Jan 26, 2022 | Uncategorized
The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: Legislature debates bill seeking to establish single-payer healthcare system MD: Bill introduced to cover adult dental through MCOs instead of a separate program NV: New law requires providers to report certain business arrangements to DHHS OK: OHCA and Pear Therapeutics enter into an opioid related value-based agreement Click to read more.
Jan 25, 2022 | Physician Fee Schedule, Physicians
Radiology: Spending for diagnostic and interventional radiology has been mostly flat in recent years and the impact of policy in PFS rules has been mixed for this specialty, including E&M reform which will negatively impact radiology once fully implemented. Click to read more.
Jan 25, 2022 | Physician Fee Schedule, Physicians
Vascular Surgery: PFS updates for vascular surgery have been stable with modest fluctuations until 2021 due to E&M reform. Rates in 2022 are negatively impacted by the second year of E&M BNAs, and PE RVU changes that result in significant cuts to vascular codes. Click to read more.
Jan 21, 2022 | Managed Care Friday
One: The number of people out of 4 who have a chronic musculoskeletal condition, such as arthritis, back and neck pain and osteoporosis, according to data from insurer Highmark. These conditions collectively account for 50% of medical spending and so Highmark’s Well360 program is providing self-funded employer group members access to wearable FDA-listed motion sensors that give real-time feedback through their exercise sessions. Born Free: The Boss, Bruce Springsteen, could not have predicted this - BCBS of Massachusetts members now have access to childbirth services through a free-standing...
Jan 18, 2022 | BRG Publications
The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the fourth quarter of 2021, we have taken particular note of: DOJ/HHS activity OIG Fall 2021 Semiannual Report to Congress OIG Data Brief on Genetic Testing Growth OIG Report - 2021 Top Management and Performance Challenges Facing HHS Two Comparative Billing Reports Two GAO reports OCR activity Approved and proposed additions to the RAC audit list Click to read...
Jan 14, 2022 | Managed Care Friday
73: The percent of 20- to 35-year-olds in our poll of 652 consumers this month who say they don’t see themselves ever getting a colonoscopy and, for about 40 percent, the idea of the at-home test Cologuard “seems” like a better option, while a not-so-surprising 30 percent expect there to be an easier solution by the time they need to be screened for colon cancer. “There isn’t a pill yet? If not, there will be” says 27-year-old Caylee Parker of Springfield MA. Remove The Blues: Minnesota Blue is removing preapproval requirements for its commercial and Medicare members needing partial...
Jan 13, 2022 | Drugs, Medicare Advantage, Part D, Pharmacy
On January 6, 2022, CMS released the proposed rule for Contract Year 2023 Policy and Technical Changes for MA and Medicare Prescription Drug (Part D) Programs. The proposed rule includes changes to network adequacy standards, dual eligible Special Needs Plans (D-SNPs), negotiated drug price in Part D, consumer information about MA plans, and oversight and transparency measures for third-party marketing operations (TPMOs). Click to read more.
Jan 11, 2022 | BRG Publications
BRG’s annual Federal Policy Review is a guide to federal healthcare policy for 2021 and 2022. BRG’s policy experts review macro trends in healthcare spending and coverage, federal legislative efforts, and regulatory updates to each of the Medicare payment systems. Click to read more.
