LTC Pharmacy News
June 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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Elise Covers CMS Proposed Patient Driven Payment Model
CMS recently proposed a major change in the way SNFs are paid under Medicare Part A. Elise takes us through the proposal and explains how CMS arrived at this approach and what it's likely to mean for LTC Pharmacy. 
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MedPAC Addresses A Key Element in the Uniform PAC PPS
As you know from Elise's previous updates, the Medicare Payment Advisory Commission has been studying the process of moving toward a unified post-acute care prospective payment system. Sound simple? Not so fast. Elise explains the issues MedPAC is considering in this latest update.
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Medicare Bundled Payments and SNFs
CMS' Bundled Payments for Care Improvement seems to have left nursing homes out of the driver's seat on managing care for Medicare patients. In this comprehensive overview of the latest policy moves by CMS on bundled payments, Elise 
patiently takes us through the history of bundled payments in Medicare and how SNFs have been positioned and why, as well as how the industry has responded.

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.

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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The President's Plan to Cut Drug Costs
President Trump held his long-awaited pronouncements on how he and his administration plan to reduce the escalating prices consumers pay for drugs in the United States. 

While the President promised tough action on manufacturers, the Administration's Blueprint didn't cause many sleepless nights for PhRMA's executives. Rather than aiming directly at the industry's pricing policies, HHS Secretary Alex Azar is focusing on limiting manufacturers' ability to stifle generic drugs through the FDA's REMS process and by colluding with generic companies on pay for delay tactics.

The Administration has also discussed moving some Part B drugs to Part D and requiring manufacturers to negotiate with health plans for formulary access to the Medicare drug benefit. 

Officials also took aim at international price differences and suggested, without elaboration, that it was time for other countries to stop freeloading on American innovation. 

Senators Introduce Medicare Part D Electronic Prior Authorization Bill
Senators Pat Roberts (R-KS), Tom Carper (D-DE) and Chuck Grassley (R-IA) have introduced legislation to require Medicare to facilitate electronic prior authorization in the Medicare Part D program. Health Data Management
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Federal Agency News
HHS Announces 2018 Healthy Aging Summit
The HHS Office of Disease Prevention and Health Promotion announces its Healthy Aging Summit July 16-17 in Washington, DC. The focus of this event will be to help Americans stay healthy as they age. See details

CDC Issues Recommended Immunization Schedule for Adults
The Centers for Disease Control and Prevention has introduced a new continuing education (CE) activity that describes the recommended immunization schedule for adults aged 19 years or older in the United States, based on updated guidance from the Advisory Committee on Immunization Practices.

CMS Seeking Comment on Durable Medical Equipment Interim Final Rule
CMS is seeking comments on an interim final rule that increases payments to suppliers for some DME and enteral nutrition in areas of the country that are not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DEMPOS) Competitive Bidding Process (CBP). These include rural areas, and Alaska, Hawaii and the territories. From June 1 through December 31, 2018, payments will return to the blended rates that were in effect in 2016. See Detail

CMS Administrator on Expanded LTC Benefits
The Center for Medicare and Medicaid Services (CMS) administrator has provided more detail on the agency's decision to allow plans to offer additional services in 2019. 
Next year plans will be allowed to offer services such as bathing, dressing and managing medications. ThinkAdvisor

Webinar: Home and Community-Based Services Quality and e-LTSS
The Home and Community-Based Services (HCBS) Quality and e-LTSS webinar is the fifth event in ACL's HCBS quality informational webinar series. The development of e-LTSS (long-term services and supports) and data systems interoperability may provide new avenues for person centered and high quality HCBS.

US Government Bookstore:  Your Guide To Choosing a Nursing Home or Other Long-Term Services & Supports
This informative booklet about choosing nursing homes and other types of elder care explains:

How to find and compare nursing homes and other long-term services and supports,
How to pay for nursing home care,
Your rights as a nursing home resident, and
Alternatives to nursing home care.
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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
Three Firms Dominate Medicare Part D Enrollments
The Kaiser Family Foundation published an analysis showing that UnitedHealth, Humana and CVS Health collectively cover more than half of all Medicare Part D enrollees, and pending mergers threaten to consolidate coverage even more.

SCPC-Sponsored Analysis Shows No Fiscal Barrier to Federal LTCP Definition
The Senior Care Pharmacy Coalition (SCPC) announces the results of an analysis showing that legislation that would create a federal definition of LTC Pharmacy would have no fiscal impact. The trade association representing LTC pharmacies has advocated for a definitive federal definition of long-term care pharmacy in order to ensure that senior benefits delivered through federal programs are consistently applied.

Medically Complex Patients Get Advantage under PDPM
Skilled Nursing News reports that facilities that can accomodate medically complex residents are likely to see a boost in payments under the newly-proposed Patient-Driven Payment Model (PDPM) in Medicare Part A.

Will Best Buy Be the Next Entrant in Senior Care?
MedCity News reports that electronics retailer Best Buy may be looking at playing a role in keeping seniors at home through the use of monitoring technology. The company is testing a service called Assured Living that leverages technology to allow seniors to remain independent longer.

$90 Billion in Improper Medicare/Medicaid Payments
According to the Government Accountability Office (GAO) CMS made $90 billion in improper payments related to Medicare and Medicaid coverage. The GAO report blamed poor payment methodology. Healthpayer Intelligence (Free Registration Required)

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