Aug 18, 2023 | Managed Care Friday
66: Percent of adults in the US who have a personal or familial experience with alcohol or drug addiction, according to a new KFF poll, highlighting how substance use disorders affect not only individuals but also their friends and family. 27% of adults who have a relative with an addiction report that their mental health was significantly affected by it, but only 46% got treatment. Bye Bye Pre Approval? United Healthcare will begin a two-phased approach to eliminating some prior authorization requirements in September. This will occur across commercial, MA and Medicaid plans and most...
Aug 17, 2023 | Hospitals, Inpatient, LTCHs, Medicare
CMS Releases Final Inpatient Prospective Payment (IPPS) and Long-Term Care Hospital (LTCH) Rule: The IPPS rule increases rates by +3.1% and CMS estimates hospital payments for the approximately 3,100 acute care hospitals will increase by a total of $2.2B. CMS expects the LTCH standard payment rate to increase by +3.3%. Click to read more
Aug 17, 2023 | Medicare, Physician Fee Schedule, Physicians
CMS Announced Proposed Physician Fee Schedule (PFS) Rule: The proposed rule would reduce the conversion factor by -3.4% for 2024. CMS projects $89B in fee-for-service (FFS) allowed charges, $2B less than estimated during 2023 final rulemaking. Click to read more
Aug 15, 2023 | Drugs, Medicare
CMS Releases Inflation Reduction Act (IRA) Guidance for Medicare Drug Price Negotiations: Guidance was revised to improve transparency and support an effective negotiation process. On September 1, 2023 CMS will publish the first ten drugs selected for negotiation. Click here to read
Aug 15, 2023 | Legislation/ Budgets/ Macro, Payers
Proposed Rule to Modify Definition of Short-Term, Limited-Duration Insurance (STLDI): The proposed rule seeks to limit access to STLDI plans as alternatives to ACA-compliant coverage. Click here to read more
Aug 15, 2023 | Behavioral, Legislation/ Budgets/ Macro
Proposed Rule to Amend Mental Health Parity Requirements: The Departments of Treasury, Labor and HHS would introduce a framework to determine whether a health plan or insurer has implemented standards that impose greater limits on access to mental health and substance use disorder services as compared to medical/surgical benefits. Click here to read
Aug 11, 2023 | Managed Care Friday
20: The percentage of adults diagnosed with opioid use disorder in 2021 who received medication to treat it according to federal data. Encouragingly, people who utilized telehealth for substance treatment were ~38 times more likely to receive medication compared to those who were not treated virtually. We’ve seen a rise in telehealth companies focused on these disorders over the past several years, which hopefully means the percentage of those treated will continue to rise – especially considering the data also showed disparities by ethnicity, gender and location. For instance, those in...
Aug 10, 2023 | Medicare, Post-Acute Care, Skilled Nursing Facilities (SNF)
CMS Finalized a 4.0% Update to Skilled Nursing Facilities (SNF) payments. SNF payments will increase by $1.4B. The market basket update of 6.4% includes a one-time, 3.6% correction for a previous forecast error, less a -2.3% budget neutrality adjustment and a 0.2% productivity adjustment. Click here to read more
