President signs legislation poised to bring 128 million for Iowa’s Medicaid program

President Obama has signed into law legislation extending stimulus funding to states. One of the provisions in this bill includes 16.1 billon dollars in Federal Medical Assistance Percentages (FMAP) of which, Iowa is expected to receive approximately 128 million for the state’s Medicaid program.

This comes at a great time as it will give a six month extension to the FMAP assistance from the American Recovery and Reinvestment Act of 2009, which is expected to end on December 31, 2010. This legislation helps the states as they are all experiencing shortfalls in their economies and trying to balance their budgets at the same time. Many states were going to have to cut Medicaid funding without the passage of this bill.

More information from national pharmacy organizations:

NCPA

NACDS

APhA

Refusal to dismiss lawsuit challenging health care reform law

A U.S. District Court Judge is refusing to dismiss a lawsuit challenging the new health care reform law, asserting that Congress exceeded its authority to regulate commerce by imposing the insurance mandate. The lawsuit was filed by Virginia’s Attorney General.  The lawsuit challenges a provision of the health care reform bill, which mandates that individuals buy health insurance or pay a penalty.

In response, the federal government believes that Congress did act within its constitutional authority. They are confident that the provision in the health care reform bill is constitutional and they will ultimately prevail.

Federal Judge Won’t Dismiss Virginia Challenge to New Health Care Law

Judge Permits Virginia Health Care Suit to Proceed

Cuccinelli Pleased with Health Ruling, While Feds Express Confidence in Case

Contact your Senator and Congressman!- Help build support for the MTM Expanded Benefits Act of 2010

This week Senators Hagan (D- NC) and Franken (D- MN) and Representative Ross (D- AR) issued Senate and House, Dear Colleague letters, in support of this legislation. Dear Colleague letters are influential letters used within Congress to educate about the benefits of a bill to help build peer-to-peer support. Contact Senators Harkin (D) and Grassley (R) and your Congressman (Braley (D-1), Loebsack (D-2), Boswell (D-3), Latham (R-4) or King (R-5) today and encourage them to co-sponsor S 3543/HR 3108.

This bill would expand Medicare beneficiary access to MTM services. The proposed changes include:

• Expanding the list of conditions used to determine beneficiary eligibility for MTM services.
• Requiring prescription drug plan (PDP) sponsors to establish processes for identifying individuals who are not targeted beneficiaries for MTM services and who a pharmacist or other qualified provider determines may benefit from MTM services, allowing any such individual to be treated as a targeted beneficiary.
• Requiring any MTM program to offer both comprehensive and targeted medication reviews at the time of initial enrollment and of a transition of care, respectively, to individuals dually eligible for both Medicare and Medicaid (regardless of whether they are MTM-targeted beneficiaries).
• Requiring PDP sponsors to offer any willing pharmacy in its network and any other health care provider the opportunity to provide MTM services.
• Requiring PDP sponsors to reimburse pharmacies or other qualified health care providers furnishing MTM services based on the resources used and the time required to provide such services.
• Directing the Secretary of HHS to: (1) establish measures and standards for data collection by PDP sponsors to evaluate performance of pharmacies and other entities in furnishing MTM services; and (2) support the continued development and refinement of performance measures.
• Providing pharmacies and other entities that furnish MTM services with additional incentive payments based on their performance in meeting quality measures established under this Act.

Pharmacists can utilize Call to Action by NACDS to send an online letter!

Insurance plans to provide free preventative health services

Patients who enroll in a health insurance plan on or after September 23, 2010 will be eligible for a long list of free preventative health services when they are delivered by a network provider. This new rule is a provision of the Affordable Care Act, in order to make wellness and prevention services more affordable, accessible, and appealing to Americans. Insurance plans will be required to cover all evidence-based preventive services that are recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices. Some of the services included are: blood pressure, diabetes, and many cancer screenings. Also included are cholesterol tests, routine vaccinations, regular well-baby and well-child visits, tobacco cessation interventions, and much more.

Not everyone agrees with the intentions of this new rule. Some concern has been shown that these services might be offered, but the next challenge will be to convince Americans to take advantage of them. Others are concerned about an increase in insurance premiums as these out-of-pocket costs are eliminated.

Sources:

New Health Insurance Plans Required to Provide Free Preventive Health Care

The Affordable Care Act’s New Rules on Preventive Care and You

Health Plans to Provide Free Preventive Care

Surescripts.com announces e-prescribing progress reports for all 50 states and the District of Columbia

Earlier this year, Surescripts released its National Progress Report on E-Prescribing and now data regarding e-prescribing is available at the state level. Surescripts.com contains reports which track the growth of e-prescribing adoption and use in each state for the past three years.

Surescripts operates the nation’s largest e-prescription network. The network connects prescribers in all 50 states, through their choice of e-prescribing software, to the nation’s leading payers, chain pharmacies, and independent pharmacies.

Selected highlights of the Surescripts.com website:

• Downloads and webinars containing e-prescribing information

• Daily links to the latest e-prescribing headlines

• A new interactive map of e-prescribing incentive programs by state

• An enhanced prescriber software certification table that allows a visitor to search the Surescripts certification status of all e-prescribing software by vendor, product name, and software type

• Ability to search for healthcare providers in your area who e-prescribe

Regulation of meaningful use released by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT have now released regulation regarding meaningful use of EHR’s. This new regulation involves the first two years (2011-2012) of a multiyear incentive program. According to David Blumenthal, National Coordinator for Health Information Technology, “the goal of the Health Information Technology for Economic and Clinical Health Act was not adoption alone, but meaningful use of electronic health records – that is, their use by providers to achieve significant improvements in care.” The legislation ties provider payments to the achievement of advances in health care processes and outcomes.

There was not a lot of movement on the implementation of EHR’s until last year when Congress and the Obama administration passed the Health Information Technology for Economic and Clinical Health Act. This act authorized incentive payments to clinicians and hospitals for Medicare and Medicaid claims when they used EHR’s privately and securely to improve health care delivery.

One of the most important aspects of meaningful use regulation is how hospitals and providers must utilize EHRs in order to be considered meaningful users in 2011-2012. The final regulation consists of two sets of objectives. First is a set of core objectives, which are a starting point for meaningful use implementation, and the second is a menu of 10 additional important activities which providers will choose 5 to implement over the 2 years. For a complete listing of the objective and menu sets, please refer to The “Meaningful Use” Regulation for Electronic Health Records.

How will the Patient Protection and Affordable Care Act impact hospitals and other employers?

The American Hospital Association created a document highlighting how the Patient Protection and Affordable Care Act will impact hospitals and other employers. The four key areas employers will see significant changes in are:

1) Changes requiring employers to amend their employer health plans or the way they operate or administer their plans

Included in the Patient Protection and Affordable Care Act are some employer health plan amendments which could significantly change employer health plans and change the cost to provide coverage. New provisions may cause some employers to re-structure their employer health plans. The changes include a ban on annual and life-time benefit limits and pre-existing condition limitations for children under 19. Employers must also provide a number of preventative care benefits in the health care plan, including benefits for mental health and substance abuse. Lastly, there will be new regulations banning executive-only health insurance arrangements, and a new excise tax on Cadillac, or high premium, plans that will become effective in 2018. Generally no distinction is drawn between insured and self-insured plans.

2) Changes affecting the availability and cost of health insurance

Insurance market reforms bring changes affecting insurance companies. These reforms hope to make it easier for employers to obtain and afford a health plan for their employees. Two temporary insurance programs were implemented, a reinsurance program for early retirees and a high-risk insurance program for those with pre-existing conditions. It is not known how helpful these changes will be, as some are only available to small employers (no more than 25 full-time equivalent employees) or those that provide retiree health coverage.

3) The employer health insurance mandate

The employer mandate does not require employers to provide coverage to all employees or provide a minimum level of coverage. The employer health insurance mandate allows employers to receive financial incentives to provide coverage to at least lower-income full-time employees. Health insurance exchanges will be developed to allow employers and employees easy access to the coverage available.

4) Revenue provisions and other tax changes affecting employers

The provisions in the Patient Protection and Affordable Care Act allow employers to increase revenue, but they will also require time, effort, and other related expenses on behalf of the employer. Employers will be required to report the cost of all health coverage provided to an employee on their W-2 form. This will help to enforce the excise tax on “Cadillac” health plans.

For further information, including implementation dates see the AHA Legislative Advisory: Summary of the most Significant Health Reform Changes Affecting Hospitals and other Employers

AHA Health Care Reform Implementation Timeline

More checks are being mailed to Medicare patients

Procedures to start closing the donut hole, or coverage gap, for Medicare seniors were passed as part of the major health care reform bill in March. This year, seniors will be receiving a $250 check to help with costs associated with the coverage gap. Approximately 80,000 checks were mailed out to patients in June who fell into the coverage gap during the first three months of the year. A second round of checks is now being mailed out to patients who entered the coverage gap in April and June and were not eligible for the low-income subsidies. Next year, seniors who have reached the coverage gap will get a 50 percent discount on prescription medications. This percentage is expected to gradually increase until the coverage gap no longer exists.

CMS announces new fact sheet regarding pharmacy accreditation for DMEPOS

The Centers for Medicare and Medicaid (CMS) announced the availability of a new fact sheet regarding pharmacy accreditation for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The fact sheet outlines changes the health care reform bill made to the 2008 Medicare Improvements for Patients and Providers Act. It provides information to pharmacies regarding the DMEPOS accreditation process and requirements for exemption.

The deadline for pharmacies, who do not meet the exemption criteria passed in the health care reform act (see below for criteria), to submit evidence of accreditation has been extended to January 1, 2011. Please visit the CMS website for information regarding the accreditation process. It is recommended that pharmacies begin the accreditation process early.

Pharmacies that supply DMEPOS may qualify for an exemption from the requirements if they meet the following criteria:

1. The total billings by the pharmacy for DMEPOS are less than 5 percent of total pharmacy sales for the previous 3 calendar years; and

2. The pharmacy has been enrolled as a supplier of durable medical equipment, prosthetics, orthotics, and supplies and has been issued a provider number for at least 5 years; and

3.No final adverse action has been imposed on the pharmacy in the past 5 years; and

4. The pharmacy submits an attestation, in the manner and at the timeframe to be determined, that the pharmacy meet the criteria listed in 1-3; and

5. The pharmacy agrees to submit materials as requested during the course of an audit conducted on a random sample of pharmacies selected annually.

Sources and further information:

DMEPOS Accreditation Fact Sheet

CMS Releases New Fact Sheet on DMEPOS Accreditation for Pharmacies

APhA and NCPA both offer advice to CMS regarding the implementation of Long-term Care Waste Reduction (Health Care Reform bill- Section 3310)

The Long-term Care Waste Reduction mandate, which is a provision that passed with the Health Care Reform bill, is causing the American Pharmacists Association (APhA) and the National Community Pharmacists Association (NCPA) to speak up and offer advice to the Centers for Medicare and Medicaid Services regarding how they will implement the provisions. The law changes the 30 day dispensing cycle of prescription drugs filled for long-term care facilities. The mandate was put in place to help reduce pharmaceutical waste. This provision directs CMS to require Medicare Part D plans to use weekly, daily, or automated dose dispensing techniques when dispensing to Medicare Part D patients residing in long-term care facilities. Unfortunately, this change in dispensing practices could come with financial and logistical hardships for community pharmacies.

Recommendations from APhA

* Have a single approach for each facility and pharmacy;

* Provide grant monies to help pharmacies purchase technology;

* Pay a dispensing fee for each transaction;

* Recognize that states vary in how they address automation in long-term care settings;

* Phase in the program to provide pharmacies time to implement;

* Focus on brand medications rather than less expensive generic medications;

* Allow some flexibility, including allowing for a pharmacist’s clinical judgment;

* Carve out drugs such as controlled substances and drugs that may need to be titrated; and

* Assess current return and reuse programs.

Recommendations from NCPA:

* Conduct a scientific study of the actual benefits of reducing dispensing cycles from a monthly to weekly basis, since NCPA contends pharmacies already incorporate numerous strategies to deal with unused prescription drugs that are paid for under Medicare Part D; and/or utilize an interim stage of reducing the dispensing window to every 14 days to ascertain its impact before moving forward with a tighter window, such as a seven-day cycle or less.

* Allocate greater, timely financial compensation to help pharmacies adjust to the need to account for the extra dispensing cycles, which may entail, for example, hiring more staff or investing in additional technology.

* Create an exemption for small pharmacies (those meeting the Small Business Administration’s definition as having revenues of $7 million or less) and those in rural areas that will likely lack the incentives or capital to continue providing long-term care services.

*Allow for a two-year transition for these changes to occur from January 1, 2012 until January 1, 2014 instead of having the earlier date be the line of demarcation for full compliance, so pharmacies can effectively implement the changes without too much disruption to their long-term care services.

Both organizations recognize the importance of reducing pharmaceutical waste and the role pharmacists can play, but would like the provisions to allow pharmacies to make the transition smoothly.

For more information:

NCPA Offers Constructive Solutions to Potentially Problematic Pharmaceutical Waste Reduction Efforts in Long-Term Care Dispensing

HCR Update: APhA Talks to CMS on Implementing the Long-Term Care Waste Reduction Provisions