Aug 9, 2018 | Skilled Nursing Facilities (SNF)
CMS finalized the FY 2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNFs), which will increase payments by an estimated 2.4%, or $820 million. CMS also finalized its proposal for FY 2020, shifting from RUG-IV to the Patient-Driven Payment Model (PDPM) system. The final rule closely mirrors the proposal. The SNF industry, and particularly contract therapy providers, had expected that CMS would soften some parts of the proposal, such as the limits on combined concurrent and group therapy. We expect that the SNF industry will continue to lobby for...
Aug 8, 2018 | Inpatient Psych, Inpatient Rehab (IRF), Post-Acute Care
CMS recently finalized a +1.1% update to the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS). This brief summarizes updates that will be effective for discharges occurring during fiscal year 2019 and the IPF Quality Reporting Program (QRP). Click to read more. Likewise, CMS finalized a +1.3% update to the Inpatient Rehabilitation Facility (IRF) PPS, which will be effective for discharges occurring during fiscal year 2019 and the IRF QRP. This brief summarizes key provisions included in the final rule. Click to read more.
Aug 3, 2018 | Managed Care Friday
1. By the Numbers: Of 54 million adults suffering from arthritis, 44 percent have limitations that affect mental health. According to the American Psychological Association, anxiety affects blood pressure and high blood pressure often goes untreated in those with rheumatoid arthritis (RA). Chronic daily pain can change the levels of the brain and nervous system chemicals. This changes thinking, behavior and depression. 2. ADHD: Insurance coverage for ADHD drugs and therapy programs is inconsistent between healthcare providers. Cigna released their prescription drug list changes for...
Aug 2, 2018 | ASC, Outpatient
Outpatient Hospital and Ambulatory Surgical Center proposed rules for CY 2019 have been released. The outpatient proposal is effectively a net zero update: a +1.25% rate update is offset by a reduction to the facility fees associated with clinic visits, which has a -1.2% impact on payments. The rule also refines payment policies related to 340B drugs, off-campus clinics, and non-opioid pain medications. The ASC proposal is a significant positive for the industry. The rule proposes a net +2% update for 2019 based on the hospital market basket instead of the CPI-U that has previously been...
Jul 31, 2018 | Dental, Medicaid, Medicaid Managed Care
Florida recently announced contract awards to 3 managed care organizations (MCOs) to provide dental care, and Texas released a Request for Proposals (RFP) for dental MCOs for Texas Children's Medicaid and CHIP. Florida's dental MCOs are to be fully implemented by March 1, 2019. Texas' deadline for proposals is September 7, 2018, and the State plans to award at least 2 dental MCO contracts for 2020 through 2022. Click to read more.
Jul 30, 2018 | Physician Fee Schedule, Physicians
The recently released proposed Physician Fee Schedule (PFS) for calendar year 2019 is estimated by CMS to reduce pathology specialty codes by a net -1% for next year. However, while the net change is basically neutral overall, some key codes are seeing significant changes due to a CMS update of input prices for basic office supplies and equipment for the first time since 2004. Click to read more.
Jul 27, 2018 | Managed Care Friday
1. One Million: Number of people over 5 years of age that are considered functionally deaf. More than half of those people are over the age of 65. With the great popularity of the ear buds and beat headphones at the gym, hearing loss is becoming more of an issue. Letting your kids playing video games at full volume can be more damaging to their hearing than you think. A recent study involving participants aged 18-41 shows those who showed small amounts of hearing loss had unusual activity in their right frontal cortex of their brain. The study concluded these changes show signs of dementia...
Jul 26, 2018 | Legislation/ Budgets/ Macro
Federal debt and entitlement trust fund insolvency is likely to negatively impact federal healthcare spending starting in the mid-2020s and continuing into the 2030s. Both CBO and the Social Security and Medicare Trustees have published their annual forecasts of the fiscal posture of the Federal Government. CBO examines the entire government and the US economy. The Trustees focus on Medicare and Social Security programs, which constitute almost half of federal spending. Both reports project difficulties for the specific programs and the entire federal government. The programs face insolvency...
Jul 25, 2018 | Behavioral, Substance Abuse
The Affordable Care Act designated mental health and substance use services as essential health benefits in Marketplace plans and also extended parity requirements to the individual and small-group markets. This brief highlights a recent Health Affairs study that analyzed the extent to which the law improved coverage for these services. Read more here.
