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Nuts and Bolts of Medicare and Medicaid 2020

Speaker(s): Beth Shyken-Rothbart, Caroline L. Farrell, Edo Banach, Frederick Isasi, Kevin J. Malone
Recorded on: Nov. 11, 2020
PLI Program #: 278441

Frederick Isasi was selected to be Families USA’s second-ever Executive Director in January 2017 because of his life-long commitment to achieving high-quality, affordable health care for all. Mr. Isasi frequently testifies in Congress and is a well-known national speaker on Medicaid, state innovation, health system transformation, behavioral health, and the social determinants of health as well as health care quality, payment, and equity issues. Mr. Isasi’s passion for health care reform began when he was growing up in North Carolina as the son of Cuban immigrants. There, he saw firsthand many of the barriers to health care experienced by the poor, people of color, people with language barriers, and rural communities. Before joining Families USA, Mr. Isasi served as the Health Division Director at the bipartisan National Governors Association’s (NGA) Center for Best Practices. Prior to NGA, Mr. Isasi served as Vice President for Health Policy at the Advisory Board Company where he founded its Health Policy Department. Prior to this work, Mr. Isasi served as Senior Legislative Counsel for Health Care on both the U.S. Senate Finance Committee and Senate Committee on Health, Education, Labor, and Pensions (HELP) for former Senator Jeff Bingaman (D-NM), the only Democrat serving on both committees during the creation of the Affordable Care Act. Earlier in his career, Mr. Isasi served as a health care attorney with Powell Goldstein, where he worked closely with states on Medicaid reforms and represented public hospitals; prior to that, he served as Senior Policy Advisor to the District of Columbia Primary Care Association. Mr. Isasi holds a JD from Duke University, an M.P.H. from the University of North Carolina, and a B.S. in Cellular Biology and a second major in Spanish from the University of Wisconsin.

Managed care organizations trust Kevin Malone to help them understand and navigate their most difficult legal, compliance, and strategic risks and opportunities. Kevin draws on more than a decade of experience working at the highest levels of health care financing policy and law to help managed care organizations navigate the web of federal and state regulations and program policies governing the health care financing system. Kevin is a go-to lawyer on issues concerning the Mental Health Parity and Addiction Equity Act (the federal parity law), delivery systems for Medicare-Medicaid dually eligible beneficiaries (such as special needs plans and the Programs of All-Inclusive Care for the Elderly (PACE)), and demonstration models for Medicare and Medicaid.

Kevin also advises providers ranging in size from large hospital systems to start-up health and telehealth companies on legal and strategic matters involving corporate formation, licensing, and third-party payment and coverage with a particular focus on value-based payment strategies. Provider organizations rely on his experience with managed care organizations and government regulators to develop successful strategies for market entry and growth.

Kevin also represents a number of national behavioral health specialty societies, providing legal support and strategic advice on trends in the regulation of utilization management and efforts to license intellectual property to managed care entities for inclusion in medical necessity criteria.

Through the firm’s affiliates EBG Advisors, Inc., and National Health Advisors, LLC, Kevin also offers strategic counsel in health policy and on health care reimbursement changes.

He joined Epstein Becker Green in 2016 after six years in health care financing policy roles at the U.S. Department of Health and Human Services, most recently with the Centers for Medicare & Medicaid Services (CMS).

Prior to joining Epstein Becker Green, Kevin served as a Health Insurance Specialist with the duals office, where he was the federal lead for implementing demonstration programs that aim to integrate the financing and delivery of Medicaid and Medicare benefits for dually-eligible beneficiaries in Illinois, New York State, and Washington State. Kevin was a lead in the development of a new federal demonstration model for individuals with disabilities, based on the PACE model, expanding the model of care to new populations. Previously, Kevin worked with the Disabled and Elderly Health Programs Group at CMS, developing a new policy for the identification and counseling of the medically frail within the Medicaid Expansion population.

As a Public Health Analyst with the Substance Abuse and Mental Health Services Administration (SAMHSA) prior to joining CMS, Kevin managed multiple multimillion-dollar federal procurements and led the agency’s efforts to help substance abuse and mental health treatment providers implement advanced contracting, billing, and care coordination practices. In addition, he spearheaded SAMHSA’s efforts at public and private insurance enrollment following the enactment of the Affordable Care Act.

Before joining HHS, Kevin served as a Peace Corps volunteer in Zambia, where he founded the nation’s first male-focused domestic violence prevention project.

Beth Shyken-Rothbart is the Senior Counsel for Client Services and New York Policy at the Medicare Rights Center. Medicare Rights is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives. Beth provides individual counseling to Medicare beneficiaries, caregivers, and professionals, as well as represents individuals in Medicare appeals. She also provides assistance to dual eligible individuals in New York who receive Medicaid managed long term care services. Additionally, Beth contributes to Medicare Rights Center’s policy initiatives both federally and in New York State. She holds a B.A. from the University of Michigan, a M.Ed. from DePaul University, and a J.D. from City University of New York School of Law. She is admitted to practice in New York.

Caroline Farrell is an attorney in the Office of the General Counsel, Centers for Medicare & Medicaid Services (CMS) Division at the U.S. Department of Health and Human Services.  In this role, she is primarily responsible for providing advice and counsel to CMS on legal issues arising under the Medicaid program.  Other areas of her practice include advising CMS’ Medicare-Medicaid Coordination Office on its Financial Alignment Initiative and the Center for Medicare and Medicaid Innovation on ACO models.  Prior to joining OGC, Caroline served as an analyst in the Medicare Drug & Health Plan Contract Administration Group at CMS.  Caroline received a Bachelor of Arts degree and a Master of Public Health degree from the George Washington University, and her J.D. from the University of Maryland School of Law, where she served on the Maryland Law Review.

Edo Banach is President and CEO of the National Hospice and Palliative Care Organization

Prior to that, he was Partner in the firm of Gallagher, Evelius & Jones in Baltimore, MD.  He previously was the Deputy Director of the Medicare-Medicaid Coordination Office at the Centers for Medicare & Medicaid Services and Associate General Counsel at the Visiting Nurse Service of New York.  Prior to that, Edo Banach was the Medicare Rights Center’s General Counsel.  Edo also practiced health law at the firm of Latham & Watkins and clerked for U.S. Judge John T. Nixon of the Federal District Court for the Middle District of Tennessee.  Prior to attending law school Edo worked for the New York City Department of Homeless Services and Mayor's Office of Operations. Mr. Banach holds a B.A. from Binghamton University and a J.D. from the University of Pennsylvania Law School.