| LTC Pharmacy News
November 2023
Dear Pharmacists and Pharmacy Owners, I am thankful for many things during this season. Among them you, my faithful readers.
I hope you have a wonderful Thanksgiving weekend and enjoy time with those you love. Paul |
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| | | | Senate Finance Committee Votes to Endorse PBM Bill
The powerful Senate Finance Committee unanimously voted to approve The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which hands some relief to physicians on payment issues, addresses behavioral issues, as well as some modest provisions related to PBMs in the Medicare Drug benefit.
The legislation puts the "any willing pharmacy" provision that is now in a regulation, into law. The bill also empowers HHS to obtain information from PBMs on contract provisions for pharmacies and to use that information to create standards by regulation.
CMS Publishes Regulations and Proposals As the year draws to and end CMS is pushing out the remaining payment rules for 2024. Among them: - Medicare Advantage Program (MA), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. This proposed rule focuses on issues such as how brokers are to be paid for enrolling beneficiaries in Medicare plans, the availability of provider enrollment in behavioral health benefits and new requirements for MA plans on communicating around supplemental benefits. More
- Nursing Home Transparency Final Rule The final rule requires nursing homes enrolled in Medicare or Medicaid — the majority of this country’s nursing homes — to disclose additional information regarding their owners, operators, and management; for example, nursing homes will disclose individuals or entities that provide administrative services or clinical consulting services to the nursing homes. Nursing homes will also be required to disclose entities that exercise financial control over the facility, such as an organization the nursing home hires to manage all of its financial matters. More
- Calendar Year 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared
Savings Program Requirements; Medicare Advantage; Medicare and
Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program Federal Register
Health Care Fraud and Abuse Control Program Fiscal Year 2022 Report
The National Health Care Fraud and Abuse Control Program is designed to coordinate Federal, State, and local law enforcement activities with respect to health care fraud and abuse. The program is under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services, acting through HHS-OIG. Report
2023 Top Management & Performance Challenges Facing HHS
OIG has identified five top management and performance challenges (TMCs) that the Department of Health and Human Services (HHS) faces as it strives to fulfill its mission to enhance the health and well-being of all Americans. These top challenges reflect overarching issues that affect multiple HHS programs and responsibilities, though these are not the only challenges that confront HHS. OIG reports are a key resource that highlights specific opportunities to improve HHS programs and operations. More
Expanded Home-Health Value-Based Purchasing Model Building upon experience from the original Home Health Value-Based Purchasing Model (HHVBP Model), this page provides information, resources, and technical assistance to support implementation of the expanded HHVBP Model nationwide.
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| | What's Happening in the States |
| | California Healthcare Legislation 2023
The California legislature has had a busy year, including activity related to the delivery of and payment for healthcare services. Check out this summary for more.
State Long-Term Care: Recent Developments and Policy Directions
This is a bit dated (June 2022), but it provides a helpful summary of the LTC environment in the states and was produced with the input of the National Conference of State Legislatures under the auspices of the HHS Assistant Secretary for Planning and Evaluation |
| | | | Cigna Reported to Consider Selling MA Plans
A news report from Reuters says it looks like insurance giant Cigna is considering the sale of its Medicare Advantage (MA) business. Cigna has been a major player in the MA business but speculation is that recent federal moves to pull back on spending may have persuaded the company to consider shedding the Medicare plans. The insurer recently agreed to settle charges by the feds that it had inflated MA claims. The company will pay Medicare $179 million.
Flu Season Milder This Year? A rare piece of good news in a sea of crises: this year's flu season may not be as bad as some expected. Based on what our neighbors in the southern hemisphere have experienced, as their winter draws to a close, the seasonal flu season in the northern hemisphere (our home) may not be as it could be. The vaccine we're using appears to be quite effective against the most active strains. More
Getting Senior Living Residents Vaccinated is a Struggle While FDA has approved a new COVID-19 vaccine, along with the new RSV and flu vaccine, getting seniors in these communities vaccinated has become a challenge. Operators cite reluctance from LTC pharmacies, local health departments and retail pharmacies lead the list of problems. Pharmacies face uncertainty concerning reimbursement and vaccine availability. Community staff members continue to be reluctant to embrace immunization.
World Population Hits New Milestone While we go about our day, tending to our work and families, the human population of the planet continues its relentless growth, having reached a major milestone, sometime in September (or maybe in November, 2022).
Will Elder Care Break US? Not news to you that the nation is getting older. Also, not news to you that long-term care is increasingly expensive. But, did you realize how bad this is? An article in Kaiser Health News puts the situation in stark terms and warns that is will only get worse as the country continues to age and as seniors to continue to outlive their bank accounts.
Express Scripts Sued by Independent Pharmacies Four independent pharmacies, located in Wisconsin and Minnesota and New Jersey, have filed a class-action antitrust complaint against Express Scripts, alleging the company conspired with Prime Therapeutics to reduce reimbursements to pharmacy.. More
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