LTC Pharmacy News

April 2024

April is one of the busiest months for regulatory aficionados. CMS pushes out final payment rules, and this year we also got a final rule on overtime pay from the Labor Dept.

The result has been a triple blow to the nursing home and home care industries. The long-awaited minimum staffing rule from CMS will result in massively increased cost for nursing homes and the Medicaid Access rule will give the same treatment for home care agencies. The Labor overtime rule hits both industries, as well as several others.

Meanwhile, the CHANGE Healthcare data hack has begun affecting LTC pharmacy owners, forced to look for financing to stay alive until the damage get's unwound. 

The only happy note:  It's Spring!
AmplifyLTC Conference Registration Open
RedSail Technologies announces the inaugural AmplifyLTC Conference for LTC Pharmacies in Nashville from May 16-19. The agenda is non-stop LTC Pharmacy. You don't want to miss this.
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Federal News and Updates
Biden Administration Releases Minimum Staffing Rule for Nursing Homes
After much anticipation, The Biden Administration announced the release of the Final Rule for Nursing Home staffing for facilities that accept payment under the Medicare and Medicaid programs. The industry's worst fears were realized as the new staffing minimum is 3.48 hours of nursing care per day per resident, .55 hours of which must be administered by a registered nurse and the remainder by a certified nursing assistant. 

Medicaid Access Final Rule Released
CMS released the final Assuring Access To Medicaid Services rule. The rule requires, among other provisions, that nursing homes spend a minimum of 80 percent of payments for home and community-based services (HCBS) be devoted to compensation for direct care workers. Nursing home industry groups reacted quickly, suggesting that this provision will discourage providers (especially assisted living facilities) from participating in HCBS programs. 

CMS Issues Part D and MA Payment Policies for 2025
CMS released the final Part D and Medicare Advantage payment policies for 2025. The document implements changes included in the inflation reduction act, including a $2000 annual out-of-pocket cap for beneficiaries. MA plans will receive a 3.7% ($16 billion) increase in payments from 2024 levels. 

MA Plans slammed the announcement as inadequate, noting that MA plans experienced a 7% increase in costs in 2023 and the new rates will leave plans strapped to care for beneficiaries.

Part D Updates
In the same announcement, CMS announced the implementation of the $2000 cap on out-of-pocket payments and updating the Risk Adjustment model to include more recent years of data.

CMS Requests Information on NTA Data in SNF Proposed Payment Rule
The annual proposed rule on payment updates for Medicare Part A payments for SNF services has been released. Among the items of interest is CMS' request for information on its proposal to update the sources for calculating non-therapy ancillary (NTA) costs. The drug component of the payment formula is in this section. Take a look at the document page 23459 for details.

Labor Department Overtime Final Rule Released
The Dept of Labor released its final rule on worker protections on overtime pay, establishing a threshold of $43,888 for salaried workers to be exempt from overtime pay requirements, up from the current $35,568. The threshold will increase to $53,656 in January. More

GAO: Save Billions in Medicare Through Site-Neutral Payments
The Government Accountability Office released a report on ways for the agency to dramatically reduce overspending on services, including the implementation of site-neutral payment policies. Other suggestions include provider screening and pre-payment claim reviews. Combined, Medicare and Medicaid experience more than $100 billion in payment errors per year.  More

Medicare's Chronic Disease Management Program: Docs Not Joining
Two-thirds of Medicare beneficiaries have at least two chronic medical conditions. Even though Medicare pays physicians to participate in its management program, they aren't signing up. More

DOJ, HHS and FTC Create Portal to Report Anti-competitive Practices
If you have run across examples of anti-competitive behavior in healthcare, the feds want to hear your story and have created a web portal to make it easier. The page includes representative examples of what might constitute such behavior.

Census Bureau Reports on 2022 Congressional Mid-Term Election
Although record numbers of citizens registered to vote in the 2022 mid-term election, fewer people actually voted than in the previous mid-term contest. Seniors and college-educated voters voted in higher proportions than their populations. Does data like this interest you? Check out the Census report.
What's Happening in the States
NASHP Posts State Legislation to Lower Rx Drug Cost
The National Academy for State Health Policy has updated its tracking file on state legislation to lower prescription drug costs.
Everything Else
LTC Pharmacies Forced to Borrow Money to Supply Drugs reports that the continuing consolidation in the PBM industry has resulted in reimbursement that is crippling LTC pharmacies' ability to provide prescribed medications to LTC residents. Some pharmacies are able to borrow to fill the gap between acquisition cost and reimbursement while others have been forced to close.

Surescripts Announces Continued Progress in Interoperability
Surescripts has issued its annual National Progress Report on health intelligence sharing for 2023. The report documents the ongoing effort to allow authorized clinicians to receive and transmit EMR data and improve access for patients living in areas of primary care shortage.

19 MillionMedicaid Recipients Culled From Rolls
States are required to confirm Medicaid recipient eligibility for continued enrollment every 12 months. The requirement was suspended during the Public Health Emergency but one year ago the requirement was reinstated. So far, the process has resulted in more than 19 million individuals losing coverage, despite efforts from the federal government to discourage kicking people off the rolls...more

UnitedHealth Group Says Many Americans Had information Stolen
Without disclosing exact numbers, UnitedHealth announced the a "substantial proportion" of people in America had their healthcare and personal information stolen during the Change Healthcare hack. Despite paying the hackers a ransom, the system has not fully recovered and UnitedHealth says it will take several months to get a full analysis of the impact of the intrusion. More

Guardian and Heartland Partner to Expand Pharmacy Access West
Guardian Pharmacy Services (now 20 years old!) announces a partnership with Heartland LTC Pharmacy that expands access to services in seven western states for residents in SNFs, ALFs, behavioral health facilities and facilities for individuals with intellectual and developmental disabilities.  More

The Change Healthcare Cyberattack Cost United Healthcare How Much?
The February cyberattack against United Healthcare's Change Healthcare unit is reported by United to cost upwards of $1.6 billion in 2024. More

Increased Telemedicine Use Equals Higher SNF Spending?
Skilled Nursing News reports on a Health Affairs article that claims an association between hospital systems with high telemedicine use and higher SNF spending. The authors aren't ready to make a cause-and-effect argument, but their speculations seem reasonable. More