Jun 13, 2018 | Medicaid, Medicaid Managed Care
A report by the Medicaid Innovation Accelerator Program includes data on annual expenditures for long-term services and supports (LTSS). The most recent report includes FY2016 expenditures data and shows the continued trend of home and community-based services (HCBS) as a growing share of total LTSS expenditures. Click to read more.
Jun 12, 2018 | Legislation/ Budgets/ Macro
Trump recently signed the VA Mission Act into law, which enacts several major reforms of the VA healthcare system. This brief highlights key provisions included in the legislation. Click to read more.
Jun 11, 2018 | Drugs, Legislation/ Budgets/ Macro, Pharmacy, Products
The Trump Administration has released a collection of policy proposals related to drug prices. The Trump proposals include concepts from the President’s fiscal year (FY) 2019 Budget and a number of new policy options on which the Administration is seeking public input. The Trump proposals are relatively modest in scope and are unlikely to have an immediate impact on the pharmaceutical industry. The proposals are, to a certain degree, more notable for what they do not contain. There are no specific or direct changes to the existing government programs or the existing business models of drug...
Jun 9, 2018 | Home Health
CMS recently released proposed updates to the home health (HH) prospective payment system (PPS) for CY 2019 and 2020. The proposal updates payments for episodes of care ending in CY 2019, but includes significant reforms to the payment system effective in CY 2020. Proposed changes include case-mix methodology refinements, which aligns episode payment rates to patient characteristics, as well as the implementation of 30-day periods of care, rather than the current 60-day period system. CMS also released its proposal for home infusion therapy temporary transitional payments for 2019 and...
Jun 8, 2018 | Managed Care Friday
1) 425: Dollars that several surgeons told us they are charging Anthem patients upfront before cataract surgery to cover anesthesia services since the insurer no longer considers anesthesiologists or nurse anesthetists medically necessary for administering and monitoring sedation during the eye procedures. Kids under 18 aren’t impacted but adults are and one practice here in my state told us the policy has changed patient behavior – in some cases the patient flat out refuses and leaves rather than doing the procedure, others ‘have got wind of the charge’ and ‘cancelled’ the procedure,...
Jun 6, 2018 | Legislation/ Budgets/ Macro
Trump administration has proposed a $15 billion rescissions package that includes cuts to discretionary healthcare programs such as CHIP. However, the proposal involves technical budget maneuvers that even if enacted are unlikely to affect actual spending. Further, the Congress is very unlikely to act on the proposal. Click to read more.
Jun 1, 2018 | Managed Care Friday
1. 350 Million: The total dollars that five drugs cost Texas managed care plans in the fourth quarter of last year. Abilify (antipsychotic) Vyvanse (stimulant) Nexium (GI), Invega (antipsychotic) and Norditropin (growth hormone) were the five most expensive drugs here. In contrast, through the smaller fee for service program, Ibrance, an antineoplastic systemic enzyme inhibitor, was the most expensive drug at just $2 million, followed by Abilify and three stimulants. In terms of utilization, ibuprofen, amoxicillin (the penicillin) and the bronchial agent Albuterol used to treat Asthma were...
