LTC Pharmacy News
April 2017
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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The MedPAC March Report: MedPAC's Role in Public Policy
The Medicare Payment Advisory Commission was created to advise Congress on Medicare payment policy. This agency is a mystery to many of us. Thankfully, Elise Smith once again makes the opaque transparent with an excellent overview of the Commission's March report, as well as helpful background on the role MedPAC plays in post acute care. Read Elise's Post.

Implementing the CMS LTC Final Rule: Where are we?
Remember our anxiety, waiting for CMS to release its final rule on LTC Requirements for Medicare and Medicaid? 
We all (mostly) read the rule eagerly, looking to see how hard life was about to become for the nursing home industry.

A few months have passed since then. So, where is the industry on implementing all those very expensive requirements? Elise Smith has, once again, been talking with the movers in the industry and files this informative report

The new year is upon us, and with it another year of triumph, near misses and major disappointments. So, what keeps our friends in the nursing home industry awake at night?

Take a look at Elise's take on the major policy issues facing the industry in the months ahead. 
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Legislative Highlights

Senior Democrat Files PBM Transparency Bill
On March 15th Senator Ron Wyden (D-OR), Ranking Democrat on the Senate Finance Committee, filed legislation to require PBMs to begin disclosing rebates from manufacturers and to begin passing some of their discounts back to patients. 

The bill has been co-sponsored by Senators Brown (D-OH) and Heitkamp (D-ND). Read Bill Here.  See Story in Business Insider

House Health Reform Bill Pulled from Consideration
House Speaker Paul Ryan abruptly cancelled consideration of the American Health Care Act on March 24th, confessing that he did not have the 216 votes necessary to pass the legislation. The White House announced that it would change its focus to tax reform and wait for the Affordable Care Act to "explode" and then revisit the law when both Democrats and Republicans were more motivated to arrive at a solution.

Nursing home executives breathed a sigh of relief with the announcement, having grave concerns over the provisions of the legislation that would have changed Medicaid to a per capita cap funding mechanism.  

Senators Introduce Drug Price Legislation
A group of Senate Democrats, including Senators Baldwin (D-WI), Franken (D-MN) and Brown (D-OH), have introduced The Improving Access to Affordable Prescription Drugs Act. The legislation would allow drug importation, require Medicare drug price negotiation and prohibit "pay to delay" arrangements between brand name and generic drug manufacturers. 

While Republicans have rejected this approach in the past, Democrats believe that President Trump's support for lowering drug prices may improve odds of passage.
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Federal Agency News
President Trumps Nominates FDA Chief
President Trump has nominated Scott Gottlieb, MD, as the next Commissioner of the Food and Drug Administration. Dr. Gottlieb is well-known to healthcare policy wonks, and has experience in the agency, having served as Deputy Commissioner under the George W Bush Administration. 

His nomination will be reviewed by the Senate Health Education Labor and Pensions Committee. See profile on Drug Channels

Agency for Community Living Posts Profile of Older Americans

CMS Postpones Bundled Payment 
CMS published an Interim Final Rule in March 21st Federal Register postponing implementation of the cardiac rehabilitation incentive program and the comprehensive care for joint replacement model from July 1, 2017 to October 1, 2017. The notice requests comments on moving implementation to January 1, 2018. The rule provides for a comment period, which ends on April 19, 2017. 

AHRQ Data Highlights Out-of-Pocket Health Spend for Seniors
The Agency for Healthcare Research and Quality posted a statistical brief outlining what non-institutionalized seniors paid out-of-pocket for health care services between 2000-2014. Data show a steady decrease from more than $1000 in 2000 to less than $500 in 2014.

HHS Launches Web Page on Patient Empowerment
Health and Human Services Department launched a new page on highlighting the regulatory and administrative actions the Department is taking to relieve the burden of the current healthcare law and support a patient-centered healthcare system.

AHRQ Blog Post on Helping Nursing Homes Fight HAIs
The Agency for Healthcare Research and Quality published a post on helping nursing homes better avoid healthcare-acquired infections. HAIs are a serious concern, affecting nearly 4 million nursing home residents per year, with nearly 10 percent of these infections resulting in death.

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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
Samuelson: Transfer Medicaid LTC to Feds
Noted economist and Washington Post columnist Robert J Samuelson proposes a fix to the growing cost of Medicaid: transfer coverage of long-term care from Medicaid to the federal government, and perhaps merging this coverage into Medicare. This solution wouldn't necessarily control costs, but would lighten the financial burden on the states.

Pharmacy Organizations Sue Washington State Medicaid
NACDS, NCPA and the Washington State Pharmacy Association have filed a lawsuit against Washington State to prevent implementation of a Medicaid reimbursement rules that the organizations believe would pay pharmacies below their cost to dispense medications to Medicaid recipients. See NACDS Release

Safe Handling of Hazardous Drugs
Pharmacy Practice News features a review article discussing the recent revisions to USP Chapter 800 regarding the safe handling of hazardous drugs.

California Considers PBM Disclosure Law
California Assemblyman Jim Wood has introduced legislation to require PBMs to disclose details on rebates and price concessions for contracts that may be attributable to residents of California, and what amount of those rebates are returned to enrollees. 

AMDA Cites CCRCs as ACO Candidates
AMDA – The Society for Post-Acute and Long-Term Care Medicine, adopted a resolution at its recent annual conference to work with other long-term care trade groups to encourage participation by continuing care retirement communities (CCRCs) in Accountable Care Organization (ACO) Investment Models. According to the report in McKnight's, AMDA views CCRCs as ideal venues because of the congregate living model and the presence of a medical director. 

Kaiser Issue Brief on Medicaid Change Impact on Duals
The Kaiser Family Foundation recently published an Issue Brief on the potential impact of Republican proposals to move Medicaid from an open-ended entitlement to a per capita cap method of financing. The brief envisions ominous consequences.

Nursing Home Occupancy Continues to Fall
The National Investment Center for Seniors Housing & Care has issued its Q4 2016 Skilled Nursing Data Report, highlighting the continuing decline in occupancy levels, increased importance of Medicaid, and the gradual easing of managed care reimbursement reductions.

Aging America: Opportunities and Challenges for Managed Care
Global management consulting firm Oliver Wyman published a post on the general characteristics of long term services and supports and the challenges and opportunities managed care organizations face when attempting to understand and manage this highly-fragmented healthcare sector.

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