Jun 28, 2018 | Medicare, Post-Acute Care
Medicare spending often varies significantly by geography, despite a national fee schedule. In 2013, the Institute of Medicine (IOM) put forth a study finding significant geographic variation in spending, with 70% of variation explained by differences in post-acute care utilization patterns. Other organizations including CMS and Dartmouth have come to the same conclusions. Utilizing CMS’s most recent data, this brief contrasts two major cities in 2016, as well as 10-year change in Miami to the national average, to provide examples of these spending discrepancies. BRG analysis finds that...
Jun 27, 2018 | Home Health
CMS has proposed restarting home health pre-claim review in Illinois, North Carolina, Texas, and Florida. The demo is likely to start towards the end of 2018 or early 2019. The program is likely a meaningful administrative burden for smaller providers, but has the potential to improve claims processing for larger providers while reducing scrutiny of industry for fraud and abuse. Click to read more.
Jun 21, 2018 | Drugs, Medicaid, Medicaid Managed Care, Substance Abuse
In its June 2018 Report to Congress, the Medicaid and CHIP Payment and Access Commission made recommendations to change a Medicaid rebate loophole preventing states from paying the lowest price for certain drugs, and to clarify privacy requirements for people with substance use disorder that may inhibit care coordination. The report also addressed the growth of managed long-term services and supports and state coverage of substance use disorder services. Click to read more.
Jun 20, 2018 | Autism, Behavioral
The prevalence of autism spectrum disorder (ASD) has increased over the years, from about 1 in 150 children in 2000 to 1 in 59 in 2014, according to the CDC. While a broader ASD definition and improved diagnosis may explain some of this increase, experts note that a true increase in prevalence cannot be ruled out. Over the past decade, more and more states have required Medicaid and commercial plans to cover applied behavioral analysis (ABA), the leading type of autism service. We expect coverage rates to grow as states continue to expand services, such as New Jersey’s recently proposed...
