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California pharmacies will no longer be required to pay back the state under its new reimbursement methodology

Natalia Mazina

Back in 2017, the California Department of Healthcare Services (DHCS) approved a new methodology – National Average Drug Acquisition Cost (NADAC) – for reimbursing pharmacies for their drug cost. NADAC prices significantly reduced pharmacy reimbursements. See a related blog post. This lead to overpayments to pharmacies.

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Our Nursing Home Industry – A National Scandal

HIT Consultant

It has led me to found Tapestry Health, a multispecialty medical practice that focuses on providing medical infrastructure in skilled nursing facilities (SNFs), as well as Project Patient Care, a patient advocacy organization based in Chicago, Illinois. increase, home health services seeing a 1.4%

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Weekly Roundup – October 22, 2022

Healthcare IT Today

At the recent RARE Patient Advocacy Summit, John caught up with three entrepreneurs who used their personal experiences with rare diseases to create solutions for themselves, their loved ones, and patients facing the same challenges. Read more… A Look at 3 Startups in the Rare Disease Space.

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CMS Finalizes Major Changes to Hospital Price Transparency Rule

Hall Render

The Centers for Medicare & Medicaid Services (“CMS”) finalized significant updates to the Hospital Price Transparency regulation for the first time since the rule took effect on January 1, 2021. This data element supplements the existing requirement to disclose payer-specific negotiated charges for all items and services.

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Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program

CMS.gov

The Meaningful Measure Areas serve as the connectors between CMS goals under development and individual measures/initiatives that demonstrate how high quality outcomes for our Medicare, Medicaid, and CHIP beneficiaries are being achieved.

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DIR Reform: what you need to know

Natalia Mazina

Many pharmacy and patient advocacy groups have spoken out against the obscure methods employed by PBMs to increase their profits. These groups have advocated for the fees to be applied at the time a patient picks up the medication at the pharmacy rather than subjecting pharmacies to these fees months later. What are DIR fees?

Medicare 137
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Home Health PPS Final Rule for CY 2024: CMS Steps Back from the Brink

Hall Render

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. CMS received 85 comments in response to the RFI.