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NAHC Report: Issue# 2471, 7/21/2014
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ARTICLE ARCHIVES MEMBER RESOURCES eNEWSLETTERS CARING STORE
CMS Eases Scope of PA for Part D Beneficiaries on Hospice: Limits PA to 4 Drug Categories Identified by OIG as a Concern
AACA Update: More than 100,000 Early Retirees Now Qualify for Medicaid Under ACA Expansion, GAO Says
For Your Information: Replay of the NAHC and HHNA Teleconference from July 11, 2014 Now Available Online
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CMS Eases Scope of PA for Part D Beneficiaries on Hospice: Limits PA to 4 Drug Categories Identified by OIG as a Concern

On July 18, 2014 the Centers for Medicare & Medicaid Services (CMS) released a memorandum, Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice, which updates the guidance previously released in March.  Under the new guidance, in lieu of placing a beneficiary-level prior authorization (PA) on all drugs for beneficiaries who have elected hospice, CMS strongly encourages Part D sponsors to place beneficiary-level PA requirements on only four categories of prescription drugs: analgesics, antinauseants (antiemetics), laxatives, and antianxiety drugs (anxiolytics).

Drugs prescribed for hospice patients under these four categories and paid for under Part D were the subject of a 2012 Office of the Inspector General (OIG) report in which concerns were raised that Medicare may be paying twice for drugs for hospice patients -- once under the bundled hospice per diem that includes drugs that are prescribed for the terminal diagnosis and related conditions and again under Part D.

In the memo, CMS conveys that it expects that medications in these four drug classes will rarely be unrelated to the patient’s principal terminal diagnosis and related conditions so hospice will be paying for these medications most of the time.  While CMS indicates that the change is effective immediately and strongly encourages plans to implement the guidance as soon as possible, plans MUST implement the guidance by until Oct. 1, 2014.

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ACA Update: More than 100,000 Early Retirees Now Qualify for Medicaid Under ACA Expansion, GAO Says

The following article originally appeared in Modern Healthcare, and was also recently reprinted in Hospice Notes. As it is relevant to both the home care and hospice community, the article - with links to the GAO report – is reprinted below in its entirety:

Obamacare is allowing many Americans to retire early and claim Social Security benefits at age 62 without shouldering exorbitant healthcare costs until they can get Medicare, according to the U.S. Government Accountability Office (PDF).

About a million early claimers did not have Medicaid or employer-sponsored health insurance before the coverage provisions of the Patient Protection and Affordable Care Act kicked in this year. Of those, 14 percent may be newly eligible for Medicaid in the 25 states (and the District of Columbia) that expanded the program under the law. Another 58 percent could be eligible for tax credits toward purchasing coverage through the new insurance exchanges. 

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Replay of the NAHC and HHNA Teleconference from July 11, 2014 Now Available Online

NAHC and its affiliate Home Healthcare Nurses Association’s recent teleconference on the proposed changes to the face-to-face requirement is now available online.

The teleconference was presented by NAHC and HHNA and was hosted by a faculty of: Val J. Halamandaris, NAHC’s President; Elaine Stephens, HHNA’s Executive Vice President; Jeff Kincheloe, NAHC’s Vice President for Government Affairs; Bill Dombi, NAHC’s Vice President for Law; and Mary Carr, NAHC’s Vice President for Regulatory Affairs.

To access the full teleconference, please click here.

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