Jan 3, 2019 | Legislation/ Budgets/ Macro
Congress and the President have not completed the FY 2019 appropriations process resulting in a partial government shutdown since December 21. The only agency related significantly to the healthcare system that is affected by this impasse is the FDA, which will likely experience a slow-down of certain regulatory processes. Click to read more.
Jan 3, 2019 | Managed Care Friday
1. Nine: That’s the number of splat points I had at Orangetheory Fitness before Christmas, the lowest in the class, 15 worse than my bride and 25 worse than my daughter leading me to believe that managing my own care is exhausting, humiliating and undoubtedly hurting my status in the family. The hit gym classes aren’t just winning with families, millennials and 30 and 40 somethings, they are getting the attention of self insured employers and a few large group plans. We asked 12 different benefits administrators for leading employers with more than 15,000 employees – 10 of them said they are...
Dec 20, 2018 | Legislation/ Budgets/ Macro
A Texas District Court Judge’s recent decision, declaring the entire ACA is unconstitutional and must be invalidated, is very unlikely to be upheld on appeal. This brief discusses the court case and the broad and significant changes, should the ruling stand upon appeal. Click to read more.
Dec 18, 2018 | Post-Acute Care, Skilled Nursing Facilities (SNF)
Skilled nursing facility payments are adjusted in FY 2019 based on their hospital readmissions, as part of the SNF Value-Based Purchasing program. Only about 1/4 of SNFs will receive an incentive bonus payment, and over 10,000 facilities will see a 1-2% cut to their payments in FY19. Click to read more.
Dec 14, 2018 | Managed Care Friday
1. 3: The number of physical therapists in a small group in my home state who are creating a training guide or course to help PTs identify and address depression, addiction, and eating disorders in patients. The PTs are trying to make a less standard approach to detecting these conditions, and engaging patients about delicate topics. ‘That sounds like the definition of value based medicine if you ask me,’ according to Michelle Feller, a network contracting manager for BCBS. 2. Cataract Policy Change: Recently, Anthem Blue Cross/Blue Shield of California announced it would no longer be...
Dec 11, 2018 | Behavioral, Medicaid
Last month, CMS announced a new demonstration opportunity to expand Medicaid inpatient mental health treatment services. A long-standing restriction has prohibited the Medicaid program from paying for services provided to adults in an institution for mental disease (IMD), but recent federal activity, including this demonstration, has significantly loosened the IMD exclusion. Waiver approval is contingent on states providing a complete continuum of care, with actions that are linked to CMS-defined goals and milestones. 12 states have already expressed interest in this type of waiver, and more...
Dec 10, 2018 | Drugs, Medicare Advantage, Part D, Payers, Products
On November 26th, CMS released a proposed rule with several policies that would affect the Medicare Part D drug program, as well as Medicare Advantage plans. These proposals are largely in line with the Trump administration’s previous pricing proposals to lower drug prices and reduce out-of-pocket costs for enrollees. This brief discusses major provisions included in the proposed rule. Click to read more.
Dec 7, 2018 | Managed Care Friday
1. 4: The number of vitamin D tests you can do per year, starting in January, if treating United California Medicaid patients with certain conditions, as a result of what the plan calls ‘recent clinical evidence about the test’. We would not be surprised to see this policy find its way into United coverage policies beyond California. 2. Homeless Healthcare: One woman’s story chronicles the positive impact of a program in Massachusetts designed to address gaps in care for this population: click here 3. Sound Off--Sorry Moms: United’s Community plan for Medicaid patients will no longer...
