Enclara wholeheartedly supports NHPCO’s request for CMS to delay implementation of this clarification and to engage with industry stakeholders to address this important issue.
West Deptford, NJ (PRWEB) January 21, 2014
On December 6, 2013, Centers for Medicare & Medicaid Services (CMS) released its latest position statement regarding the intersection of the Medicare Part D and Medicare Hospice benefits. Seeking to clarify the issue, CMS stated that ““[a]s a general rule, hospice providers are expected to cover virtually all drugs for hospice beneficiaries during the hospice election.” This statement followed similar announcements from CMS over the past few months. CMS proposed a March 1, 2014 implementation date, although interested parties were invited to submit comments to CMS by January 10, 2014.
Enclara is prepared to support their hospice clients through this process. In fact, Enclara is preparing to roll out enhanced formulary management tools, templates and a suggested drug review framework, all of which are intended to assist clients as they adopt the protocols necessary to document whether the patient’s profiled drugs are reasonable and necessary and related to the terminal illness and/or related conditions. Regardless of the final position taken by CMS, such determinations will be critical on a going forward basis.
If implemented as proposed by CMS, the clarification appears to provide little room for hospice providers to argue against CMS’ “general rule,” particularly since CMS states that it will be the “extremely rare” occurrence for beneficiaries “who have elected hospice to be prescribed a medication for a condition that is completely unrelated to the terminal illness or related conditions.”
“While Enclara believes that the industry would be well served by additional clarity in this area, we feel strongly that CMS has swung the pendulum too far (to the detriment of the hospice industry) in trying to address the underlying issue. As a result, Enclara wholeheartedly supports NHPCO’s (National Hospice and Palliative Care Organization) request for CMS to delay implementation of this clarification and to engage with industry stakeholders to address this important issue,” states Andy Horowitz, Enclara’s CEO and Founder.
“I firmly believe Enclara has a unique perspective to the challenges facing the hospice industry today, as they mirror what the long-term care industry experienced years ago when I owned and operated a provider pharmacy serving that industry. Long-term care providers battled increased regulation and shifting reimbursement structures with the introduction of PPS and Part D. Our pharmacy supported its clients then with forward thinking drug utilization management and pricing strategies that allowed them to proactively react to such changes, and, ultimately, survive for the long run. We intend to provide similar guidance and strategies to our hospice partners now in this similarly changing environment,” Horowitz added.
About Enclara Health At Enclara Health, we support our hospice partners through cost effective, clinical excellence in both mail order and local pharmacy access. Enclara is committed to meeting the unique and changing needs of the hospice market and truly demonstrate that there is a difference in hospice pharmacy providers. For more information, visit http://www.enclarahealth.com