Jan 17, 2023 | Medicare Advantage, Part D, Payers
CMS has issued a proposed rule for MA and Part D policy for the 2024 plan year and later that includes proposals related to coverage policies, prior authorization requirements, Star Rating calculations, behavioral health, and health equity. Click to read more.
Jan 13, 2023 | Managed Care Friday
1,000: The approximate number of deaths prevented by a naloxone vending machine, according to a recent study published by the University of Cincinnati and Caracole. The vending machines are placed outside a targeted naloxone distribution and syringe service program. Anyone can access the program’s counselors as well as two injectable doses and two nasal spray doses of naloxone, a sharps disposal kit, kits for safe injections, smoking, and sex, as well as a pregnancy test, PPE and a box of bandages every seven days. 637 individuals registered for the program in the first year, 12% of them...
Jan 10, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Radiology: Impact of policy in PFS rules mixed for diagnostic and interventional radiology, with congressional mitigation providing some relief. Spending for both specialties has been generally flat in recent years, with a slight decrease in diagnostic for 2022. Click to read more.
Jan 10, 2023 | Medicare, Physician Fee Schedule
Recent Developments in Vascular Surgery: Impact of policy in PFS rules has been negative for vascular surgery, with congressional mitigation providing some relief. Spending for vascular surgery has been relatively flat over the past few years, with slight decreases in 2022-23. Click to read more.
Jan 6, 2023 | Managed Care Friday
20: Percent reduction in telehealth commercial reimbursement rates for medical visits, not behavioral, starting this spring for a few New England area insurers. The trend is accelerating in pockets of the US as we predicted with some insurers lowering rates 20-30%, one as much as 50%, but none changing the policy for behavioral sessions. One New Hampshire plan will keep telehealth rates for “medical sessions” at the same level as in-person. Empire Strikes Back: Just like Vader’s effort to retaliate against the resistance, nonprofit health plans SCAN Group and CareOregon are merging to create...
Jan 4, 2023 | BRG Publications, Medicaid
BRG’s 2022 Medicaid Policy Review focuses on the upcoming unwinding of the public health emergency (PHE) continuous coverage requirement, as well as broader enrollment and rate trends. As states begin to prepare unwinding operational plans, there have been several projections on how the end of the PHE could impact Medicaid programs across the country. This report highlights and summarizes key areas related to enrollment trends and provider-level implications. Click to read more.
Jan 3, 2023 | Legislation/ Budgets/ Macro
2022 Election Brings Divided Government & Policy Stability For Healthcare: The 2022 elections have resulted in Republican control of the House and Continued Democratic control of the Senate. With a divided Congress and active Presidential campaigns, it is very unlikely for Congress to enact major legislation on any topic to be enacted in the next 2 years -- with healthcare particularly unlikely due to the wide partisan disagreements on healthcare policy. Click to read more.
Jan 3, 2023 | Uncategorized
FY 2023 Omnibus Includes Healthcare Policies: Congress passed an Omnibus Appropriations Bill for FY 2023 during the December 2022 lame duck session. In addition to the annual appropriations for 2023, the legislation included several dozen healthcare related provisions including mitigation of cuts to the PFS, phase-out of enhanced Medicaid FMAP, and delay of Medicare lab repricing. Click to read more.
Dec 23, 2022 | Managed Care Friday
Extra Point: The late Jerry Stiller invited everyone to air their grievances on this day, using a symbolic pole in lieu of a Christmas tree. “You gather your family around, and you tell them all the ways they have disappointed you over the past year,” Stiller’s Frank Costanza said in the classic Seinfeld. In my home, that’s really more of a Thanksgiving tradition, although sometimes if I’m lucky, the grievances come in the afternoon after school when I forget to pick up Sophie or when I’m cooking dinner, and despite all the effort, it tastes a little bit like garbage. My wife, God love her,...
