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February, 2016

LTC Pharmacy News
February 2017
The healthcare industry is in the beginning of massive change and the long term care pharmacy industry will be affected by this change. is your guide to understanding this process, the legislation and regulation that will implement this change and the key to adjusting your approach to succeeding in this new environment. We will try to not just tell you the "what" of this change, but the "how" as well.
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CMS Final Rule on Medicaid Pass-through payments
You may have seen stories in the trade press concerning CMS' new final rule on the states' use of pass-through payments in Medicaid managed care and wondered what this is all about.

Wonder no more. Elise has put together an informative overview of the issue and its potential impact on hospitals and nursing homes. 

Nursing Home Policy Priorities in 2017
The new year is upon us, and with it another year of triumph, near misses and major disappointments. So, what keeps our friends in the nursing home industry awake at night?

Take a look at Elise's take on the major policy issues facing the industry in the months ahead. 
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Legislative Highlights

Republicans Tackle ACA Changes
On January 20th the nation began its latest experience in unified government. This time the Republicans are in charge. Among the first orders of business is dismantling the Affordable Care Act.

The GOP is not yet unified on a replacement plan, although individual members have expressed preferred approaches, including allowing states to keep provisions of the ACA, and extending health savings accounts. 

Democrats have promised a vigorous defense of the current system, and there are enough Democratic senators to sustain a filibuster on provisions of policy. Republicans can start the process through budget reconciliation, but a major overhaul requires cooperation from some senators from the other side of the aisle.

Meanwhile, you can keep track of all the action on a new website, sponsored by the majority in the House Energy and Commerce Committee. The site: Health Care Central, promises to be your "one-stop shop" for all things health reform, if only from the majority point of view.

Cabinet Confirmations
The Senate is busy holding hearings on President Trump's cabinet choices. No appointee has faced as much scrutiny as Rep. Tom Price (R-GA), the president's choice for Secretary of HHS. Much of the hearing included hostile questioning from the Democrats, but it appears Price will be confirmed, since confirmation requires only a majority of senators voting in the affirmative. Thanks to a Democratic rule change in 2013, presidential appointments (other than Supreme Court nominations) are not subject to filibuster.

Pharmacist Provider Legislation Reintroduced in House
Congressman Brett Guthrie (R-KY) reintroduced legislation to provide for limited coverage under Medicare for pharmacist services in the Medicare program. The legislation was introduced with 113 co-sponsors and has been assigned to the House Energy and Commerce Committee and The House Ways and Means Committee. The bill is now known as HR 592. An identical bill has been introduced in the Senate by Senator Chuck Grassley (R-IA) as S 109.  
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Federal Agency News
President Trumps Signs Executive Order on ACA
As one of the first acts of his presidency, President Trump signed an executive order requiring federal agencies to "waive, defer, grant exemptions from, or delay the implementation" of provisions related to the Affordable Care Act. This was a campaign promise that resonated with his supporters. 

The President, in a procedure that is common in all new administrations, put a freeze on all pending regulations pending review by incoming officials, The only exemption will be emergency regulations that are required for public safety, health, and national security.

CMS Releases Draft Call Letter for 2018 Medicare Part D
With February comes the traditional call letter review of Medicare Part D. CMS has released the draft document and will accept comments on this until March 3rd. 

FDA Releases Final Guidance on Repackaging
The FDA finalized the long-awaited guidance on Repackaging of Certain Human
Drug Products by Pharmacies and Outsourcing Facilities.

The final guidance is improved from the draft document in that it does not contain restrictions on how much non-patient-specific repackaged product can be stored in the pharmacy. The bulk of the guidance deals with appropriate beyond-use dating.

Energy and Commerce Subcommittee Holds Medicaid Hearing
The Oversight and Investigations subcommittee of the Energy and Commerce Committee held a hearing on January 31 to review issues related to Medicaid expansion, which was part of the Affordable Care Act. Witnesses included representatives of the GAO, Manhattan Institute, Foundation for Government Accountability, The Office of Inspector General and Georgetown Law Center.

CMS Community First Choice Letter
CMS issued a letter to State Medicaid Directors on December 30th providing guidance on the implementation of the Community First Choice (CFC) option for Medicaid recipients in need of institutional care. The CFC offers states the ability to offer personal care services and supports to individuals in a home and community-based setting. 

The program comes with an enhanced federal medical assistance percentage match of 6 percent and requires the state to submit a waiver request. 

Home Health Agency Final Rule Released
CMS announced the publication of the final rule on Home Health Agency conditions of participation. This final rule is the first major re-write of Home Health rules in more than 20 years and focuses on patient rights, care coordination and documentation. Please see CMS News Release for more information.

2017 data book on dually eligible beneficiaries from MedPAC and MACPAC now available
MedPAC announces the release of MedPAC and MACPAC’s joint data book: Beneficiaries Dually Eligible for Medicare and Medicaid. This data book is part of an ongoing effort by MedPAC and MACPAC to create a common understanding of dually eligible beneficiaries, a relatively small group that accounts for a disproportionate share of both Medicare and Medicaid spending.
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Go to the LTC Pharmacy website for regular updates on what's coming from CMS, including proposed and final rules, new programs, news from Medicare and Medicaid and updated Medicare Learning resources. Go there now.

The FDA often updates its website with drug safety information, news about drug approvals and implementation information on laws, such as the Drug Quality and Security Act. Keep checking our site for the latest news from FDA.

THE HHS Office of Inspector General publishes audit reports and results of investigations on federal health programs, such as Medicare and Medicaid. Congress frequently looks at these reports when deciding where to focus on oversight and legislation. Keep in touch here.

The Government Accountability Office is the official investigative arm of Congress and publishes important reports that often guide the national conversation. We keep track of announcements coming out of GAO, so you don't have to. All you need to do is click here.

News Items of Interest
Kaiser: 50-State Survey of Medicaid Eligibility and Enrollment Policies in 2017: A Baseline for Measuring Future Changes
Kaiser Family Foundation publishes its 15th annual report on state Medicaid enrollment, renewal and cost-sharing policies.

McKesson to buy Cover My Meds
Drug Wholesale Giant McKesson has announced an agreement to buy pharmacy technology company CoverMyMeds, according to a story in Med City News. The price for the company is reported to be $1.1 billion. The company will operate independently and remain headquartered in Columbus, Ohio.

Federal Court Blocks Aetna-Humana Merger
Healthcare Finance News reports that DC District Court Judge John D. Bates has blocked the proposed merger of health insurers Aetna and Humana. Aetna announced that it is considering an appeal to the DC Circuit.

Coalition Urges Prior Authorization Reform
A coalition of 17 healthcare organizations, including the American Medical Association and the American Pharmacists Association, have proposed a list of principles health insurers should be required to follow in order to minimize disruption of patient care and eliminate unnecessary administrative burdens. 

Software Shown to Reduce Medication Errors
An Israeli software startup, MedAware, recently had its machine-learning software validated by a study of more than 750,00 medical records, in which the program issued more than $15,000 alerts due to potentially serious medication-related problems. Investigators determined that more than 75 percent of the alerts issued were correct. See story in MedCity News.

Kaiser: Everything you need to know about Medicaid Block Grants
Congressional Republicans have long advocated for reforming Medicaid by giving states a fixed allocation of money and letting them operate their Medicaid programs with less interference from Washington. Kaiser Health News offers a primer on how this program might operate.

Consumer Electronics Show Highlights Healthcare
Didn't make it to Las Vegas this year for the CES? Well, maybe next year. Meanwhile, take a look at some of the innovations in healthcare technology showcased at this year's event, courtesy of Mobi Health News.

NIC Updates Market Outlook for Senior Living
National Investment Center for Seniors Housing & Care February newsletter updates the outlook for senior living. The report notes increased demand for independent living, while skilled care occupancy rates languish at 82 percent. See details
Best Places to open Telepharmacy Practice
Thinking about starting up a telepharmacy practice? The telepharmacy blog suggests three places where you are likely to find success.

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