CY 2021 Proposed Rule for ESRD

Aug 4, 2020 | ESRD

CMS published the proposed CY 2021 rule for the end-stage renal disease (ESRD) prospective payment system (PPS), which will be finalized at least 60 days before January 1, 2021 – likely the week ending on Friday, October 30, 2020. This brief summarizes the proposed changes to the ESRD PPS, which applies to approximately 7,400 dialysis facilities. Click to read more.

Managed Care Friday

Jul 31, 2020 | Managed Care Friday

61: The percent of college students who will forgo school this year, according to our random poll of 417 incoming freshman and sophomores. Read what they’ll do instead and how it may impact healthcare by clicking here. David Gets a Win vs. Goliath in New Pay Model: BCBS of Massachusetts is launching a new payment model for small practices that will combine value-based care and support payments. The model is designed for practices with 1K-20K members and will incorporate upside risk. The pilot does not launch until 2021, but immediate support payments will go out to any provider participants...

BRG Medicaid Update

Jul 29, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  AZ: State releases its 2020 AMRP to assess the adequacy of FFS rates –  OH: State publishes RFP for a single PBM to process all Medicaid MCO pharmacy claims –  VA: Recently approved demo provides housing and employment services for high-need individuals Click to read more.

Recent Court Decisions Back Trump Administration Regulations

Jul 27, 2020 | Commercial Insurance, Exchanges, Hospitals, Legislation/ Budgets/ Macro

Three recent court decisions ruled in favor of the Trump administration regulations on price transparency, short-term plans, and hospital site-neutrality. While the rulings on short-term plans and site-neutrality uphold current regulations, the hospital price transparency rule will not go into effect until 2021. Trade associations that oppose the regulations intend to appeal these decisions. Click to read more.