Managed Care Friday

Nov 12, 2021 | Managed Care Friday

40: Percent of coverage policies with step therapy protocols for getting medications, according to a recent study published by Health Affairs. Using data that covers 17 of the 20 largest payers in the US, the study shows that more payers are implementing step therapy protocols for certain diseases compared to previous years, and some payers’ plans may be stricter than needed. Those with step therapy protocols used an average of 1.5 steps but 90 protocols, 3.1%, included as many as four steps and one plan had eight steps protocol. Researchers emphasized “onerous step therapy protocols can add...

Congressional Update

Nov 12, 2021 | Legislation/ Budgets/ Macro

On Friday, November 5, the House voted along party lines to set ground rules for consideration of President Biden’s Build Back Better (BBB) plan, a nearly $2T reconciliation package that includes drug pricing policies, expanded Medicaid and ACA Exchange access and funding, and other health care policies. Click to read more.

Weekly Medicaid Update

Nov 10, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: State to implement CalAIM dental initiative statewide January 1, 2022 LA: FY22 Medicaid initiatives include assessing adult dental coverage and improving mental health and SUD care MA: State Senate introduces legislation enhancing mental health parity and increasing access to services OH: Court rules against Paramount Advantage in its lawsuit protesting Medicaid MCO contract awards Click to read more.

CY 2022 OPPS & ASC Final Rules

Nov 9, 2021 | ASC, Hospitals, Outpatient

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC): CMS finalized a +2.0% increase to payment rates under the hospital OPPS and a +2.0% ASC rate update for CY 2022. Click to read more.

CY 2022 Physician Fee Schedule

Nov 9, 2021 | Physician Fee Schedule

Physician Fee Schedule (PFS): CMS has published the final PFS Rule for CY 2022. The most significant new policy from the proposed rule is a four-year phase in of changes to clinical labor values. Click to read more.