Aug 23, 2018 | Ambulance, Ground, Home Health
CMS recently extended regulations preventing enrollment of new home health agencies and Part B ground ambulance suppliers in Medicare and Medicaid, for specific geographies across the country. Since first being implemented in 2013, the moratoria have been extended and expanded every 6 months to date. In this brief, we highlight the existing moratoria and look at CMS market saturation and utilization data, which provides insights as to why such restrictions exist in certain areas. Click to read more.
Aug 22, 2018 | Medicare, Physician Fee Schedule
CMS is proposing to significantly limit the time an ACO can be upside only and to streamline the risk-bearing ACO tracks from 4 Track options to a 2 Track Option (renamed Basic and Enhanced) to simplify the ACO program. Click to read more.
Aug 17, 2018 | Managed Care Friday
1. 12.8: That’s the percentage of adolescents In the US who experience at least one episode of major depression according to the National Institute of Mental Health. New research shows depression in teens is linked to parents, and when treating it, their parent’s mental health improves as well. As social creatures, treating one member of the family helps the other. Check out this story and study we did related to the impact of sports on parents and their kids. Click here 2. Palliative Outsourcing Avalanche: Several Anthem MCOs now use a vendor called Aspire to provide Palliative support to...
Aug 16, 2018 | Medicaid, Medicaid Managed Care
In early August, the state of North Carolina released a request for proposal for plans seeking to participate in its newly-launched Medicaid managed care. The state will shift from a predominately fee-for-service model to a managed care model, starting in late 2019. North Carolina is the largest state left with an unmanaged Medicaid population, with about 2 million covered lives. Click to read more.
Aug 15, 2018 | Drugs, Medicare Advantage, Physicians
CMS recently issued new guidance that allows Medicare Advantage (MA) plans to use step therapy for Part B drugs, starting in plan year 2019. According to the CMS memo, MA plans would be allowed to have patients start treatment with a preferred drug and then shift to other therapies only if medically necessary. We believe interested parties will challenge the legality of the program, and will also turn to Congress to try and weaken or block the action. If step therapy is allowed, though, we believe it could materially impact a subset of Part B drug categories. Click to read more.
Aug 14, 2018 | LTCHs, Medicare
Updates to the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) have been finalized for fiscal year 2019. These changes will affect the approximate 420 LTCHs that Medicare pays for extended inpatient stays under the PPS. This brief summarizes key provisions included in the final rule. Click to read more.
Aug 13, 2018 | Hospitals, Inpatient, LTCHs, Medicare
CMS finalized a 1.85% rate update to the Hospital Inpatient Prospective Payment System (IPPS) for fiscal year 2019. This and other changes will affect the approximate 3,300 acute care hospitals that Medicare pays for inpatient stays under the IPPS. This brief summarizes key provisions included in the final rule. Click to read more.
Aug 10, 2018 | Managed Care Friday
1. 60: That’s the percentage of people suffering from Alzheimer’s who are women. Recent studies show women endure Alzheimer’s disease more than men. For years it was written off as an age issue because women live longer than men. Now, neurologists are studying that it could be for more reasons than just life expectancy. Read the full story on the Kaiser Permanente studyhere. 2. Asthma City: Asthma Capitals and the Asthma and Allergy Foundation of America (AAFA) released research on the “Most Challenging places to live with Asthma” including Springfield, MA, Richmond, VA and Dayton, OH. New...
