LTC Pharmacy News
March 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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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

CMS Final Rule on Medicaid Pass-through payments
You may have seen stories in the trade press concerning CMS' new final rule on the states' use of pass-through payments in Medicaid managed care and wondered what this is all about.

Wonder no more. Elise has put together an informative overview of the issue and its potential impact on hospitals and nursing homes. 

Nursing Home Policy Priorities in 2017
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

Republicans Launch American Health Care Act
On March 6th, House Republicans introduced their long-awaited legislation to "repeal and replace" the Affordable Care Act. The new legislation is called the American Health Care Act and, at 70 pages, is significantly shorter than the law it seeks to replace.

See Section-by-Section Summary from Energy and Commerce Committee

See Fact Sheet from the House Committee on Ways and Means

Major Changes to Medicaid:  The legislation proposes to limit Medicaid expansion under the provisions of the ACA. As expected, the bill also proposes changing Medicaid funding to a per-capita cap formula beginning in 2020. This would mark the end of the open-ended Medicaid entitlement. 

Anticipating such a development, more than 100 organizations sent a letter to Congressional leadership asking them to reconsider imposing limits on Medicaid funding. 

Bumpy Road Ahead;  While the Republicans have been promising a complete repeal and replacement of the ACA for years, the unveiling of the replacement has drawn hostile reviews, not only from Democrats, but from some Republicans as well. 

The legislation has already survived marathon markup sessions and has been approved by the Energy and Commerce and the Ways and Means Committee. Congressional Republicans are hoping to have final legislation on President Trump's desk by late March or early April. The consensus view is that this is optimistic.

Legislation Introduced to Prohibit DIR Fees
Bipartisan legislation has been introduced in the House and Senate to prohibit the practice of retroactive reductions in payments by PBMs in Medicare drug plans. The Senate Bill was introduced by Senators Capito (R-WV) and Tester (D-MT). Legislation in the House was introduced by Reps Morgan Griffith (R-WV) and Peter Welch (D-VT). 
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Federal Agency News
President Trumps Makes Nomination for Medicaid Director
President Trump has nominated Brian Neale to become the Director for Medicaid and CHIP Services. Neale has close ties to Vice President Mike Pence, having served as his health policy advisor while governor of Indiana. His most recent service was as Executive Director of the US Congress Joint Economic Committee. 

If confirmed, Neale will report to the presumption CMS Administrator, Seema Verna.

See story in Modern Healthcare

AHRQ Stats: Out-of-Pocket Expenses for Chronic Conditions
Among adults with health care expenses in 2014, those treated for multiple chronic conditions had average out-of-pocket expenses that were more than three times as high as expenses for adults with one or no chronic condition. See Brief

CMS Solicits Applications for Next Gen ACOs
The Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation Center (CMS Innovation Center) released the Request for Applications (RFA) and Letter of Intent (LOI) for organizations interested in applying to the Next Generation Accountable Care Organization (ACO) Model for 2018.

The CMS Innovation Center will be holding informational open door forums to help guide applicants through the application process and provide more detailed information on the Model. A recording of the material, and the slides from the Next Generation ACO (NGACO) Model’s first two open door forums for 2018 NGACO Applicants are now available. These open door forums focused on an overview of the NGACO Model and information on the LOI.

          April 11 Open Door Forum

National Adult Immunization Plan Available
The National Vaccine Program Office has published The National Adult Immunization Program and a companion document A Pathway to Implementation. 

Regulatory Reform Task Forces
President Trump issued an Executive Order, directing federal agencies to appoint regulatory reform officers and perform a thorough review of agency regulations. Agencies would recommend regulations that should be amended or repealed.  

National Health Statistics Reports
The National Center for Health Statistics published a report titled Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013. This reports on practice characteristics of physicians in practices that are designated as Patient-centered Medical Homes.

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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
Kaiser:How Does a Medicaid Block Grant Work?
The Kaiser Family Foundation has published a video slide show explaining how a Medicaid Block Grant or Per Capita Cap would work and what's at stake. See more here

How Will Trump Administration Affect Pharmacies?
Drug Topics published an article examining the various ways in which the new administration could impact pharmacies.

States Push for Drug Pricing Transparency
Drug pricing continues to dominate health policy as costs continue to rise faster than many other healthcare products and services. Not limited to federal government intervention, more discussion is taking place in state capitols, as legislators and governors attempt to force manufacturers to justify their prices. The Hill

Health Info Tech in Medication Reconciliation
A former hospital chief information officer recounts the difficulty of getting accurate medication reconciliations during transitions of care. There will always be human error to contend with, but health information technology can help in getting the job done. 

Consumers Clamor for Virtual Care
Citing convenience, respondents to a recent poll sponsored by consulting giant Accenture, overwhelmingly agreed that they would like to try virtual healthcare options such as video visits and physician communication via email. The demand, however, appears to outstrip supply. Only 20 percent of healthcare providers offer virtual care. See article in Modern Healthcare

Taking Generic out of Generic Drugs
Remember the Generic Pharmaceutical Association (GPhA)? Not to worry, no need to remember that name any longer, The trade association for the generic drug industry has changed its name to the Association for Accessible Medicines. Feel better now?

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