Managed Care Friday

Sep 11, 2020 | Managed Care Friday

80: The amount of new counties Cigna is adding individual plans in for 2021, increasing their ACA market size by 27%. Key benefits included in some of the plans are no copay for virtual visits, including behavioral health providers, a new diabetes care plan that includes no copay for diabetes equipment and supplies, and increased coverage for nontraditional healthcare services, like acupuncture. Oral Health Uptick: Kaiser Permanente and Delta Dental of Washington have partnered to launch Health360, a medical-dental plan focused on better overall outcomes and a lower total cost of care. The...

BRG Medicaid Update

Sep 9, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  CA: State Legislature passes law authorizing NPs to practice independently –  FL: AHCA adds new temporary services and requirements for Adult Day Care providers –  PA: State distributes CARES Act funding for direct care workers Click to read more.

2021 PFS Proposed Rule: Changes Beyond E&M Reform

Sep 8, 2020 | Labs, Physician Fee Schedule, Physicians

In addition to proposing to reform office visit codes, the 2021 PFS proposed rule includes several other notable policies. This brief outlines those provisions, including telehealth, orthopedics, vascular surgery, substance use disorder, care management, dermatology, GI, ophthalmology, pathology, labs, FQHCs, and ACOs. Click to here to read more.

CMS Proposes Policy Changes for Outpatient Hospital and ASCs

Sep 8, 2020 | ASC, Outpatient

In addition to a standard +2.6% rate update to the outpatient hospital payment system, CMS is proposing to eliminate the inpatient-only list for all procedures by 2024. After a recent court ruling in CMS’s favor, the agency also proposes to cut reimbursement for 340B-eligible drugs to ASP-28.7% from ASP-22%. Click to here to read more.

Managed Care Friday

Sep 4, 2020 | Managed Care Friday

3: The number of Walmart locations that the company is replacing with Oak Street Health clinics in the Dallas-Fort Worth area this fall. Newly public Oak Street has a network of 60 value-based primary care centers and the three new centers will offer preventative primary care and urgent care services focusing on patients of all ages. 5 and Dime: Payments focused on improving patient outcomes will be five to 10 times larger than what is contained in a typical outcomes-based, risk-bearing agreement under a new Blue Cross Blue Shield of Minnesota multiyear pact with Allina Health, a Minnesota...

CMS Releases 2021 IRF Final Rule

Sep 3, 2020 | Inpatient Rehab (IRF)

CMS has finalized Medicare policy updates for inpatient rehabilitation facilities (IRFs) in fiscal year 2021. The final rule implements many of the provisions included in the proposed rule, including changes to IRF coverage criteria and expanding the role of non-physician practitioners. Click to read more.

BRG Medicaid Update

Sep 2, 2020 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: –  AZ: State announces intent to increase FFS rates for variety of services –  CA: Legislature strengthens mental health parity; healthcare transaction oversight bill does not                      advance –  IN: State awards new managed care contract –  OH: State proposes to expand telehealth coverage on a permanent basis Click to read more.

BRG Quarterly Compliance and Program Integrity Developments

Sep 1, 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 first half of 2020, we have taken particular note of: –  DoJ/HHS enforcements/settlements –  Four OIG reports –  Two Comparative Billing Reports –  Five GAO reports –  Pending additions to the RAC audit list Click to read more.