IHA Daily Briefing: Aug. 8

CMS Gives MA Plans Option to Negotiate Part B Drugs
Preliminary FFY2020 Wage Index & Occupational Mix Reports
Tips on Safe Use of Lawn & Garden Pesticides

CMS Gives MA Plans Option to Negotiate Part B Drugs
For the first time, the Centers for Medicare & Medicaid Services (CMS) has introduced a negotiation process designed, as the agency believes, to lower the costs of drugs for patients. In past years, legislation that would have permitted CMS to competitively bid to lower the cost of drugs for Medicare Part D (Prescription Drug coverage), fee-for-service beneficiaries did not move forward.

In a memorandum sent to Medicare Advantage (MA) plans, beginning Jan. 1, 2019, plans will have the option of applying “step therapy” for physician-administered, Medicare Part B drugs in an effort to lower drug costs and improve the quality of care for Medicare beneficiaries. Step therapy is a form of prior authorization for drugs that begins medication for a medical condition with the most preferred drug therapy and progresses to other therapies if necessary. Implementing step therapy, together with care coordination and MA plans’ drug adherence policies, will lower costs and improve care.

MA plans that elect to offer step therapy to enrollees must ensure that beneficiaries are sufficiently informed; that information must be disclosed in their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents. More details are available in CMS’ Fact Sheet.

According to statistics published last month by CMS, over 20 million Medicare beneficiaries nationally (representing approximately 34 percent of all Medicare beneficiaries) are enrolled in MA plans; in Illinois, approximately 560,000 (just under 25 percent of eligible Medicare beneficiaries) are enrolled in those plans. MA enrollment numbers for both the U.S. and Illinois have been increasing steadily over the past several years.

Preliminary FFY2020 Wage Index & Occupational Mix Reports
IHA yesterday made available to its member hospital CEOs and CFOs, via the IHA website C-Suite, preliminary federal fiscal year 2020 hospital-specific wage index and occupational mix reports.

This data, which is based on the Centers for Medicare & Medicaid Services (CMS) Public Use File (PUF) issued in May, will be used in the computation of the wage index values used to calculate Medicare payments in FFY 2020.

Members should review their reports and submit any corrections (along with supporting documentation) to their Medicare Administrative Contractor (MAC) no later than Sept. 4. This is the only opportunity for hospitals to submit any changes or corrections to their data; subsequent corrections to the reports will only address errors or omissions committed by the MAC.

Tips on Safe Use of Lawn & Garden Pesticides
Each year, poison control centers in Illinois and across the country receive more than 75,000 calls about pesticide exposures that happen at someone's residence. These calls are most common in the warmer summer months, May through September.

Although pesticides can be useful, they also can be dangerous if used carelessly or are not stored properly. Here are some tips for safer pest control from the U.S. Environmental Protection Agency:

  • The most effective way to reduce risks posed by pesticides is to use non-chemical control methods to reduce or eliminate pest problems. Around the home, such measures include: removing sources of food and water (such as leaky pipes); and destroying pest shelters and breeding sites (such as litter and plant debris).
  • If you decide you must use pesticides, always read the label first and follow the directions to the letter, including all precautions and restrictions.
  • Don't use products for pests that are not indicated on the label and don't use more pesticide than directed by the label. Don't think that twice the amount will do twice the job.
  • Use protective measures when handling pesticides as directed by the label, such as wearing impermeable gloves, long pants, and long-sleeve shirts. Change clothes and wash your hands immediately after applying pesticides.
  • Before applying a pesticide (indoors or outdoors), remove children, toys and pets from the area and keep them away until the pesticide has dried or as recommended by the label.
  • Remove or cover food during indoor applications.
  • Don't spray outdoors on windy or rainy days. Take precautions to keep the pesticide from drifting or running off into the vegetable garden, pool or neighbor's yard.
  • If using a commercial applicator or lawn care service, ask for information about potential risks and safety precautions to take.
  • Don't buy more pesticides than you will need. If you have leftover pesticides, check with your local government to determine whether your community has a household hazardous waste collection program or other program for disposing of pesticides. If no community program exists, follow label directions and any state or local regulations regarding disposal.

Also, save the Illinois Poison Center (IPC) number in your phone(s): 1-800-222-1222.

For more information and tips, see the IPC's webpage on safe lawn and garden practices and a toolkit of consumer education resources from the American Association of Poison Control Centers and National Pesticide Information Center.