LTC Pharmacy News
November 2016
Long Term Care Pharmacy, like the rest of the healthcare industry, experiences constant change, from new legislation to changes in existing regulation, it's hard to keep up. Make your life a little easier by keeping in touch through
See Video Overview of Final LTC Facility Rule
The long-awaited CMS final rule on long term care facilities has been published. Take a tour of the pharmacy-related provisions here.

We also have a video overview of the CMS SNF PPS Final Rule for FY 2017

Elise Smith Joins LTC Pharmacy News
If you've been in the long term care industry for any length of time you are probably familiar with Elise Smith, long time Senior Vice President of Finance Policy and Legal Affairs at the American Health Care Association until her recent retirement.

She has a longstanding interest in the Medicare and Medicaid programs and became an expert on the pharmacy side of the industry during the implementation of the Medicare Modernization Act, which created the prescription drug benefit. 

We are honored to have Elise working with us. She brings a depth of knowledge that is unequaled in the industry. 

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CMS Publishes Advance Copy of SOM Revisions
Following the publication of the final rule on long-term care facilities, CMS has published an advance copy of changes to the State Operations Manual, the document that gives specific guidance for nursing facility staff and state surveyors on how to evaluate performance relative to the requirements. The document is a daunting 800-plus pages, but Elise has put together a quick memo to guide you along the way.
AHRQ 2016 Nursing Home User Comparative Database Report
AHRQ’s Nursing Home Survey on Patient Safety Culture: 2016 User Comparative Database Report is now available and provides results from 209 nursing homes and 12,395 nursing home staff respondents. Results are compared by characteristics of the participating nursing home including nursing home bed size, ownership, urban/rural status, and census region, and respondent characteristics that include job title, work area, interaction with residents, hours worked per week, shift, and tenure with the nursing home.

CMS Requests Information on Accelerating Home and Community Care
The Centers for Medicare and Medicaid Services published a request for information and data on ideas to accelerate the provision of home and community-based services to Medicaid enrollees, taking into account the issues affecting beneficiary choice and control, program integrity, ratesetting, quality infrastructure, and the homecare workforce.

The comment deadline is January 9, 2017

New AHRQ Guide Helps Nursing Homes Tackle Antimicrobial Stewardship
AHRQ’s new Nursing Home Antimicrobial Stewardship Guide is a research-based resource that offers step-by-step instructions and materials to help nursing homes improve antibiotic use and decrease harms caused by inappropriate prescribing.

ACL Publishes Final Rule on Independent Living
The Agency for Community Living (ACL) published the final rule implementing provisions of the Workforce Innovation and Opportunity Act (WIOA), transferring the Independent Living programs, the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), and the Assistive Technology programs to ACL, and creating the Independent Living Administration.

Among the provisions of the rule is a requirement that all centers for independent living "Facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based settings. This includes providing consumer-controlled supports and services and the advocacy needed to move from an institutional setting to community-based setting."

HCUP 2014 National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) Released
The The Healthcare Cost and Utilization Project (HCUP) announces the release of two databases:

The 2014 National Inpatient Sample (NIS) is the largest publicly available all-payer inpatient health care database in the United States. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

The 2014 Nationwide Readmissions Database (NRD) is a unique and powerful database designed to support various types of analyses of national readmission rates for all payers and the uninsured.

CMS Delays Mandatory Part D Enrollment for Prescribers
Concerned that not all prescribers are aware of the requirement that they be enrolled in the Medicare Part D program in order to prescribe medications for Part D enrollees, CMS has delayed the requirement until January, 2019. See Modern Healthcare story
Congress Currently in Lame Duck
Congress is currently in lame duck session and will be in recess during Thanksgiving week, to return the following week to finish legislative business for the year.

How The New Administration and Congress Impact LTC Pharmacy
Although it's early, we can make a few assumptions about what's ahead for LTC pharmacy with the new Congress and Administration. Take a look at the Baldwin Health Policy Group take on what's coming.

Trump and Long Term Care
Washington think tanks, lobbying shops and pundits are scrambling to figure out what impact the President-elect will have on healthcare, taxes, regulation and immigration. Unlike everyone else in DC who pretend to know, I will confess I have no idea. There is no record of candidate Trump ever making a point about long term care, but he did say he had no plans to fool around with Medicare.

McKnight's posted a recent article featuring leadership from AHCA, NASL and ASCP on what we're likely to see. They are, no doubt, more prescient as I when it comes to seeing the changes ahead.

Senators Unveil Chronic Care Draft Bill
McKnight's reports that key members of the Senate Finance Committee have put together a discussion draft of legislation that would build on the ACA's Independence at Home demonstration project and expand access to renal dialysis at home, as well as expanded access to Special Needs Plans in Medicare Managed Care. Expansion of Telehealth is also a key part of the proposal.
Federal Agency News
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
Updates and Tips on Pharmaceutical Waste
Although the EPA appears to have no immediate plans to publish a final rule, the issue of managing hazardous pharmaceutical waste has been on the agenda for some time. This article from Pharmacy Practice News provides a concise update on the problem and an overview of the proposed rule.

Kaiser Updates Health Facility Database
If you've ever wondered how many nursing homes there are in your state, or how many skilled nursing facility days Medicare paid for or how much Medicaid pays per year for a dual eligible, you may want to check out Kaiser's State Health Facts. Although the data can be a bit old, this is a great resource for helping to understand the way seniors use healthcare services in the United States and how that looks at the state level. 

Pew Research Center Analyzes How We Voted
The prestigious Pew Research Center took a detailed look at how Americans voted in the recent election. Everything from differences in voting patterns based on education and religion, to how issues were perceived as either important, or not. 

HCCI Examines Rehospitalization Trends in Medicare Advantage: The Health Care Cost Institute published a data brief focused on the trends in hospital readmission in Medicare Advantage plans during the years 2010-14. The data brief examines readmissions for five major conditions, including acute myocardial infarction, COPD, congestive heart failure and pneumonia. 

Handling of Hazardous Pharmaceuticals
You may be aware that USP has updated the requirements for handling of hazardous drugs under a  new Chapter 800. The update was published in February, 2016 and becomes effective in July, 2018. Pharmacy Practice News has a good overview of the requirements in its October 23 issue. 

The Rise of Pharmacy Robots
CNBC Profiles the rising demand for pharmacy automation services, including robotic medication dispensing and packaging machines. Proponents argue that machines are less likely to make errors in dispensing and can fill orders far faster than humans. The pharmacy automation industry, currently valued at $2.5 billion per year, is set to increase to $5.5 billion by 2021.

Why Medicare Advantage Plans May not Want Duals
It turns out that Medicare/Medicaid dual eligible members tend to drag down the performance scores of Medicare Advantage plans, contributing to lower payments from CMS. The problem is detailed in a story in Modern Healthcare, which refers to a study by that correlates lower quality scores to enrollment by significant numbers of dual eligibles. The article also notes that states have had difficulty recruiting insurers to establish plans for dual eligibles and suggests that this may be a contributing factor.

Pictures Improve Prescription Adherence
The American Journal of Pharmacy Benefits reports on a study of 50 adults aged 65-84 and provided the sample group with pictograms of medication instructions. This cohort had a higher understanding of the instructions than those who received only plain text instructions.

What Really Matters to Healthcare Consumers
Just when we thought we had this all figured out, Deloitte publishes a comprehensive study of consumers revealing that they value personalized care and economically rational coverage and choices more than they value technology-enabled convenience and access. See the Deloitte 2016 Consumer Priorities in Health Care Survey.

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