg, Ph.D., Esq., a former Director of Mental Health, Mental Retardation and Alcoholism Services in Columbia County, N.Y. with over 20 years direct experience in the health, mental health and human services fields. Dr. Berg currently practices in the areas of Behavioral Health Law and Health Law, as well as in the areas of Disability and Elder Law.