LTC Pharmacy News
October 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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New: 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.

What's in the Opioid Bill?
The House of Representatives Committee on Energy and Commerce Subcommittee has released an analysis of the massive SUPPORT for Patients and Communities Act. The bill breaks new ground in Treatment and Recovery, Prevention, Protecting Communities, and Fighting Fentanyl, according to senior members of the committee. President Trump has signed the legislation into law.

President Trump Signs Anti-Gag Clause Legislation
President Trump has signed legislation that prohibits contracts between PBMs and pharmacies that prohibit pharmacists from providing information to consumers on lower drug price options at point of sale. The Know the Lowest Price Act of 2018 was passed by large bipartisan Congressional majorities and was quickly signed into law by the president. House Energy and Commerce Committee
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Federal Agency News
HHS Announces Effort to Tie US Drug Prices to International Prices
“President Trump promised that he would bring down drug prices and put American patients first,” said HHS Secretary Alex Azar. “With this innovative approach, he is now proposing historic changes to how Medicare pays for some of the most expensive prescription drugs, securing for the American people a share of the price concessions that drug makers voluntarily give to other countries.” (HHS Press Release)

Policy brief on the ANPRM
Fact sheet on the ANRPM
The ANPRM can be downloaded here

MedPAC Announces Updated Payment Basics Series
The Medicare Payment Advisory Commission announced updated versions of its popular and informative Payment Basics series, defining how Medicare payment systems work in under the Medicare program.

Dept. of Justice Approves CVS/Aetna Merger
The Dept. of Justice announced that it would not challenge the proposed merger of CVS Health and Aetna Insurance. The agency requires that Aetna divest its Part D plans, which the company has already agreed to do. CVS commented that it plans to deploy its pharmacists to influence enrollees with chronic medical conditions.
Healthcare Dive

CMS Posts Proposed Rule on Disclosure of Drug Prices
CMS announced a proposed rule that would require drug manufacturers to disclose drug prices in their direct-to-consumer advertising.
"As part of the agency’s ongoing efforts to empower patients and lower prescription drug prices, the Centers for Medicare & Medicaid Services proposed today to require that prescription drug manufacturers post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in direct-to-consumer television advertisements."

2019 Medicare Parts A & B Premiums and Deductibles
On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, an increase of $1.50 from $134 in 2018. See More

FDA Turns Its Attention to Compounding, Revises Draft MOU
FDA has posted a newly-revised Memorandum of Understanding that would revise the percentage of a pharmacy's compounded drugs delivered out-of-state subject to state identification from 30 percent to 50 percent. 

GAO Reports on Home and Community-Based Services
The Government Accountability Office released a report highlighting the challenges states experience in delivering long-term services and supports in the wake of low wages and difficulty in recruiting workers. GAO examines state efforts to respond to these challenges.
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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
Argentum Lists Largest Senior Living Operators
McKnight's Senior Living  The list of the largest senior living operators hasn't changed since last year, with Brookdale Senior Living continuing to outpace its competitors. National Senior Campuses holds the lead as the nation's largest not-for-profit provider. 

Medicare Advantage Plans Continue Momentum
Kaiser Health News. Despite predictions that the Affordable Care Act would prove fatal to Medicare Part C plans, recent enrollments and new plan availability has demonstrated an eagerness for seniors to sign up for new offerings. Seniors seem to be drawn by supplemental benefits not available under traditional Medicare.

CMS Chief on Medicare Advantage LTC Benefits
CMS Administrator Seema Verma discussed CMS' new stance on allowing Medicare Advantage plans to offer supplemental benefits, including non-medical aid to seniors. Verma expressed her hope that the private sector would prove especially innovative in delivering novel benefits to America's aging population. Think Advisor (Free Registration)

Non-Profit Skilled Facilities Selling Off
Skilled Nursing News. A shakeout appears to be underway as non-profit health organizations shed their skilled nursing facilities. The difficulty in finding staff and in securing vendor contracts has forced many non-profits to sell, often to for-profit companies.

Kaiser Updates Medicaid State Fact Sheets
The Kaiser Family Foundation has released its latest version of its popular Medicaid State Fact Sheets. The product is an interactive look at a host of statistics that shape the nation's largest public health programs. For example, did you know that 62 percent of certified nursing facility residents are Medicaid enrollees? 

Initial Assessment Key to PDPM Success
Skilled Nursing News:   According to experts, properly capturing and coding for resident medical condition upon admission will be key to SNF success under the new Patient Driven Payment Model, slated to take effect in October of 2019. Failure to capture all of a resident's conditions and limitations will have consequences in lower payment for the remainder of the SNF stay under Part A.

NIH Halloween Special: Fly-Through of a Mouse Skull
Although the National Institutes of Health is not known for frivolity, it seizes upon the season to take us on a journey through the skull of a mouse. Enjoy!

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