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©Partners Behavioral Health Management 2016. All Rights Reserved. Subject to edits.
November 15, 2016Charity Bridges, UM/AppealsAndrew Walsh, General Counsel
©Partners Behavioral Health Management 2016. All Rights Reserved. Subject to change w/o notice.
I. What is Mediation? II. Types & Parts of Mediation
A. “Traditional” MediationB. MCO Consumer Medicaid MediationC. Provider Dispute Mediation
III. Tips, Tricks & Traps
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}Alternative Dispute Resolution (“ADR”)? Alternative to what? ? Going to “court!” � – including North Carolina’s Office of Administrative Hearings
(OAH) for a Medicaid “State Fair Hearing”
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} Sue} Fight} Argue} Negotiate
} Get Even} Ignore} Mediate,
Arbitrate,“ADR”
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} Mediation} Arbitration} Med-Arb or Arb-
Med
} Early Neutral Evaluation (ENE)
} Summary or “Mini” Trial} Collaborative Law
“Mediation is an informal process in which a third-party mediator facilitates settlement discussions between parties. Any settlement is voluntary. In the absence of settlement, the parties lose none of their rights to trial by judge or jury.”
“Mediation: The act of bringing disputants together with a neutral third person who assists them in reaching a voluntary agreement that satisfies both parties.”
“Arbitration is an informal process in which a third-party arbitrator issues an award deciding the issues in controversy. The award may be binding or non-binding. …”
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• 1-Minute Thumb Wrestling
• Pair up-- teams of 2• Prize for most pins} Ready}Set}Go!
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STOP
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} No pins?} 1-5 pins?} 6-10 pins?} 11-25 pins?} Over 26 pins?
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1. How’d “winner” get the most pins?v Mediation is merely facilitated negotiationv Did you need a Referee?v Mediation helps the process of
communication
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2. “Principled” vs. “Positional” negotiationv Avoid the Blame Game Ø but let vent & trust the process
v GETTING TO YES:Ø Separate the people from the problemØ Focus on interests, not positionsØ Insist on using objective criteriaØ Invent options for mutual gain
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3. Ideas for “real” disputes?Ø Money not always the answerØ “Out of the Box” thinkingØ Apologies/EmpathyØ Sharing/Schedules
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I. Opening Statements Ø by Mediator: Confidentiality &
ProcessØ by Each Party (plaintiff normally 1st)
II. Plenary Sessions & CaucusesIII. Declare Impasse &/or Memorialize
Agreement(s)
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ABA Video Contest: Consider Mediation [job issue]: http://www.youtube.com/watch?v=vusZamARvVA
Honorable Mention:Elder mediation [family re aging Dad]: http://www.youtube.com/watch?v=DSLx9JwDK-M&fmt=18
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Did you notice the …} Informality?} Privacy?} Venting?} Caucuses?} Other?
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Pros/Advantages} Control Process &
Solution (incl’g neutral)} Faster, Cheaper} Venting} Clarification} On-going relations/
Cooperation} Confidentiality/Privacy} Flexible
Cons/Disadvantages} Enforceability} “Victory”
? Right-Wrong? “Principle”
} Precedent} Publicity} No Agenda
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} Evaluative} Facilitative} Transformative
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I. OAH orders Mediation; mediator schedules
II. MCO and Petitioner decide who to invite
i. Providers, Advocatesii. UM, CC, Attorneys?
III. Mediator Conferences In All Participants
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IV. IntroductionsV. Opening Statements by:Ø Mediator: Confidentiality &
Process—Agreement to MediateØ Each Party (MCO normally 1st)
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VI. Plenary Session (Caucuses rare)VII. Memorialize Agreement(s) &/or
Declare ImpasseVIII. File Report of the Mediator(ROM)
with OAHhttp://www.ncoah.com/hearings/medicaid.html
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} Goal is to Foster an Agreement} Avoid moving to a Formal Hearing} HOW??Setting a Warm Tone� Venting & Problem Solving� Empathy vs. Blame Game
?Us vs The Problem?Questions (facilitate) vs Statements
(evaluative)?Solution Focused &/or Criteria Driven
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} BATNA: Best Alternative to No Agreement?Partial Agreements, Stipulations &
Issue Narrowing} Reciprocal Concessions} Education & persuasion?Visuals: Paint a picture, exhibits, charts }Others?
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P’s P’s OpeninOpening Offer: g Offer: 40h/w 40h/w
P’s P’s Target Target Point:Point:30h/w30h/w
R’s R’s ResistaResistance nce Point:Point:25h/w25h/w
P’s P’s ResistaResistance nce Point:Point:20h/w20h/w
R’s R’s Target Target Point:Point:15h/w15h/w
R’s R’s OpeninOpening Offer: g Offer: 5 h/w5 h/w
P’s P’s OpeninOpening Offer:g Offer:40h/w40h/w
P’s P’s Target Target Point:Point:30h/w30h/w
P’s P’s ResistaResistance nce Point: Point: 25h/w25h/w
R’s R’s ResistaResistance nce Point: Point: 20h/w20h/w
R’s R’s Target Target Point:Point:15h/w15h/w
R’s R’s OpeninOpening Offer:g Offer:5 h/w5 h/w
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} Remember the BIG PICTURE!} Consider Bundled Offers} Attorneys can be helpful—or not} Ensure balance of expertise} Remember the importance of the decision for
all parties
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QuestionsQuestions?
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ContactContact InformationInformation
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Ø Andrew Walsh, Chief Legal Officer & General Counsel? [email protected]? 704-884-2634
Ø Charity Bridges, UM Manager-IDD UM and Appeals ? [email protected]? 705-884-2637