Quarterly Compliance and Program Integrity Developments

Nov 19, 2020 | 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 third quarter of 2020, we have taken particular note of: DOJ/HHS activity Two OIG reports Three Comparative Billing Reports Four GAO reports OCR activity Proposed and approved additions to the RAC audit list Click to read more.

Weekly Medicaid Update

Nov 18, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CA: State delays transition to single statewide pharmacy benefit vendor to April 2021 FL: State to implement EVV requirement for behavioral analysis December 2020 NC: State releases Request for Applications for behavioral health/IDD tailored plans as part of transition to Medicaid managed care Click to read more.

2021 Medicare DMEPOS Policies

Nov 16, 2020 | Devices, DMEPOS, Medicare, Products

CMS has made several DME-related announcements. The 2021 Competitive Bidding Program (CBP) will only have new prices for OTS back/knee braces – all other categories have no new 2021 prices. CMS has also made several policy changes, including expanding coverage of non-therapeutic glucose monitors and home infusion pumps. Click to read more.

Managed Care Friday

Nov 13, 2020 | Managed Care Friday

59: Percent of dentists reporting increasing prevalence of stress-induced oral health problems like bruxism or teeth grinding, chipped and cracked teeth, and temporomandibular disorder symptoms like jaw joint pain. As CMS Goes: CMS will begin paying doctors to use two different AI systems, one focused on diagnosing diabetic retinopathy and the other that alerts specialists when a brain scan shows a patient may have suffered a stroke. MA and commercial plans may also provide coverage, though the parameters around reimbursement may vary. Both products were approved by the FDA back in 2018, and...

Weekly Medicaid Update

Nov 12, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: NJ: State increases substance use disorder long-term residential rate NC: State to review claims for Long-Acting Reversible Contraceptive and Depo-Provera, based on recent billing anomalies WA: State to submit SPA outlining transition to Consumer Directed Employer model for individual providers of in-home personal care and respite services Click to read more.

Managed Care Friday

Nov 6, 2020 | Managed Care Friday

4: Stage of cancer one of my friends has. He found out the other day. Colon cancer spread to the body. Missed his annual checkup in the office but had a tele-encounter with his PCP. If there’s a cautionary tale here, it’s that my friend had no symptoms but didn’t get to the lab for an annual lab test his doctor ordered. 700: Percentage increase in addiction-related hotline calls during the pandemic, according to the Indiana Family and Social Services Administration. Sudden stoppages of in-person therapy or group sessions of Alcoholics Anonymous can have major impacts on addiction, including...

Weekly Medicaid Update

Nov 4, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: •  FL: Voters pass ballot measure increasing minimum wage to $15 • GA: CMS approves state’s plan to eliminate HealthCare.gov portal and establish another hub for individuals to purchase coverage •  IL: State announces coverage of ABA services •  TN: CMS approves coverage of children with disabilities and/or complex medical needs who do not otherwise qualify for Medicaid Click to read more.