LTC Pharmacy News
September 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.
New LTC Pharmacy Marketing Newsletter Coming
You may have noticed that we didn't publish our newsletter in August. We weren't lounging at the beach, we were working on a new project to help LTC Pharmacy professionals expand their market and recruit new clients through the use of digital marketing. All Subscribers to LTC Pharmacy News will soon receive an email announcing the new site. You won't be automatically subscribed to the new publication, so if you're not interested, simply ignore that.

If you are interested in growing your enterprise this could be valuable. Keep your eyes open for the upcoming announcement.
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Proposed Changes to the Inpatient Only Rule Could Impact SNFs
CMS recently published a proposed rule on Hospital Outpatient Payment System updates and asked for comments on allowing hip and knee replacements to be performed in outpatient settings. Elise discusses the implications on nursing facilities if Medicare beneficiaries stop using SNFs for rehabilitation. See more here.

Getting to a Unified Post-Acute Care Payment System
Various Federal agencies have been working for years to come up with a unified payment system for post-acute care (PAC). In this paper, Elise gives us a much-needed history of the policy and its development, featuring the star players CMS and MedPAC. 

Why should you care? Your PAC customers have a lot riding on how the drama finally resolves. They care about this, and so should we. See more here.

CMS Reverses Its 2016 Position on Pre-Dispute Arbitration
On June 8, 2017, CMS issued a proposed rule that reversed its position prohibiting pre-dispute arbitration agreements in long term care facilities. This was the culmination of policy making and unmaking that, with respect to the latest clash on Skilled Nursing Facility/ Nursing Facility arbitration practice, started on October 4, 2016. See more here

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 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 Returns with Much to do
Following a lengthy August recess, Congress has returned to Washington, DC to take care of a few pressing concerns. The most immediate issue was raising the debt ceiling which, if it hadn't passed, would have restricted the federal government from borrowing money. President Trump, in a surprise move, made a deal with House and Senate Democrats to raise the ceiling and continue funding the government through mid-December. Republicans were generally not pleased, but the president noted that his party seemed unable to accomplish anything on its own, so he decided to work with Democrats.

Other items on the must-do list included reauthorizing the Children's Health Insurance Program and a host of arcane Medicare and Medicaid payment provisions that expire at the end of September or at the end of the year. 

Without question, the debt ceiling and the government funding authorization were the highest-profile issues. That's off the table now, so we'll see if Congress can complete its work before the end of the year.

House Ways and Means Panel Clears Medicare Bills
Ways and Means passed bills related to Medicare Advantage Telehealth, Stark Law Simplification and Ambulance Services. These bills all had bipartisan sponsorship and are also being considered in the Energy and Commerce Committee.

House Passes Home Infusion Temporary Payment Bill
The House passed HR 3178, which allows for a temporary payment schedule for drugs commonly used in home infusion settings. The bill provides a bridge between the reduction in payment for drugs as a result of a provision in the 21st Century Cures Act and the new Medicare Home Infusion Site of Care Act, which provisions were also included in the Act but do not become effective until 2021. The same legislation is being considered in the Senate. See Energy and Commerce memo and Senate Bill 1738.

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Federal Agency News
CMS Cancels Mandatory Bundled Payments
The Centers for Medicare and Medicaid Services has issued a proposed rule that would cancel the mandatory bundled payment programs, scheduled to go into effect January 2018. 
The press release notes the agency proposes to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas. Comments are due October 16th.

HHS Webinar: Aging and the Immune System: Rethinking Vaccines for Older Adults
The National Vaccine Program Office is sponsoring a webinar on September 26 on 
the subject of rethinking vaccines for older adults.The webinar will include 1 hour of presentations and a Q&A session. This event will also offer 1 hour of free continuing education.  See registration details here.

AHRQ Publishes  2016 Compendium of Health Systems
The Agency for Healthcare Research and Quality published its first compilation of US Health Systems, defined as at least one hospital and at least one group of physicians providing comprehensive care, and who are connected with each other and with the hospital through common ownership or joint management. AHRQ has identified 626 such systems in the US. See AHRQ

Educating Adults on Chronic Disease Self Management
The Adminstration for Community Living has published a briefing document on how professionals can best help people suffering from chronic disease and their loved ones best help them become more self sufficient.

IMPACT Act Special Open Door Forum: 
Thursday, September 28, 2017
This Special Open Door Forum (SODF) will provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). This SODF will focus on the goals of the IMPACT Act, update attendees on the RAND contract activities for item development, including pilot test results and plans for the upcoming national field test, and identify opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year.

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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
California Legislature Passes Restrictions on Drug Makers
Governor Jerry Brown now has to decide whether to sign a bill that would require drug manufacturers to provide justification for price increases and require health plans to report the most frequently-prescribed drugs, and the costliest drugs. Manufacturers fought a losing battle to prevent the legislation's passage. See LA Times.

Quintiles IMS New Report on Rx Drug Cost Drivers
Lots of discussion around drug pricing and who's to blame. Quintiles IMS Institute recently published a paper that provides some context around this incendiary topic, including the impact of negotiated pricing, the price consequences of patent erosion and prescription drug volume. See Understanding the Drivers of Drug Expenditure in the U.S.

NASP Publishes StopDirFees website
The National Association of Specialty Pharmacy announced the creation of a new website to promote its efforts to limit PBM ability to impose DIR fees. The site is

Do You Have a Disaster Plan? 
Hurricanes Harvey and Irma inevitably force us to ask the Boy Scout question: Are you prepared? Drug Topics features a report from the International Pharmaceutical Federation suggesting that having a disaster plan is a good idea. Sadly, most of us think of this about as seriously as we do about changing the batteries in our smoke detectors. 

Kaiser Surveys Section 1115 Pending and Approved Waivers
If someone asked you about a state's Medicaid waiver, could you answer? Well, now you can, thanks to the Kaiser Family Foundation's recent survey of Section 1115 waivers. Even if you're not sure what an 1115 waiver does, Kaiser has you covered. See the survey.

Nursing Home Census Continues Slide 
The National Investment Center for Seniors Housing & Care (NIC) released its report on skilled nursing facilities for the second quarter of 2017, demonstrating the lowest occupancy rate in five years and decreasing Medicare days. See Report.

Nursing Homes Slower to Adopt EHRs than Acute Care
While 64% of Skilled Nursing Facilities use electronic health records, rates of adoption general are lower than acute care facilities, according to an article in Health Data Management. The Office of National Coordinator suggests that slower adoption is because SNFs are barred from receiving financial incentives for adoption.

FTC Approves Walgreens Acquisition of Rite Aid Stores
Bloomberg reports that the Federal Trade Commission has approved Walgreens acquisition of more than 2,000 stores.

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