Apr 21, 2023 | Managed Care Friday
1 In 575: The average ratio of psych counselors to students based on our poll of 340 school districts in 19 states. We learned that the proportion of calls to 911 or 988 related to a suicide situation were about 4-5 times more likely in the schools that had to rely on an extremely high case load for each counselor. New PBM Pricing Model: Express Scripts has launched a new pricing model called ClearCareRx to allow employers, health plans, and government employers to pay exactly what Express Scripts pays for drugs. ESI’s new copay assurance plan will cap copays for members – $5 for...
Apr 20, 2023 | Hospice, Medicare
CMS Proposes +2.8% Hospice Payment Update for FY 2024: Hospices would receive +2.8% payment increase from Medicare for FY24 and the proposed cap amount for FY 2024 is $33,396.55. Click to read more.
Apr 20, 2023 | Inpatient Rehab (IRF), Medicare, Post-Acute Care
CMS Proposes +3.0% Rate Update For IRFs For FY 2024: CMS has proposed Medicare policy updates for inpatient rehabilitation facilities (IRFs) in fiscal year 2024. Click to read more.
Apr 20, 2023 | Behavioral, Inpatient Psych, Medicare
CMS Proposes +3.0% Rate Update For IPFs For FY 2024: CMS has proposed Medicare policy updates for inpatient psychiatric facilities (IPFs) in fiscal year 2024. Click to read more.
Apr 14, 2023 | Managed Care Friday
20: The percent of current prior authorization requirements United announced it will roll back beginning in the third quarter of this year. Beginning in early 2024, the insurer will also implement a Gold Card program for eligible provider groups that would eliminate prior authorization for many procedures. Keep in mind that for some services, like pain management, even if the health plan doesn’t require pre-approval they likely still have coverage criteria and step therapy rules to follow. In Prison: Ventura County of California is finally opening a mental health unit at the Todd Road Jail...
Apr 13, 2023 | Medicare, Post-Acute Care, Skilled Nursing Facilities (SNF)
CMS Proposes a 3.7% Update to Skilled Nursing Facility (SNF) Payments. SNF payments will increase by $1.2B. The market basket update of 6.1% includes a one-time, 3.6% correction for a previous forecast error. The payment update also factors in a -2.3% budget neutrality adjustment, the second of a two-year BNA phase-in totaling -4.6%. Click to read more.
Apr 11, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Oral Maxillofacial Surgery: Recent PFS policy has been generally negative for maxillofacial surgery. Despite limited coverage, Medicare FFS spending on oral/maxillofacial surgery has increased. Click here to read more.
Apr 11, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Allergy and Immunology: PFS reform has been mostly positive for the specialties. Allergy and immunology spending has been relatively flat in recent years. Click here to read more.
