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LTC Pharmacy News
September 2018
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. 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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What Will LTC Pharmacy Look Like 10 Years From Now?
OK, no one really knows the answer to that question. If history shows us anything it's that we are terrible at predicting the future. So, perhaps the better question is "If present trends continue, what is the future likely to look like?"

Take a look at this month's blog and see if you think I could be right.
CMS Publishes Final SNF PPS Rule for 2019: PDPM Approved
The long-awaited final PPS rule has been published. Elise has been through it with her usual attention to detail and reports on the changes that will take place beginning in October of 2019. This rule represents a major shift in incentives for SNFs; away from a focus on therapy to a new emphasis on the objective medical needs of the residents.
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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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Energy and Commerce Looks at Nursing Homes
The House of Representatives Committee on Energy and Commerce Subcommittee on Oversight held a hearing on federal efforts to ensure that Medicare beneficiaries in Skilled Nursing Facilities and Nursing Facilities are receiving appropriate care and are free from abuse and neglect. Witnesses represented the HHS Inspector General, the Government Accountability Office and CMS. 

The hearing was precipitated by deaths of 12 residents in a Florida nursing home. during Hurricane Irma last year. 

Senior Ways and Means Members Ask CMS for Red Tape Relief
House Ways and Means Chairman Kevin Brady (R-TX) and House Ways and Means Subcommittee on Health Chairman Peter Roskam (R-IL) wrote three letters to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma applauding action taken to date and encouraging the Administration to take further steps to improve patient care by alleviating administrative and regulatory burdens for Medicare providers.

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Federal Agency News
CMS Issues Declaration on Claims for Residents of Flood Zone
On September 10, 2018, pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared that, as a result of the effects of Hurricane Florence, an emergency exists in North Carolina and South Carolina

HRQ Reports on Disappointing Results of Med Reconciliation
The Agency for Healthcare Research and Quality reports on the results of a 5-hospital intervention using a standardized toolkit to help pharmacists and clinicians better manage drug regimen reconciliation during transitions of care. The intervention was not found to have achieved an overall reduction in potentially harmful medication discrepancies.

CMS Rejects Low Dispensing Fee in Washington Medicaid
The National Association of Chain Drug Stores (NACDS) announced that CMS had rejected Washington State's proposed Medicaid dispensing fee based on it's 2016 guidance that states are required to pay dispensing fees that, at minimum, cover the cost of pharmacies to dispense.

New Data Chartbooks for National Survey of Older Americans Act Participants
A new series of eight chartbooks is now available in the Data Sources section of ACL’s AGing Integrated Database (AGID) website about the National Survey of Older Americans Act (OAA) Participants.

The chartbooks outline the background of the survey, selected results for all services, and chartbooks specific to each of the six surveyed services: Homemaker, Case Management, Transportation, Home-Delivered Nutrition, Congregate Nutrition, and Caregiver/NFCSP.

CMS Denies Massachusetts Request to Close Medicaid Formulary
In a letter to Massachusetts Medicaid, CMS officials declined to allow the state to exclude certain drugs from coverage under the program. CMS argued that it was bound by law and regulation to disapprove the state's request, but offered its assistance in coming up with legal solutions to drug affordability.

AHRQ Patient Safety Primer on Medication Administration
The Agency for Healthcare Research and Quality issued a new patient safety primer focused on medication administration. The problem is not news to consultant pharmacists but does signify that at least one federal agency recognizes med administration as a significant safety issue.
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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
NIC Releases Q2 2018 Skilled Nursing Data Report
Skilled Nursing Facility occupancy continues its long slide, with a record-low 81.7 percent of beds occupied. Rural markets suffered marginally higher losses in occupancy than their urban counterpart. Managed Medicare stays have remained flat over the past year, representing 6.4 percent of nursing home occupants. See details at National Investment Center for Seniors Housing & Care (NIC) Q2 Report. Also, see Skilled Nursing News.

Home Infusion Providers Worry About CMS Proposed Rule
A CMS proposed rule implementing the transitional payment for home infusion providers has home infusion providers concerned. The proposal would allow for transitional payment only when a nurse is physically present, rather than for the entire episode of care. Providers and some members of Congress argue that this is contrary to Congressional intent and are working to persuade CMS to allow for payments covering the entire episode. See Modern Healthcare

Apple Watch Has Senior-Friendly Features
Apple announced new features for its Apple Watch, including the addition of technology that will detect falls and call for help if it detects that the wearer has fallen. The watch will also have the ability to monitor heart rate and perform an EKG on its wearer.

Private Payers Challenged on LTSS
While we tend to think of Medicare and Medicaid as the payers for home health services and nursing care. It's true, but these programs account for 77 percent of total payments, and there is a growing percentage of non-public money being spent on these Long Term Services and Supports (LTSS). Health Payer Intelligence takes a close look at the private market for LTSS and points out ways these payers can improve.

Hospitals Start Their Own Drug Company
The plan was announced in January and has now been named and senior executives have been introduced. The new company, Civica Rx, will supply up to 14 essential generic drugs to more than 500 US hospitals. The venture was formed by Intermountain Health, the Mayo Clinic and other major hospital systems, frustrated by the continuing shortage of drugs that are vital to hospitalized patients.  See CNBC

Larry Lane Retires as VP Government Affairs at Genesis
Veteran Government Relations executive Larry Lane has retired from Genesis Healthcare effective September 10. Larry has been a long-time passionate advocate for long term care facilities and their residents. He is also a friend. Lane will continue service to Genesis is a consulting capacity. 

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