LTC Pharmacy News
September 27, 2010
Elise Reports on MedPAC Work on Unified Post-Acute Care Model
Post-acute care rules and payment policy is dependent on where the care is delivered. The Medicare Payment Advisory Commission (MedPAC) is charged with making recommendations on how to create a single policy. Elise reports on the agency's latest discussions.
More From Elise Smith
If you have missed any of Elise Smith's insights on federal payment policy for long-term care, check out Elise's page at
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House Democrats Introduce Drug Pricing Plan
House Speaker Nancy Pelosi announced the introduction of legislation that would impose severe restrictions on prescription drug pricing. Among other provisions, the bill would require Medicare to negotiate prices for Medicare Parts B and D and impose penalties on manufacturers if they refused to negotiate. In addition, drug makers would face limits on price increases. Medicare beneficiaries would be limited to $2,000 in annual out-of-pocket drug expenses.
Federal Agency Updates
CMS Issues Benefit and Cost Info for Medicare Drug Benefit 2020
CMS completed the final step in preparation for kicking off the 2020 Medicare enrollment season. Officials announced that Medicare Advantage premiums would decline 14 percent from 2019 and Medicare Part D premiums are down 13.5 percent over last year;

CMS goes on to announce that more than 500 Medicare Advantage plans have supplemental benefits included, which CMS first authorized in 2019 to help keep beneficiaries out of the hospital, nursing homes and other expensive care venues.

Take a look at the Part D and Medicare Advantage landscape files for more information on which plans are available, by state.

Post-Acute Care and Hospice Provider Data 2017
The Centers for Medicare and Medicaid Services (CMS) posted the first annual release of the Post-Acute Care and Hospice Utilization and Payment Public Use Files (herein known as “PAC PUF”) with data for 2017.
The PAC PUF replaces the Home Health, Hospice, and skilled nursing facilities (SNF) Utilization and Payment PUFs released in past years. The PAC PUF has a number of improvements over these earlier files including data for inpatient rehabilitation facilities (IRF) and long-term care hospitals (LTCH), a number of new metrics, and standardized metrics across all PAC and hospice settings.
CMS Publishes Final Discharge Planning Rule
The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that empowers patients preparing to move from acute care into post-acute care (PAC), a process called “discharge planning.”

The rule also implements requirements from the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) that includes how facilities will account for and document a patient’s goals of care and treatment preferences.).
CMS Releases Final RAI Manual for PDPM
CMS has published the final MDS Resident Assessment Instrument Manual for the new Patient-Driven Payment Model.
See CMS Presentation, beginning on page 52
GAO Reports

Elder Abuse:  Federal Requirements for Oversight in Nursing Homes and Assisted Living Facilities Differ

Healthcare Quality
CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives

Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries

Medicare Part D
Use of Pharmacy Benefit Managers and Efforts to Manage Drug Expenditures and Utilization.
HHS Inspector General Reports

Some Medicare Part D Beneficiaries Face Avoidable Extra Steps That Can Delay or Prevent Access to Prescribed Drugs

Medicare Incorrectly Paid Providers for Emergency Ambulance Transports From Hospitals to Skilled                                                Nursing Facilities
                                         See Report

Rebates for Brand Name Drugs in Part D Substantially Reduced the Growth in Spending from 2011 to 2015
Everything Else
Best Buy to Target Seniors with Tech
America's largest technology retailer has big plans to supply America's seniors with technology solutions to help maintain their independence longer. 
Best Buy sees real opportunity in serving the senior population and has been aggressively buying up promising companies that can help it succeed.
We May Know the Impact of PDPM Early Next Year
HCR ManorCare's VP of Reimbursement believes we will have a good picture of the impact of moving to the new Medicare Part A payment system by Q1 2020. The change takes place October 1st on the first day of the new federal fiscal year. Medicare Part A SNF services will no longer be covered under the RUGs methodology, but will be covered under the new Patient Driven Payment Model.
Employer-sponsored Family Health Insurance Premiums Top $20K
The Kaiser Family Foundation is out with its annual report on employer health benefits and the data show an increase of 5 percent in cost, resulting in a $20,000 per year tab per employee for health insurance.
Medicare Advantage Plans Slow to Add Supplemental Benefits
Last year, CMS allowed Medicare Advantage plans to offer supplemental benefits to their enrollees for services that were not strictly healthcare related in order to help beneficiaries to avoid more serious conditions.

For those who have added benefits, meal delivery and adult day care services have been the most popular.

Senators Want Answers on Medicaid LTSS

Senators Chuck Grassley (R-IZ) and Bob Casey (D-PA) have asked CMS and non-governmental quality review organizations to provide information on how state Medicaid programs and CMS ensure quality and oversight for beneficiaries who receive home and community-based care through managed Medicaid programs.
Demographic Wave May Not Save SNFS
Just because America continues to get older doesn't necessarily mean that the fortunes of the nation's nursing homes will improve as a result. Several industry watchers continue to believe that operational excellence will separate the successful facilities and poorly-run operations are unlikely to stay afloat simply because the demographics are in their favor.