CMS Announces Direct Contracting Entities

Apr 22, 2021 | Medicare

CMS’s Innovation Center announced participants in its Direct Contracting demonstration program, while also declining to accept new applicants for the 2022 demo year. Click to read more.

Weekly Medicaid Update

Apr 21, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA:  DHCS accepting public comments regarding CalAIM waiver proposal CO:  Budget committee seeks to fund more developmental disability waiver slots MO:  State to implement new outpatient payment policy OH:  Announces new MCOs NJ:   State publishes request for applications for PACE Click to read more.

Recent Developments in Neurology

Apr 20, 2021 | Physicians

Recent developments in neurology include E&M reform, mixed FFS reimbursement trends, and a change in the role of neurologists inside health plans, as prevelance and overall cost of neurological conditions increases. Click to read more.

CMS Proposes FY22 SNF and Hospice Rules

Apr 16, 2021 | Medicare

CMS has proposed Medicare policy updates for skilled nursing facilities (SNFs) in fiscal year 2022. The rule proposes a +1.3% payment increase, with minimal policy changes. Click to read more. CMS has proposed Medicare policy updates for hospices in fiscal year 2022. The rule proposes a +2.3% payment increase, with minimal policy changes. Click to read more.

CMS Proposes FY22 IRF and IPF Rules

Apr 14, 2021 | Medicaid, Medicare

CMS has proposed Medicare policy updates for inpatient rehabilitation facilities (IRFs) in fiscal year 2022. The rule proposes a +2.2% update and no major policy changes. Click to read more. CMS has proposed Medicare policy updates for inpatient psychiatric facilities (IPFs) in fiscal year 2022. The rule proposes a +2.1% update and no major policy changes. Click to read more.

Study on the Evolving Role of Social Risk Investments in Healthcare

Apr 13, 2021 | BRG Publications

BRG’s managed care survey team recently conducted a new nationwide study revealing challenges in scaling and achieving a quick return on investments in social determinants of health (SDoH) initiatives, but significant longer-term savings from sustained programs, including medical, pharmacy, and economic gains. Health investors looking for opportunities to invest in social service models can help address these limitations with investments in technology, analytics, and infrastructure. Click to read the study.

Managed Care Friday

Apr 9, 2021 | Managed Care Friday

42: The number that hangs from baseball’s rafters and now also the percentage reduction in the rate of asthma-related emergency department visits and hospitalizations, thanks to a collaboration between health insurer HCSC and the American Lung Association. The project, Enhancing Care for Children with Asthma, launched 9 years ago and works with community clinics across the insurer’s 5 states to implement a quality improvement program to support asthma management in children. Devising An Outcomes Contract: Spectrum Health, the integrated health system in Michigan, is entering into a...

DRA 2% Medicare Sequestration Suspension Extended For All CY21

Apr 8, 2021 | Medicare

Congress is in the process of suspending the 2% Medicare sequestration imposed by the Deficit Reduction Act of 2011 for the remainder of CY2021. Additionally, the 4% sequestration scheduled for 2022 by the Statutory Pay-As-You-Go Act of 2010 is likely to be waived prior to implementation. Click to read more.

Weekly Medicaid Update

Apr 7, 2021 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: ·       MN: 10% rate increase for outpatient services under SUD waiver ·       NY:  Governor signs FY21-22 budget ·       OH:  State selects MCO for children with complex behavioral health needs ·       TX:   State’s OIG opens investigations on four dental providers based on billing patterns Click to read more.

BRG Quarterly Compliance and Program Integrity Developments

Apr 6, 2021 | Legislation/ Budgets/ Macro

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 first quarter of 2021, we have taken particular note of: ·       DOJ/HHS activity ·       Two OIG reports ·       Two Comparative Billing Reports ·       Four GAO reports ·       OCR activity ·       Proposed and approved additions to the RAC audit list Click to read more.