Complimentary Webinar Series Highlights Key Regulatory Trends Impacting Medical Management

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Annapolis, MD / PRWeb / March 22, 2016 – RegQuest™, one of the nation’s premier online regulatory compliance resources focusing on medical management and insurance functions, is sponsoring a three-part webinar series that will offer participants informative and insightful guidance on the transformation of medical management programs and regulations and explore key aspects relevant to Utilization Management (UM), Mental Health Parity, and External Review (ER).

“Since the advent of managed care, Congress and state legislatures have passed a myriad laws governing medical management programs.  In addition, regulators have published additional guidance on how these programs should operate.  With thousands of requirements on the books, it often is confusing to sort out which regulations apply and when,” notes RegQuest Senior Legal Counsel, Catie Spivey, JD.

“As a result, a primary goal of the complimentary RegQuest webinar series is to assess key regulatory trends to better understand how health plans, provider, and patients can navigate and understand their rights and obligations when coverage determinations are being made.”

The three-part webinar series will provide attendees with valuable insights on medical management appeals processes and will examine current trends in the field.  Some of the regulatory trends have not been discussed before, which makes the presentations a must-attend event.

Webinar topics include:

  • Session I: A Focus on Regulations: Analyzing Trends in Utilization Management
    • Date & Time: April 6, 2016 at 12:00 p.m. ET
    • Description: The session will examine the evolution of utilization management (UM) programs and related medical management functions over the past three decades with a detailed overview of how UM programs are regulated. Among other issues, speakers will highlight the impact of the Affordable Care Act and other regulatory reforms on the ways that health plans make “medical necessity” determinations and how the appeals process works when a “denial” of care or adverse benefit determination is made. In addition, the presentation will review the scope, licensure requirements, reviewer qualifications and the ways in which UM services are often integrated into a “care coordination” approach to managing patients. The session will also examine liability issues associated with the “corporate practice of medicine”. To register, click here.
    • Speakers:
      • Julie O’Brien, BSN, RN, MS, President, AliCare Medical Management and President, National Association of Independent Review Organizations (NAIRO)
      • Garry Carneal, JD, MA, co-Founder, RegQuest and Former President & CEO, URAC
      • Catie Spivey, JD, Senior Legal Counsel, RegQuest (Session Moderator)
  • Session II: Mental Health Parity: Achieving Equality in Care
    • Date & Time: April 28, 2016 at 12:00 p.m. ET
    • Description: With the adoption of the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008 (MHPEA), much attention has been focused on the integration of mental health and substance use disorders into mainstream medicine. This session will focus on legislation passed since 2008 designed to increase compliance with the federal law and to strengthen state laws, common violations and tracking efforts, and look to the future. The presenters will also touch base on the importance of Americans understanding their rights under parity laws and how to take action if their behavior health treatment is being unfairly restricted. To register, click here.
    • Speakers:
          • Tim Clement, MPH, Scattergood Foundation
          • Garry Carneal, JD, MA, co-Founder, RegQuest and Senior Policy Advisor, The Kennedy Forum
          • Catie Spivey, JD, Senior Legal Counsel, RegQuest (Session Moderator)
      • Session III: External Review: Navigating Nuances in Regulatory and Market Trends
        • Date & Time: May 24, 2016 at 12:00 p.m. ET
        • Description: As consumers take on a more active role in their health care decisions, the importance of external review (ER) has grown. However, compliance with state and federal ER laws can be a nuanced endeavor. In this informative session, industry leaders will examine ER regulatory requirements and focus on the important part these regulations play in consumer protection and ensuring appropriate care is provided for patients, and oversight of health plans. In addition, an analysis of the differences between state law and the NAIC Uniform Model Act will be reviewed. To register, click here.
        • Speakers:
          • Tom Naughton, President, Health Division for MAXIMUS Federal
          • Julie O’Brien, BSN, RN, MS, President, AliCare Medical Management and President, National Association of Independent Review Organizations (NAIRO)
          • Gib P. Smith, Executive Director, NAIRO
          • Catie Spivey, JD, Senior Legal Counsel, RegQuest (Session Moderator)


      To find out more about these webinars, visit or click here to register. A Q&A session will follow each presentation, so don’t miss this opportunity to hear from national experts on the topics impacting medical management.

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      About RegQuest (

      RegQuest, Your Regulatory Compliance Resource, details many of the business, legal and regulatory forces directly impacting the medical management system, including requirements adopted under the Affordable Care Act. In addition, the guide serves as the definitive resource of detailing how regulatory and business trends are affecting medical management practices. RegQuest was created in conjunction with Schooner Strategies and EBG Advisors with private funding.

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