Charity Bridges, UM/Appeals Reserved. Subject to edits. Andrew …nctide.org/Fall2016/Partners Mediation Training 20161110.pdf · 2016-12-11 · Tips, Tricks & Traps 11/15/16 2 ©Partners

©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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©Partners Behavioral Health Management 2016. All Rights Reserved. Subject to change w/o notice. 11/15/16 3


}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”


} 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. …”


• 1-Minute Thumb Wrestling

• Pair up-- teams of 2• Prize for most pins} Ready}Set}Go!

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STOP


} 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)


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


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


} 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


IV. IntroductionsV. Opening Statements by:Ø Mediator: Confidentiality &

Process—Agreement to MediateØ Each Party (MCO normally 1st)


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



} 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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©Partners Behavioral Health Management 2016. All Rights Reserved. Subject to change w/o notice.11/15/16 27

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


} 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

Documents

Charity Bridges, UM/Appeals Reserved. Subject to edits. Andrew …nctide.org/Fall2016/Partners Mediation Training 20161110.pdf · 2016-12-11 · Tips, Tricks & Traps 11/15/16 2 ©Partners