BRG Quarterly Compliance and Program Integrity Developments

Jan 18, 2022 | BRG Publications

The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the fourth quarter of 2021, we have taken particular note of: DOJ/HHS activity OIG Fall 2021 Semiannual Report to Congress OIG Data Brief on Genetic Testing Growth OIG Report - 2021 Top Management and Performance Challenges Facing HHS Two Comparative Billing Reports Two GAO reports OCR activity Approved and proposed additions to the RAC audit list Click to read...

Managed Care Friday

Jan 14, 2022 | Managed Care Friday

73: The percent of 20- to 35-year-olds in our poll of 652 consumers this month who say they don’t see themselves ever getting a colonoscopy and, for about 40 percent, the idea of the at-home test Cologuard “seems” like a better option, while a not-so-surprising 30 percent expect there to be an easier solution by the time they need to be screened for colon cancer. “There isn’t a pill yet? If not, there will be” says 27-year-old Caylee Parker of Springfield MA. Remove The Blues: Minnesota Blue is removing preapproval requirements for its commercial and Medicare members needing partial...

Medicare Advantage and Part D Proposed Rule For Contract Year 2023

Jan 13, 2022 | Drugs, Medicare Advantage, Part D, Pharmacy

On January 6, 2022, CMS released the proposed rule for Contract Year 2023 Policy and Technical Changes for MA and Medicare Prescription Drug (Part D) Programs. The proposed rule includes changes to network adequacy standards, dual eligible Special Needs Plans (D-SNPs), negotiated drug price in Part D, consumer information about MA plans, and oversight and transparency measures for third-party marketing operations (TPMOs). Click to read more.

Weekly Medicaid Update

Jan 12, 2022 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: Governor Newsom releases FY2022-23 proposed budget IL: Proposes rate increases for community-based behavioral health services PA: Proposes IDD waiver rate increases TN: Proposes to extend postpartum Medicaid coverage from 60 days to 12 months WA: Governor Inslee releases FY2021-23 budget amendment WI: DHS increases HCBS rates by +5% Click to read more.

Federal Policy Review 2021-2022

Jan 11, 2022 | BRG Publications

BRG’s annual Federal Policy Review is a guide to federal healthcare policy for 2021 and 2022. BRG’s policy experts review macro trends in healthcare spending and coverage, federal legislative efforts, and regulatory updates to each of the Medicare payment systems. Click to read more.