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LTC Pharmacy News
December 2018
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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Introduction to PDPM for LTC Pharmacy Professionals
If you're not quite sure about the new Medicare SNF payment model, scheduled to take effect next October, take a look at our new Tutorial. This is a summary of the new payment model focused primarily on pharmacy professionals.
CMS Digs Into PDPM and MedPAC 
Following CMS' publication of the final rule, the agency has  been busy preparing for the beginning of the new Patient-Driven Payment Model in October of 2019. Elise reports on a webinar recently conducted by CMS on preparing for PDPM, as well as the December meeting of the Medicare Payment Advisory Commission (MedPAC). 

More Elise Smith Insights
The list of Elise's publications was getting too lengthy to continue listing on the newsletter, so we have created her own page on the LTC Pharmacy News site. See it all now.

The Year Ahead With Divided Government
As we approach the end of the year it seems everyone is ready to give us their expert opinion on what we can expect in the year ahead. The soothsayers can be confident that you won't remember if they're wrong and they will be certain to remind us if they are.

With that caveat, here's a few predictions to pique your interest:

Federal Judge Rules ACA Unconstitutional
Roll Call:   A federal judge in Texas has ruled that the Affordable Care Act (ACA) is unconstitutional because Congress repealed the individual mandate as part of the 2017 tax legislation. The case was brought by several state attorneys general. The decision will be appealed and most observers expect the case to be taken up by the Supreme Court.
HHS Statement on Texas vs. Azar
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Federal Agency News

EPA Releases Final Hazardous Waste Pharmaceutical Rule
The Environmental Protection Agency has released the final rule governing hazardous waste pharmaceuticals. The process has taken more than ten years and involved dozens of industry experts. EPA has held listening sessions and taken pharmacy tours before coming to a final determination. We will be publishing a summary of the provisions of the final rule in early January. If you want the details quickly, see here.

HHS Wants Your Opinion on HIPAA
Healthcare professionals frequently complain about the regulatory burdens of compliance with federal requirements. Many complaints are directed at the privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA). Now, the Dept. of Health and Human Services (HHS) wants to hear your complaints and your recommendations on how to improve regulatory compliance. Read More

CMS Office of the Actuary Releases Health Spending Data
Healthcare spending in the US in 2017 rose 3.9 percent to $3.5 trillion. Prescription drug spending rose at a lower rate of 0.4 percent, while spending on nursing facilities and continuing care retirement communities showed a 2 percent growth to $166 billion.
See more details here.

HHS Secretary Appoints New Drug Pricing Advisor
Secretary Alex Azar announced the appointment of John O'Brien to the position of Senior Advisor to the Secretary for Drug Pricing Reform. The appointment was made when the previous incumbent, Dan Best, died suddenly. O'Brien is a pharmacist and former policy executive with CareFirst Blue Cross Blue Shield. See HHS Announcement.

Trump Administration Publishes Healthcare Agenda
A report published by the secretaries of HHS, Labor and The Treasury lays out the Trump Administration's healthcare priorities as it promotes market-based solutions to America's outsized healthcare spending.

CMS Proposes Rule Targeting Protected Classes and DIR Fees
CMS announced a proposed rule that would allow Medicare drug plans to implement step therapy and limit coverage of certain drugs in the six protected classes, noting that discounts from manufacturers for drugs within the protected classes are significantly lower than for drugs in other classes. The proposal would also require plans to price their Part D drugs to account for the lowest price the plan would pay, inclusive of all possible take-backs from pharmacy typically captured in their retrospective penalties.
The comment period is open until January 26, 2019.

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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
SNFs Face Rising Drug Costs
Skilled Nursing News:     When hospitals discharge their less-complex patient's to home care, nursing homes are increasingly reserved for the residents with more complicated medical conditions. This has resulted in higher average medication costs per facility. Even relatively small individual increases can cascade into significant new expenses for skilled facilities. 

SNF Occupancy Ticks Up Slightly in Q3
The National Investment Center for Senior Housing and Care (NIC) issued its 3rd Quarter 2018 report showing a 14 basis point increase in SNF occupancy from the 2nd Quarter. However, occupancy remains well below that of a year ago and Medicaid and Medicare managed care continue to show increased penetration.

Commonwealth Fund Examines Post-Acute Spending
Spending growth in Medicare has slowed over the past ten years. The Commonwealth Fund produced a study examining how spending has changed in the post-acute care sector and what factors may be responsible for these changes. See More 

Happy Holidays from LTC Pharmacy News. All the Best for a Great New Year!

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