Managed Care Friday

Nov 12, 2021 | Managed Care Friday

40: Percent of coverage policies with step therapy protocols for getting medications, according to a recent study published by Health Affairs. Using data that covers 17 of the 20 largest payers in the US, the study shows that more payers are implementing step therapy protocols for certain diseases compared to previous years, and some payers’ plans may be stricter than needed. Those with step therapy protocols used an average of 1.5 steps but 90 protocols, 3.1%, included as many as four steps and one plan had eight steps protocol. Researchers emphasized “onerous step therapy protocols can add...

Congressional Update

Nov 12, 2021 | Legislation/ Budgets/ Macro

On Friday, November 5, the House voted along party lines to set ground rules for consideration of President Biden’s Build Back Better (BBB) plan, a nearly $2T reconciliation package that includes drug pricing policies, expanded Medicaid and ACA Exchange access and funding, and other health care policies. Click to read more.

Weekly Medicaid Update

Nov 10, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: State to implement CalAIM dental initiative statewide January 1, 2022 LA: FY22 Medicaid initiatives include assessing adult dental coverage and improving mental health and SUD care MA: State Senate introduces legislation enhancing mental health parity and increasing access to services OH: Court rules against Paramount Advantage in its lawsuit protesting Medicaid MCO contract awards Click to read more.

CY 2022 OPPS & ASC Final Rules

Nov 9, 2021 | ASC, Hospitals, Outpatient

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC): CMS finalized a +2.0% increase to payment rates under the hospital OPPS and a +2.0% ASC rate update for CY 2022. Click to read more.

CY 2022 Physician Fee Schedule

Nov 9, 2021 | Physician Fee Schedule

Physician Fee Schedule (PFS): CMS has published the final PFS Rule for CY 2022. The most significant new policy from the proposed rule is a four-year phase in of changes to clinical labor values. Click to read more.

Managed Care Friday

Nov 5, 2021 | Managed Care Friday

118: The amount of funding in millions that Workit Health recently raised for its telehealth SUD treatment. The venture funds of BCBS and CVS contributed, indicating continued interest from health plans on novel models for treating addiction. Workit currently offers SUD treatment in 10 states and plans to use the funding to expand to new markets. Seeing Straight: Arrhythmias and orthostatic hypertension can cause dizziness, panic disorders can lead to blurry vision and acute stress can cause a range of issues, including migraines, and The Department of Defense has put out a range of...

Weekly Medicaid Update

Nov 3, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: New law sets standards for timely mental health & SUD follow-up appointments MD: State increases rates for HCBS providers MO: State adds coverage of habilitative skilled therapy for expansion population NC: Temporary rate increases for personal care services and private duty nursing providers TN: TennCare FY2022-23 budget request increases spending Click to read more.

Managed Care Friday

Oct 29, 2021 | Managed Care Friday

66: On a hunch, about two thirds of parents of children on the spectrum are, themselves, somewhere on the spectrum too, though the vast majority self reported that they were never formally diagnosed, according to a random exploration into ABA and autism diagnostic and treatment spending by Paula Ortiz, a recent college graduate who conducted the study for her Master’s degree in Rhode Island.  Ortiz acknowledges this was just a random sampling of 100 and may not mean anything.  She works two jobs to help pay for her degree, and raises a 6-year-old with significant verbal delays, and “so I...

Weekly Medicaid Update

Oct 27, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: MI: Competing bills redesigning specialty behavioral health delivery system advancing in legislature MO: Adds coverage of transcranial magnetic stimulation NJ: Proposes to carve-in behavioral health services OR: Boosts 2022 health plan per-member spending +4.2% TN: OIG finds TN Medicaid program overbilled federal government nearly $767m between 2009 and 2014 Click to read more.

Recent Developments In Dermatology

Oct 26, 2021 | Physician Fee Schedule

Medicare FFS reimbursement for dermatology has been mostly positive in recent years and Medicare spending on dermatology has grown. Several top dermatology codes could be reviewed in the next few years, but any adjustments are likely modest. Click to read more.