Aug 2, 2018 | ASC, Outpatient
Outpatient Hospital and Ambulatory Surgical Center proposed rules for CY 2019 have been released. The outpatient proposal is effectively a net zero update: a +1.25% rate update is offset by a reduction to the facility fees associated with clinic visits, which has a -1.2% impact on payments. The rule also refines payment policies related to 340B drugs, off-campus clinics, and non-opioid pain medications. The ASC proposal is a significant positive for the industry. The rule proposes a net +2% update for 2019 based on the hospital market basket instead of the CPI-U that has previously been...
Jul 31, 2018 | Dental, Medicaid, Medicaid Managed Care
Florida recently announced contract awards to 3 managed care organizations (MCOs) to provide dental care, and Texas released a Request for Proposals (RFP) for dental MCOs for Texas Children's Medicaid and CHIP. Florida's dental MCOs are to be fully implemented by March 1, 2019. Texas' deadline for proposals is September 7, 2018, and the State plans to award at least 2 dental MCO contracts for 2020 through 2022. Click to read more.
Jul 30, 2018 | Physician Fee Schedule, Physicians
The recently released proposed Physician Fee Schedule (PFS) for calendar year 2019 is estimated by CMS to reduce pathology specialty codes by a net -1% for next year. However, while the net change is basically neutral overall, some key codes are seeing significant changes due to a CMS update of input prices for basic office supplies and equipment for the first time since 2004. Click to read more.
Jul 26, 2018 | Legislation/ Budgets/ Macro
Federal debt and entitlement trust fund insolvency is likely to negatively impact federal healthcare spending starting in the mid-2020s and continuing into the 2030s. Both CBO and the Social Security and Medicare Trustees have published their annual forecasts of the fiscal posture of the Federal Government. CBO examines the entire government and the US economy. The Trustees focus on Medicare and Social Security programs, which constitute almost half of federal spending. Both reports project difficulties for the specific programs and the entire federal government. The programs face insolvency...
Jul 25, 2018 | Behavioral, Substance Abuse
The Affordable Care Act designated mental health and substance use services as essential health benefits in Marketplace plans and also extended parity requirements to the individual and small-group markets. This brief highlights a recent Health Affairs study that analyzed the extent to which the law improved coverage for these services. Read more here.
