Dec 6, 2019 | Managed Care Friday
10,000: The number of psychiatrists across the country we’re missing, and 40% of the ones we do have do not take commercial health insurance, according to a panel of Medicaid behavioral health professionals who debated the issues at BRG’s healthcare leadership conference Thursday in Washington DC. Other takeaways: payers are asking providers to ‘please accept Medicaid and please make telehealth work’, and they see a growing need for transitional housing for patients swept up in the opioid crisis. Worried Well: As Archie once said, ‘why do they always give me a shot where the pain ain’t…?’ It...
Dec 4, 2019 | Behavioral, Medicare, Substance Abuse
CMS has finalized a bundled payment under the PFS for OUD treatment office-based services for 2020. This approach parallels the new bundled OUD treatment services for OTPs. Click to read more.
Dec 3, 2019 | LTCHs, Medicaid
After a year long procurement process, Texas has announced its STAR+PLUS awards. STAR+PLUS is Texas’s Medicaid Managed Care program, which integrates Acute Care services and Long-Term Services and Supports (LTSS) for people ages 65 or older, blind, or disabled. Click to read more.
Nov 25, 2019 | Home Infusion, Medicare
CMS maintained that payment under the new Medicare benefit for home infusion services will only be made on the days when a skilled professional is in the patient’s home, to the dismay of home infusion pharmacies who hoped that CMS would relax its statutory interpretation to expand the number of days reimbursed by Medicare. Click to read more.
Nov 22, 2019 | Managed Care Friday
1. 5: The amount of copay for a Physical or Speech therapy visit starting in 2020 for Cigna HMO members in Arizona, a change from the $20 this year. 2. Concierge Is Back, With A Twist: A company called Accolade will act as the “front door” concierge practice for life science manufacturer EMD Millipore’s 18,000 some employees. BCBS of Massachusetts will administer the benefits but Accolade will be the contact - handling care management, triage, steering members to care, and managing costs. Think of it as a new version of a benefit manager. 3. 2021 National Network: If you’re a physician group...
Nov 21, 2019 | BRG Publications
BRG’s annual Federal Policy Review is a guide to Federal healthcare policy for 2019 and 2020. 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 Federal Policy Review 2019-2020.
Nov 20, 2019 | ASC, Hospitals, Medicare, Outpatient
CMS has finalized 2020 updates to payments for services furnished in ambulatory surgical centers (ASCs) and hospital outpatient departments (HOPDs). This brief highlights key provisions finalized in the rulemaking. Click to read more.
Nov 19, 2019 | Behavioral, Inpatient Psych, Medicaid, Substance Abuse
On November 6th, CMS announced the approval of DC’s Medicaid 1115 Waiver that expands access to behavioral health treatment. This waiver, which will go into effect on January 1, 2020, will broaden services available to beneficiaries diagnosed with serious mental illness (SMI) or serious emotional disturbance (SED) and provide new services for beneficiaries diagnosed with substance use disorder (SUD). Click to read more.
Nov 15, 2019 | Managed Care Friday
We sat down recently with our managed care contracting veterans from more than 30 MA plans and provider groups, and they clued us in to several new and eye-opening changes finding their way into Medicare Advantage risk contracts these days, including increasingly shocking terms designed to protect the plan. In this special Managed Care Friday, we lay out some of the terms and lessons. Click to read more.
Nov 14, 2019 | DMEPOS, Medicare
CMS has finalized updates to the DME program for 2020, with minimal adjustments to the proposal. Click to read more.
