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Posted on 10/18/2018 by NTOCC ® in Public Policy Updates Patient Protection and Affordable Care Act Healthcare IMPACT NEWSLETTER 2019 AAoA Allied Against Opioid Abuse opioid crisis


                   IMPACT NEWSLETTER                     
  NOVEMBER 2018 

NTOCC Executive Director's Corner

News and updates from the NTOCC Executive Director’s desk.


As we move from fall into winter and to the mid-term elections I know many of us wonder what changes we may see?  As health care professionals we see changes in policy, regulation, structure, process and measurement constantly.   
Therefore, being flexible, open-minded, focused on quality,   and committed to excellence in all aspects of patient care is   what I believe keeps us motivated and encouraged to   identify better ways to improve care coordination and   transitions of care.  NTOCC’s participation with other   industry partners addressing the issue of care transitions continues and I would like to share an overview about three projects we have been committed to.

NTOCC has participated over the last three years with a patient-centered project that has been focused on defining what matters most to patients and caregivers during care transitions: Project ACHIEVE.  ACHIEVE stands for Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence.

Funded by Patient Centered Outcome Research Institute (PCORI), nationally recognized leaders in health care and research methods have partnered with patients and caregivers to evaluate the effectiveness of current efforts at improving care transitions and develop recommendations on best practices for patient-centered care transitions and guidance for spreading them across the U.S.

Recently ACHIEVE published findings of the study in the September/October 2018 Annals of Family Medicine and maintains a website supporting the work and outcomes.  Additional information and resources about the project can be found at:

This year NTOCC is working with two organizations addressing concerns, gaps and barriers to opioid use and access to non-opioid alternatives:

  • Non-Opioid Choices – Increasing awareness of and patient and provider access to non-opioid approaches to pain management:

    • NTOCC has partnered with Pacira, Venn Strategies and industry stakeholder building educational information and resources

    • Resources can be access at: or

    • We have participated in several DC fly-ins, meeting with legislatures and regulators discussing the issues at hand and alternative options.  Defining the importance of choice for all patients and family caregivers

  • Allied Against Opioid Abuse – AAoA - a partner-based initiative to provide education and awareness to prevent abuse and misuse of prescription opioids

    • Developing educational resources and promoting their availability to consumers, pharmacists, healthcare professionals and other stakeholders

    • Resources can be access at:

    • Identifying opportunities to educate pharmacists and providers to help reduce misuse and abuse of prescription opioids among patients

    • Educating consumers via point-of-sale pharmacy materials

NTOCC Call to Action:
In support of the important work addressing opioid abuse and the issues impacting safe transitions from post-surgical procedures, NTOCC would like to convene an educational resource committee to develop a patient decision tool about Opioid Prescribing and Patient Handling:

  • This will be an on-line working group

  • A commitment of three months

  • To identify issues and concerns

  • Create a question/discussion format to engage the patient, family caregivers and health care provider

  • Identify appropriate use, storage and disposal

  • If you would like to participate, please send an email of interest to

We would like to begin the committee work by the first of December.  I look forward to working with you.

Best regards,

Cheri Lattimer

NTOCC, Executive Director




NTOCC Joins Allied Against Opioid Abuse Coalition and Campaign
By Lee Lynch, AAOA

The National Transitions of Care Coalition recently became a partner of Allied Against Opioid Abuse (AAOA) – a national education and awareness initiative to help prevent the abuse and misuse of prescription opioids.

AAOA seeks to contribute to solving the opioid crisis in a meaningful way by educating patients about the rights, risks and responsibilities associated with prescription opioids.

The initiative is a collaborative effort with diverse partners across the pharmaceutical supply chain, as well organizations that are experts in public health and healthcare.

Prescription opioids carry serious risk of addiction and overdose, especially with prolonged use, so it is important that patients talk to their healthcare provider and pharmacist when opioid medicines are prescribed to make sure they understand the risks and potential side effects as well as their responsibility to safeguard them. When those medicines are taken home, patients can help prevent prescription opioid misuse and abuse by safely storing the medicine in a secure place and promptly disposing of any expired or unused pills.

A recent national poll conducted by AAOA found that nearly 70 percent of the consumers surveyed said they would be more likely to safely store and dispose of prescription opioids if they were given information on the best way to do so. In the same poll, more than seven in 10 said detailed instructions from a pharmacist would make a meaningful difference in addressing the opioid epidemic.

The AAOA campaign is a national program with additional focus on a number of states including, Connecticut, Florida, Minnesota, Pennsylvania, Ohio and Tennessee. In those states, AAOA has an on-the-ground presence to help raise awareness locally through informational and awareness events that include health advocates, business leaders, policymakers and consumers. Recent noteworthy AAOA activities include:

In October, AAOA worked with a team of physicians at The Johns Hopkins Hospital, to develop and release a new educational video to help patients prepare for and manage post-surgery pain. AAOA and Johns Hopkins, which has developed post-surgical guidelines for prescribing opioids to patients at discharge, share a mission of helping to prevent opioid abuse and misuse. To address the significant gap in patient education, the video, “Managing Pain After Surgery: What You Need to Know,” underscores that pain is a normal part of the healing process. Johns Hopkins physicians, led by Marty Makary, MD, MPH, discuss the expectations of post-operation pain, provide tips for managing pain without prescription opioids to a functional level and recommend patients talk with their doctor before and after surgery.

In September, AAOA worked with as its founding member, the Healthcare Distribution Alliance (HDA), and its pharmacy partners, including the National Alliance for State Pharmacy Associations (NASPA) and the National Community Pharmacists Association (NCPA) to create a pharmacy toolkit to equip pharmacists with resources to engage and educate patients about the safe use, storage and disposal of pain medicines. The partners worked together to develop a full suite of educational materials to help prevent and reduce instances of prescription opioid abuse and misuse. These materials focus on helping pharmacists to educate their patients and caregivers about the rights, risks and responsibilities associated with prescription opioids.

At the American Academy of PAs (AAPA) Conference in July held in New Orleans, AAOA worked with coalition partner the Physician Assistant Foundation to develop and launch Pledge to Pause. This pledge urges providers to take a moment to pause and talk with patients before prescribing an opioid medication. This is an important reminder to take the time to educate our patients, increase awareness about the risks of certain prescriptions and discuss the importance of safe storage and disposal. It also encourages us to keep an open mind and to individualize treatment — to pause before a PA prescribes and diagnoses, and to consider each individual patient’s family history, environment and circumstances.

Building a collaborative effort with diverse partners is central to the AAOA campaign and its success.  AAOA therefore seeks to align its goals with common-ground goals of the broader healthcare and public health community, such as raising awareness of partial-fill provisions and advocating for their adoptions.

To learn more, visit or follow us on Twitter: @AAOA_Tweets.

NTOCC Policy & Advocacy Corner


Dear NTOCC Community,

Please take a moment to read through the legislation, regulations & policy changes that we post in this section each Quarter.   Please do not hesitate to reach out to your members of Congress and express your opinion in regards to these issues as well.   If you have a legislation or policy question we can help with or information you would like for us to consider adding to our list please send them to me at


  Kindest Regards, 
  Val Emmons
  NTOCC, VP Communications & Public Policy


H.R. 6: SUPPORT for Patients and Communities Act Signed into Law by President Trump

trump sign opioid_1540419016350.PNG.jpgH.R. 6 includes Medicaid, Medicare, and public health reforms to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting communities, and bolstering efforts to combat illicit synthetic drugs like fentanyl. The policies contained in the legislation were advanced through regular order by the House Energy and Commerce Committee and the Ways and Means Committee. A detailed section-by-section can be found here. Major provisions include:


  • Require state Medicaid programs to not terminate a juvenile’s medical assistance eligibility because the juvenile is incarcerated. A state may suspend coverage while the juvenile is an inmate, but must restore coverage upon release without requiring a new application unless the individual no longer meets the eligibility requirements for medical assistance (H.R. 1925)
  • Enable former foster youth who are in care by their 18th birthday and previously enrolled in Medicaid to receive health care until the age of 26 if they move out of state (H.R. 4998)
  • Require the Centers for Medicare and Medicaid Services (CMS) to carry out a demonstration project to provide an enhanced federal matching rate for state Medicaid expenditures related to the expansion of substance-use treatment and recovery services targeting provider capacity (H.R. 5477)
  • Require all state Medicaid programs to have a beneficiary assignment program that identifies Medicaid beneficiaries at-risk for substance use disorder (SUD) and assigns them to a pharmaceutical home program, which must set reasonable limits on the number of prescribers and dispensers that beneficiaries may utilize (H.R. 5808)
  • Require state Medicaid programs to have safety edits in place for opioid refills, monitor concurrent prescribing of opioids and certain other drugs, and monitor antipsychotic prescribing for children (H.R. 5799)
  • Require CMS to issue guidance on Neonatal Abstinence Syndrome (NAS) treatment options under Medicaid and require a study by the nonpartisan Government Accountability Office (GAO) on coverage gaps for pregnant women with SUD (H.R. 5789)
  • Provide additional incentives for Medicaid health homes for patients with substance use disorder (H.R. 5810)


  • Instruct CMS to evaluate the utilization of telehealth services in treating SUD (H.R. 5603)
  • Creates a pass-through payment extension under Medicare to encourage the development of clinically superior nonopioid drugs (H.R. 5809)
  • Add a review of current opioid prescriptions and, as appropriate, a screening for opioid use disorder (OUD) as part of the Welcome to Medicare initial examination (H.R. 5798)
  • Incentivize post-surgical injections as a pain treatment alternative to opioids by reversing a reimbursement cut for these treatments in the Ambulatory Service Center setting, as well as collect data on a subset of codes related to these treatments (H.R. 5804)
  • Require e-prescribing, with exceptions, for coverage of prescription drugs that are controlled substances under the Medicare Part D program (H.R. 3528)
  • Require prescription drug plan sponsors under the Medicare program establish drug management programs for at-risk beneficiaries (H.R. 5675)
  • Provide access to Medication-Assisted Treatment (MAT) in Medicare through bundled payments made to Opioid Treatment Programs for holistic service (Section 2 of H.R. 5776)

Public Health

  • Direct the Food and Drug Administration (FDA) to issue or update guidance on ways existing pathways can be used to bring novel non-addictive treatments for pain and addiction to patients. Several approaches have proven successful in speeding the availability of treatments for serious conditions through the FDA (H.R. 5806)
  • Authorize grants to state and local agencies for the establishment or operation of public health laboratories to detect fentanyl, its analogues, and other synthetic opioids (H.R. 5580)
  • Enable clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe buprenorphine; and make the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30 patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry; or if practitioner provides MAT in a qualified practice setting. Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder (H.R. 3692)    Read more here


Marketplace Open Enrollment Opened Today
***Open enrollment for 2019 runs from November 1 – December 15, 2018.   
Starting, today,  November 1, you can log into, fill out an application, and enroll in a 2019 Marketplace health plan. Enroll by December 15, and coverage starts January 1, 2019.  2019 plans and prices will be available to preview shortly before November 1. 

·         To learn more about the Health Insurance Marketplace, read our blogs.

Medicare Open Enrollment
***Medicare Open Enrollment started October 15th and ends December 7th.  Here are links to Toolkits in both English and Spanish with downloadable graphics.



eMedicare Resources

CMS Takes Action to Modernize Medicare Home Health

On Wednesday afternoon, the Centers or Medicare & Medicaid Services (CMS) finalized significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare. Specifically, CMS made changes to improve access to solutions via remote patient monitoring technology, updated payments for home health care with a new case-mix system, begin the new home infusion therapy benefit, and reduce burden.

“This home health final rule focuses on patient needs and not on the volume of care,” said CMS Administrator Seema Verma.  ““Today’s rule overhauls how Medicare pays for home health, refocusing on the needs of patients, promoting innovation, and reducing burden for physicians and home health providers.

Verma went on to say, ”
This rule also innovates and modernizes home health care by allowing remote patient monitoring. We are also proud to offer new home infusion therapy services.  Using new technology and reducing unnecessary reporting measures for certifying physicians will result in an annual cost savings and provide home health agencies (HHAs) and doctors what they need to give patients a personalized treatment plan that will result in better health outcomes.”

Beginning with calendar year (CY) 2020, CMS is implementing changes required by law, including a new case-mix system called the Patient-Driven Groupings Model (PDGM) that puts the focus on patient needs rather than volume of care. The PDGM relies more heavily on patient characteristics to more accurately pay for home health services. Changes in data collection under the new case-mix system, coupled with the changes below regarding meaningful measures and the Home Health Quality Reporting Program, will reduce burden for HHAs by approximately $60 million annually, beginning in CY 2020. 

CMS is promoting innovation and modernization of home health care by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data are shared among patients, their caregivers and their providers. The use of such technology can allow for greater patient independence and empowerment. Supporting patients in sharing their data will advance the MyHealthEData initiative, led by Jared Kushner and the White House Office of American Innovation.

This final rule implements the temporary transitional payments for home infusion therapy services for CYs 2019 and 2020, as required by the Bipartisan Budget Act of 2018, until the new permanent home infusion therapy services benefit begins on January 1, 2021.  In addition, the final rule establishes the health and safety standards for qualified home infusion therapy suppliers of the new permanent home infusion therapy service benefit.  The final rule also establishes the approval and oversight process for accrediting organizations of these suppliers as required by the 21st Century Cures Act. We are finalizing our proposal and also seeking further comments on our interpretation of “infusion drug administration calendar day” and on its potential effects on access to care.

CMS is eliminating the requirement that the certifying physician estimate how much longer home health services are needed when recertifying the need for continued home health care.  This results in an estimated reduction in burden for physicians of $14.2 million, annually, and would allow physicians to spend more time with patients rather than on unnecessary paperwork.

The final rule helps advance CMS’s Comprehensive Meaningful Measures Initiative. CMS is removing seven Home Health Quality Reporting Program measures. As noted above, changes in data collection under the new case-mix system, coupled with the changes from these seven measure removals, will reduce burden for HHAs by approximately $60 million annually, beginning in CY 2020.

The final rule can be downloaded from the Federal Register at:

For a fact sheet on Wednesday's final rule, please visit:

For additional information about the Home Health Prospective Payment System, visit

CMS Proposes to Modernize Medicare Advantage,
Expand Telehealth 
Access for Patients

Proposed rule would strengthen the popular system for private health insurance plans to provide Medicare coverage, increase plan flexibility to offer telehealth benefits, and improve coordination for dual-eligible beneficiaries 

In a proposed rule issued today, the Centers for Medicare & Medicaid Services (CMS) took action to build upon the Administration’s ongoing efforts to modernize the Medicare Advantage and Part D programs, which provide seniors with Medicare health and prescription drug coverage through private plans. The changes proposed today would allow plans to cover additional telehealth benefits and would make other much-needed updates, including for individuals who are eligible for Medicare Advantage special needs plans. 

“President Trump is committed to strengthening Medicare, and an increasing number of seniors are voting with their feet and choosing to receive their Medicare benefits through private plans in Medicare Advantage. Today’s proposed changes would give Medicare Advantage plans more flexibility to innovate in response to patients’ needs,” said CMSAdministrator Seema Verma. “I am especially excited about proposed changes to allow additional telehealth benefits, which will promote access to care in a more convenient and cost-effective manner for patients.”

Medicare Open Enrollment for 2019 is currently underway and runs through December 7, 2018, so seniors can review their coverage options and decide how they would like to receive their Medicare benefits in 2019. CMS offered new flexibilities to Medicare Advantage plans starting in the 2019 plan year, and plans are making additional benefits available including adult day care services, in-home support services, and benefits tailored for patients with chronic diseases like diabetes. The average Medicare Advantage premium will decline by 6.1 percent, enrollment is projected to grow by 11.5 percent, and there will be approximately 600 more plans available across the country next year.

the oday’s proposed changes for plan year 2020 would leverage new authorities provided to CMS in the Bipartisan Budget Act of 2018, which President Trump signed into law earlier this year. With respect to telehealth, the proposed changes would remove barriers and allow Medicare Advantage plans to offer “additional telehealth benefits” not otherwise available in Medicare to enrollees, starting in plan year 2020 as part of the government-funded “basic benefits.”

This proposal will allow Medicare Advantage plans broader flexibility in how coverage of telehealth benefits is paid to meet the needs of their enrollees. As Medicare beneficiaries become more tech savvy, CMS is working across the agency to promote beneficiary access to telehealth, but the Medicare fee-for-service program telehealth benefit is narrowly defined and includes restrictions on where beneficiaries receiving care via telehealth can be located. The proposed rule would give MA plans more flexibility to offer government-funded telehealth benefits to all their enrollees, whether they live in rural or urban areas. It would also allow greater ability for Medicare Advantage enrollees to receive telehealth from places like their homes, rather than requiring them to go to a health care facility to receive telehealth services. Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.

The proposed changes are a major step towards expanding access to telehealth services because the rule would eliminate barriers for private Medicare Advantage plans to cover such additional telehealth benefits under the MA plan. While MA plans have always been able to offer more telehealth services than are currently payable under original Medicare through supplemental benefits, this change in how such additional telehealth benefits are financed (that is, accounted for in payments to plans) makes it more likely that MA plans will offer them and that more enrollees will be able to use the benefits.

Additional changes proposed today would improve the quality of care for dually-enrolled beneficiaries in Medicare and Medicaid who participate in “Dual Eligible Special Needs Plans” or D-SNPs. These beneficiaries generally have complex health needs. Today’s proposed changes would unify appeals processes across Medicare and Medicaid to make it easier for enrollees in certain D-SNPs to navigate the system. The proposed rule would also require plans to more seamlessly integrate benefits across the two programs to promote coordination.

Today’s proposed rule also improves accountability and bolsters program integrity within the Medicare Advantage and Part D programs. The proposed changes would update the methodology for calculating Star Ratings, which provide information to consumers on plan quality. The new methodology would improve stability and predictability for plans, and would adjust how the ratings are set in the event of extreme and uncontrollable events such as hurricanes.

The proposed rule also includes critical updates with respect to program integrity. First, CMS is making revisions to an earlier regulation that made available to Part D sponsors and Medicare Advantage plans a list of precluded providers and prescribers that have engaged in behavior that bars their enrollment in Medicare. Under the earlier regulation, plans would be required to deny payment for any prescription, service, or item that is prescribed or furnished by an individual or entity on the Preclusion List.

Second, the proposed rule would take steps to help CMS recover improper payments made to Medicare Advantage organizations. CMS conducts Risk Adjustment Data Validation audits to confirm that diagnoses submitted by Medicare Advantage Organizations for risk adjusted payments are supported by medical record documentation. CMS recovers improper payments based on these audits. The proposed rule would strengthen CMS’s ability to return dollars to the Medicare Trust Funds as a result of these audits. If finalized, the proposedchanges would result in an estimated $4.5 billion in savings to the Medicare Trust Funds over a ten year period, largely from the recovery of improper payments to Medicare Advantage plans through contract- level Risk Adjustment Data Validation audits. In addition, CMS released an analysis on the application of a Fee-For-Service adjuster in determining the Medicare Advantage payment recoveries. The analysis can be accessed at: Systems/Monitoring-Programs/Medicare-Risk-Adjustment-Data-Validation- Program/Resources.html (the Fee-For-Service Adjuster executive summary and technical appendix are available in the “Downloads” section of the webpage).

For a fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Proposed Rule(CMS-4185-P), please visit: medicare-advantage-and-part-d-flexibility-proposed-rule-cms-4185-p.

The proposed rule can be downloaded from the Federal Register at:

And on 11/01/2018 and available online at

CMS looks forward to feedback on the proposal and will accept comments until December 31, 2018. Comments may be submitted electronically through our e-Regulation website at:


CMS Releases User-Friendly Version of Hospital Cost Report Data

CMS released a new, version of cost report data for Medicare-certified hospitals. The Hospital Cost Report Public Use File (Hospital Cost Report PUF) presents select measures provided by hospitals through their annual cost report, and is organized at the hospital level. Cost report data includes provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data. To make cost report data more accessible to the general public, CMS has developed a new and user-friendly version of hospital cost report data for 2014 in a simplified Excel format.

The Hospital Cost Report Public Use File (Hospital Cost Report PUF) includes data from 2014 and has information for 6,248 facilities, including all hospital facility types and all payers. It covers 33 million discharges, 180 million days, $876 billion in net revenue, and $889 billion in operating expenses.

The Hospital Cost Report PUF presents select measures provided by hospitals through their annual cost report, and is organized at the hospital level.  The Hospital Cost Report PUF is available in a downloadable, user-friendly Excel format.  The PUF does not contain all measures reported in the cost reports, but rather includes a subset of commonly used measures.  Any hospital that submitted a cost report in a given year will be included in the PUF.  For a full list of variables included in this PUF and their descriptions, please see the “Documentation” tab in the Excel file below. 

The variables in the Hospital Cost Report PUF have not been edited or changed and will be identical to what is available in the online HCRIS system in the 2014 SAS dataset as of July 15, 2018. Please note however that the HCRIS datasets are updated quarterly, while the PUF is created annually, and therefore the data may not match if compared to later versions of the HCRIS files.

Interactive Dataset: Hospital Cost Report Public Use File 2014Downloadable Excel: Hospital Cost Report Public Use File 2014



    Lunch & Learn Fall Webinar Schedule

    WEBINAR #3
    November 21, 2018
    12pm-1:00pm CST/1pm-2pm EST

    Rush University Medical Center Bridge Program
    Presented by
    Walter Rosenberg, MSW, MS-HSM, LCSW, Director,
    Rush University Medical Center

    Webinar Meeting Link:
    Dial-in Number*: (515) 739-1513
    Access Code: 986228
    Online Meeting ID: ntocc

    WEBINAR #4
    December 19, 2018
    12pm-1:00pm CST/1pm-2pm EST

    Washington DC Update

    Presented by
    Ashton Theodore Randle, GovPredict


    Webinar Meeting Link:

    Dial-in Number*: (515) 739-1513
    Access Code: 986228
    Online Meeting ID: ntocc

    (You can find recordings of our previous webinars on the NTOCC Website "Events" section or by clicking here.)
    Copyright © 2018 The National Transitions of Care Coalition, All rights reserved.