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LTC Pharmacy News
February 2018
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. LTCPharmacynews.com is your guide to understanding this process, the legislation and regulation that will implement this change and the key to adjusting your approach to succeeding in this new environment. We will try to not just tell you the "what" of this change, but the "how" as well.
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The Policy Issues Ahead for SNFs in 2018
Nursing homes are faced with a dizzying mix of pending and likely regulatory activity that could cause us to throw our hands in the air in defeat. Unless, of course, you have Elise Smith to guide you through the quagmire.

Read what Elise sees as the major public policy issues facing the industry we serve and what we can do to lend a hand.


MedPAC Calls it a Wrap!
Elise reports on the January meeting and finalizes its recommendations to Congress for payment policy in 2019. This is the annual ritual where the Commission assembles its mountain of data and tells Congress which providers, in its estimation, are being overpaid, underpaid and how payments could be improved.

As usual, MedPAC thinks nursing homes get paid too much under Medicare and has some recommendations. I won't spoil the story, so if you want to know what they think, read more.

CMS Final Rule: Knee Replacement No Longer Inpatient Only
Elise reported earlier on the CMS proposed rule to remove total knee replacement from the list of "inpatient only" procedures under the Medicare Outpatient Payment System. The agency has finalized the rule, which means that recipients undergoing outpatient knee replacement will not have a 72-hour hospital stay in order to qualify for Medicare Part A rehabilitation in a SNF.  See more here.

Recent MedPAC actions on Nursing Home Quality
Elise reviews recent MedPAC research on why Medicare beneficiaries continue to choose lower quality nursing facilities. MedPAC staff point to statutory prohibitions against allowing hospitals to recommend SNFs for patients being discharged. How could changes affect nursing home quality initiatives and how can LTC pharmacies engage? See more here

Proposed Changes to the Inpatient Only Rule Could Impact SNFs
CMS recently published a proposed rule on Hospital Outpatient Payment System updates and asked for comments on allowing hip and knee replacements to be performed in outpatient settings. Elise discusses the implications on nursing facilities if Medicare beneficiaries stop using SNFs for rehabilitation. See more here.

Getting to a Unified Post-Acute Care Payment System
Various Federal agencies have been working for years to come up with a unified payment system for post-acute care (PAC). In this paper, Elise gives us a much-needed history of the policy and its development, featuring the star players CMS and MedPAC. 

Why should you care? Your PAC customers have a lot riding on how the drama finally resolves. They care about this, and so should we. See more here

More Elise Smith Insights
The list of Elise's publications was getting too lengthy to continue listing on the newsletter, so we have created her own page on the LTC Pharmacy News site. See it all now.

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Legislative Highlights

Congress Passes Massive Spending Bill
Banishing fears of rising deficits, Republicans and Democrats came together to do what they do best: Spend taxpayer money. In a last-minute show of unity, Congress sent President Trump a $300 billion spending package that included an accelerated closing of the Medicare drug donut holes, as well as a permanent end to nursing home therapy caps-albeit with SNF reimbursement reductions.

Donut Hole Closing Faster
Pharmaceutical manufacturers were taken by surprise when the Senate included a provision to close the Medicare drug benefit's donut hole (the portion of drug spending covered solely by consumers) a year ahead of schedule. What maddened the drug companies was the provision that required them to pay for it: manufacturers will now be responsible for covering 70 percent of the drug costs in the donut hole, rather than the current 50 percent. Drug companies called the provision a "gift to health insurers". See Axios story.

SNF Provision
In a good news/bad news development, Congress provided a permanent elimination of therapy caps, a provision that nursing homes have advocated for over the years. On the downside, the spending bill reduces Medicare reimbursement for nursing homes by $2 billion over 10 years. See story in Provider. See McKnights

Chronic Care Act Provisions
Congress also included provisions of the Senate-passed CHRONIC Care Act, including a 2-year extension of the Independence at Home demonstration, as well as permanent authorization of Medicare Special Needs Plans for vulnerable populations. See Baker Donnelson analysis 


Administration Ponders Drug Cost Reductions
Newly-confirmed HHS Secretary Alex Azar, former Eli Lilly executive, has signaled that the Trump Administration's budget proposal will include provisions that target drug prices. Among the proposals under consideration are moving some drugs currently paid for under Medicare Part B to Part D, cutting Part B drug reimbursement from ASP plus 6 percent to ASP plus 3 percent, and allowing state Medicaid programs to deny coverage of certain drugs in order to obtain larger manufacturer rebates. See Bloomberg News

White House Releases Budget Plan
President Trump released the Administration's budget proposal, which totals a whopping $4.4 trillion. HHS Secretary Alex Azar released a synopsis of the proposed HHS budget, 86 percent of which is consumed by Medicare and Medicaid.

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Federal Agency News
CMS Issues Draft Call Letter for 2019
CMS published its draft 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter on February 1st. There are no surprises in store for LTC pharmacies. CMS makes some proposed improvements to Part C programs to allow plans to develop benefit offerings to better manage chronic conditions. 

GAO Reports on Medicaid Assisted Living
The Government Accountability Office issued a report critical of state oversight of assisted living facilities serving more than 330,000 Medicaid enrollees. The issue appears to stem from the different ways in which states regulate assisted living. GAO recommends that CMS make it clear to states that they must report facility deficiencies and provide more transparent oversight.

ACL Hosts Webinar on HCBS Quality Measurement Tools
The Administration for Community Living will host a webinar on February 21st at 2:00 pm on the array of quality measurement tools CMS has for Home and Community-Based Services, including the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, the Experience of Care (EOC) Survey and the Functional Assessment Standardized Items (FASI), and how these tools can be used at state and local levels. Register Here

AHRQ's Medication Therapy Management Focus
The Agency for Healthcare Research and Quality recently published a case study of how one company is using the agency's health literacy tool to do more effective management of patient drug regimens. The tools are free and available for pharmacists to use.

Alex Azar Confirmed as HHS Secretary
The Department of Health and Human Services has a new leader. Former Deputy Secretary of the Department in the George W. Bush Administration and Eli Lilly Executive Alex Azar has been confirmed as the latest head of the federal government's most far-reaching agencies.

CMMI Reports on Cost Savings with Chronic Care Management
The Center for Medicare and Medicaid Innovation published a report, written by Mathmatica Policy Research, examining the impact of reimbursing physicians for chronic care management services. Spoiler Alert: Cost savings over 18 months are $74 per patient.

Council of Economic Advisers on Lowering Drug Prices
The Whitehouse Council of Economic Advisers published a Report proposing ways to reduce the price of drugs, including reducing the Medicare Part B reimbursement for drugs by moving drug coverage to Part D, and allowing states to exclude certain drugs in the Medicaid program. 
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Go to the LTC Pharmacy website for regular updates on what's coming from CMS, including proposed and final rules, new programs, news from Medicare and Medicaid and updated Medicare Learning resources. Go there now.

The FDA often updates its website with drug safety information, news about drug approvals and implementation information on laws, such as the Drug Quality and Security Act. Keep checking our site for the latest news from FDA.

THE HHS Office of Inspector General publishes audit reports and results of investigations on federal health programs, such as Medicare and Medicaid. Congress frequently looks at these reports when deciding where to focus on oversight and legislation. Keep in touch here.

The Government Accountability Office is the official investigative arm of Congress and publishes important reports that often guide the national conversation. We keep track of announcements coming out of GAO, so you don't have to. All you need to do is click here.
News Items of Interest
Purdue Cuts Sales Force, Stops Opioid Marketing
Purdue Pharma, embattled manufacturer of the Oxycontin line of opioid analgesics, announced that it would reduce its sales force to 200 from the current 400 sales reps. The company has been the target of lawsuits by 42 states, accusing the company of deceptive marketing. CNBC

Pharmacist Engagement in Diabetes Management
Drug Topics has created a resource for pharmacists interested in becoming more active in care for diabetic patients. The incidence of diabetes continues to increase and pharmacists are uniquely positioned to help patients manage this chronic condition. 

What to Watch for in 2018
Health Affairs Blog identifies six trends that are likely to shape healthcare this year, and gives us some insight into what healthcare leaders are following as the year unfolds.

Which Drug Patents Are Expiring This Year
MedCity News published a list of drugs that will lose patent protection this year. Estimates are that these drugs currently total some $31 billion in annual sales.

NPC Launches Health Spending Research Effort
The National Pharmaceutical Council (NPC), a pharmaceutical industry trade group, announces the launch of its Going Below the Surface Research Initiative, intended to explore the drivers of healthcare cost growth. The feature image on the web site is a bit unsettling, so let's hope the project has value that gets us past that.

Kaiser Surveys States on HCBS Programs
The Kaiser Family Foundation published its annual review of state Home and Community-Based Services programs, including data from 2015. The report highlights enrollment and policy trends across all 50 states.

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