LTC Pharmacy News
May 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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CMS Publishes Draft SNF PPS Updates for 2018
Ah Spring! The flowers in bloom, pollen in the air and CMS busy delivering fresh assaults in advance of the next fiscal year.

If thoughts of wading through another proposal rule fills your heart with dread, fear not! Our intrepid Elise Smith proves herself equal to the challenge of deciphering the most obtuse policy jargon and delivering prose simple enough for an online news editor to understand. See it here.

CMS Releases Proposed Case-Mix Payment Proposal
While you have been frolicking over these past several years, CMS has been steadily preparing an assault on the status quo as it relates to Medicare payment policy for SNFs under Part A.

According to another insightful analysis by Elise, CMS suspects SNFs have been gaming the RUGs system and proposes a new payment methodology based on more "objective" standards than the number of rehabilitation hours a resident will require.

Read this and your confusion over the new proposal will vanish like your paycheck in Las Vegas.

More of 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 Spending and House Passes Health Reform Legislation
With a looming expiration of the current continuing resolution for government spending, Congress turned its attention to providing funding for federal government operations through the end of the current fiscal year, which ends September 30.

The House of Representatives passed the American Health Care Act by a narrow margin, moving the debate to the Senate.

Congress Strikes Deal on Spending
House and Senate passed legislation reflecting an agreement to fund the federal government through the remainder of the current fiscal year, which ends on September 30th. The government has been operating under the terms of a continuing resolution, which expires on May 5th.

The agreement gives the president a modest increase in defense spending and little else. Meanwhile, the Democrats appear to have won this round, despite being the minority party in both the House and Senate.

House Passes Health Reform Bill
The House of Representatives narrowly passed the latest version of the American Health Care Act, which overhauls the Obama Administration's signature health legislation; The Affordable Care Act. The action now moves to the Senate, where the legislation will be extensively revised.

See a Section-by-Section summary of this legislation from Benefits Link

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Federal Agency News
CMS Publishes Proposed SNF PPS Rule
The annual Medicare SNF payment dance has begun with the publication of a proposed rule governing Medicare Part A payments to SNFs. The agency proposal includes a one percent increase in payments and features a fairly wide-ranging request for information on a number of payment issues. 

CMS Proposes Modification to SNF PPS Methodology
CMS Also released a long-awaited proposal to modify Medicare SNF payments to more closely reflect objective resident condition rather than rehabilitation services required. Deadline for comment is June 26. See coverage of issue by Elise.

AHRQ Seeks Nomination of New Members to the U.S. Preventive Services Task Force
The Agency for Healthcare Research and Quality (AHRQ) welcomes nominations for new members to the U.S. Preventive Services Task Force (Task Force). Each year, the Director of AHRQ appoints new members to serve 4-year terms and replace those who are completing their service. To learn more about the nomination process, how to nominate an individual for consideration, or how to self-nominate, please visit AHRQ for details. Nominations must be received by June 15, 2017 to be considered for appointment with an anticipated start date of January 2018.

CMS Posts Updated Federal Upper Limits
CMS published updated Federal Upper Limits, as defined by the Affordable Care Act. States will have up to 30 days from the May 1, 2017 effective date to implement these updated FULs.

Medicare Hospice Benefit: Proposed FY 2018 Updates to the Wage Index and Payment Rates
CMS issued a proposed rule (CMS-1675-P) that would update FY 2018 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries and releases Request for Information within the proposed rule. This proposed rule would update the hospice wage index, payment rates, and cap amount for FY 2018.

Register Now for Webinar on Improving Visual Presentations of Health Information
Register now for an AHRQ webinar on May 30 from 1:30 to 3 p.m. ET on how to improve the visual presentation of health data for patients, doctors, nurses and other health professionals. A portion of the webinar will describe how images can be used to communicate test results to patients. Other topics will include how to effectively present electronic health record (EHR) clinical notes to clinicians and how clinicians can use navigators to document information within EHRs. Eligible professionals may earn 1.5 hours of free continuing education credits.

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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
Let’s Make Doreen the Center of Her Care Plan!
The Altarum Institute's recent blog post tells the poignant tale of Doreen, an 87-year-old who lives alone. Doreen's daughter, who provides regular care, is unable to show up because of illness. This begins a cascade of events that lands Doreen in the hospital with thousands of dollars in costs for care that aren't covered by Medicare.

Nursing Homes Toss 740 Tons of Unused Drugs
When nursing home residents die or are transferred to the hospital, nursing homes typically dispose of their unused drugs. According to the Environmental Protection Agency, the annual gross weight of destroyed drugs totals about 740 tons. ProPublica recently published an article on this phenomenon. 

Drug Topics: Are Pharmacist Prescribing Rights Worth it?
There has been a loud cry for pharmacists to have increased authorization to practice and bill for services. However, with added authority comes added responsibility. Are we up to it? See Article

Seniors Need Help in Managing Drugs
Health Day reports on a Dutch study, published in the Journal of the American Geriatrics Society, that suggests that more than a third of seniors aged 85 and older need help in managing their medications. Among seniors aged 65-69 the percentage is still approximately 10 percent. 

IMS Quintiles: Medicines Use and Spending in the US
The Quintiles IMS Institute has released its annual report on the use of medicines in the US. This informative report examines national spending and trends in the use of medicines by residents of the United States and the impact of new therapies, as well as the impact of patent expirations. 

Medicare Beneficiaries Often Unable to Access Home Care
Although Medicare does have a limited home care benefit, it may be difficult to find a provider because of complicated Medicare rules and relatively low payment rate. PBS has an overview of why Medicare beneficiaries who qualify for this benefit may have a very difficult time in obtaining access.

Kaiser Reports on End-of-Life Care in the US
The Kaiser Family Foundation, in partnership with The Economist, conducted a survey on Americans' views on medical care for the aged and dying. The survey examined the respondents' views on who should bear responsibility for end-of-life care and the fear that their care will pose a financial burden on their families. 

What's a 1332 Waiver?
Lots of Beltway chatter these days about reforming (repealing and replacing) the Affordable Care Act. Until that mission is completed, the Trump Administration is encouraging states to look at pursuing ACA Section 1332 waivers to better manage cost and coverage under the current health insurance law.

If you've never heard of a 1332 waiver you have plenty of company. Fortunately, the folks at Oliver Wyman Health have provided us with a useful primer on this tool that may be used more frequently to allow states to customize health insurance for their citizens.

Spring Updates for your Pharmacy Marketing
Haven't updated your pharmacy marketing in awhile? Maybe it's time to do a bit of housekeeping. Look at this post from to see if a little spring cleaning is right for you.

Pharma Faces Major Patent Expirations
Pharmaceutical companies are facing patent expiration on drugs totaling more than $26 billion in sales. Leading brands losing patent protection this year include Rituxan, Advair, and Vytorin. See Story in Fierce Pharma.

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