LTC Pharmacy News
November 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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Introduction to PDPM for LTC Pharmacy Professionals
If you're not quite sure about the new Medicare SNF payment model, scheduled to take effect next October, take a look at our new Tutorial. This is a summary of the new payment model focused primarily on pharmacy professionals.
CMS Publishes Final SNF PPS Rule for 2019: PDPM Approved
The long-awaited final PPS rule has been published. Elise has been through it with her usual attention to detail and reports on the changes that will take place beginning in October of 2019. This rule represents a major shift in incentives for SNFs; away from a focus on therapy to a new emphasis on the objective medical needs of the residents.
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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.

Democrats Take House: What's Ahead
As expected, the Democrats won a majority in The House of Representatives as a result of the November election. Republicans expanded their Senate majority, although the final numbers await a recount in Florida. 

Capitol Hill watchers predict that a divided Congress and a Republican Administration will yield few legislative advances for either party. Some suggest that states may become the locus for action, while the Trump Administration will advance its agenda through regulatory action at CMS and FDA. 

Voters said they wanted action on drug prices, an issue on which House Democrats and the President Trump may find common ground.

House Democrats to Fight Against High Drug Prices
On the heels of their historic win in the recent elections, House Democrats vow to protect pre-existing conditions in the Affordable Care Act and to pursue efforts to rein in prescription drug prices. Washington Post
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Federal Agency News

MS Publishes Final DME Rule
CMS Published the Final Rule on Competitive Bidding on November 14th. The rule includes changes to the competitive bidding program, new payment classes for oxygen and adjustments to the fee schedule. See BRG Overview for a summary

Newly-Authorized Medicare Advantage Services Not Widely Available
CMS authorized new services that Medicare Advantage plans could include that would make it easier for seniors to live at home, including home assistance services and medical appointment transportation. Kaiser Health News reports that there are only 271 plans, out of a total over more than 3700, that will offer these supplemental services in 2019. It won't be easy for Medicare beneficiaries to search for these plans on the Medicare website, as details are not readily available. 

CMS Administrator Speaks on Protected Classes in Part D
CMS Administrator Seema Verma, speaking at Biopharma Congress, indicated that CMS has its eye on the current requirement that Part D plans cover all, or nearly all, drugs in the so-called protected classes. Verma noted that special status bestowed on these classes has resulted in lower than normal discounts.

ACL Launches Updated Eldercare Locator
The Administration for Community Living announced the launch of its newly redesigned Eldercare Locator website. Located online at, the updated website makes it easier for older adults and their caregivers to find essential aging resources. New features include:
  • A mobile-optimized design to easily access the Eldercare Locator on a computer, phone, or tablet
  • A geographical search bar allows visitors to search for local aging resources from any page on the site
  • Caregiver Corner with answers to the most frequently asked questions the Eldercare Locator Call Center receives from caregivers
  • A new “Learn More About” section that provides information on popular topics like transportation, support services, elder rights, housing, health, and insurance and benefits
  • A centralized location that enables older adults and caregivers access Eldercare Locator brochures on topics important to their health and well-being
Administration for Community Living

CMS Posts Proposed Rule on Medicaid Managed Care
CMS published a proposed rule that would amend current standards for Medicaid managed care, including contract standardization, rate development, provider payments and medical loss ratio requirements. Comments are due January 14, 2019.

DEA Releases 2018 National Drug Threat Assessment
DEA Acting Administrator Uttam Dhillon announced results of the 2018 National Drug Threat Assessment, which outlines the threats posed to the United States by domestic and international drug trafficking and the abuse of illicit drugs.

CMS Publishes Final Home Health and Home Infusion Rule
CMS published its final rule on Medicare Home Health PPS and Home Infusion for 2019. The rule proved disappointing for Home Infusion companies, as it limited payment for services to only those days in which a professional nurse was present. 

USPTF Annual Report to Congress
The The U.S. Preventive Services Task Force has released its annual Report to Congress. The report highlights seven recent topics related to cancer prevention and cardiovascular health, the leading causes of death among adults in the United States, for which more research is needed. The report also calls for more research in populations who are disproportionately affected by these conditions, yet often underrepresented in studies. Future research in these areas can help fill these gaps and could result in important new recommendations that will help to improve the health of Americans.

Census Bureau: A Snapshot of the Older US Population
The growth of the U.S. population age 65 and older exceeds that of the total population and the popula­tion under age 65. So what does it mean to be a part of this increasingly larger segment of American society? 
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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
HHS Updates Guidelines on Physical Activity
According to HHS, Americans are generally not active enough. Only 26 percent of men, 19 percent of women and 20 percent of adolescents get the recommended amount of physical activity. HHS has updated its recommendations and encourages you to get active.

Looks Like Managed Care Chooses SNFs Based on Cost
McKnight's.   McKnight's Long-Term Care News reports on a study by UC Berkeley and UC San Francisco examining programs for dual eligibles. The analysis showed that network skilled nursing facilities generally had lower quality scores than non-network facilities.

Empty Beds and Closed Nursing Homes
NY Times:     It's a story we're familiar with. Nursing home census down and nursing homes closing. We know this as healthcare professionals but don't always see it from the local viewpoint. This story brings us a bit closer to life as it is when facilities close. 

A Machine That Can Diagnose Without a Doctor
Modern Healthcare. You probably knew the day would come when the machines would start making decisions. It has arrived. The FDA recently approved software that screens images for diabetic retinopathy, makes the diagnosis and sets up an appointment with an ophthalmologist, all without intervention from the primary care physician. The system is called IDx-DR, and it's 

Kaiser Survey of Employer Health Benefits 2018
The Kaiser Family Foundation has published its annual survey of employer-sponsored health benefits. Did you every wonder how your employer benefits stack up to others?
Wonder no more. The survey reveals that employers and employees spend an average of nearly $20,000 per year on health benefits. Check into this resource to see how employers arrange for coverage of office visits and prescription drugs.

Assisted Living Regulatory Update
McKnight's: Assisted Living is generally regulated by states and the states have been busy over the course of a year to impose new regulations on the industry. Most activity has been focused on staffing issues and compliance with federal requirements related to Medicaid. The report is a project of NCAL.

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