PA Safety Net Admin, Author at Safety-Net Association of Pennsylvania

Low-Income Patients Prefer Hospital ERs

Even when they have health insurance, many low-income patients prefer receiving care in hospital emergency rooms rather than private physician offices or clinics.
According to a new study published in the journal Health Affairs, low-income patients cite convenience, cost, and quality as reasons for their preference.
These findings emerge at a time when government and insurers are working hard to find ways to reduce overuse of costly hospital emergency room services.
Emergency room overuse is especially a problem for many of Pennsylvania’s safety-net hospitals, which often have among the busiest emergency facilities in the regions they serve.
Read more about the new study in this report from the Robert Wood Johnson Foundation and find the study itself here, on the Health Affairs web site.

PA Safety Net Admin2013-07-16T06:00:59+00:00July 16th, 2013|Uncategorized|Comments Off

SNAP Asks PA Delegation to Back DSH Delay

SNAP has asked Pennsylvania’s congressional delegation in Washington to support a bill before the House that would delay planned cuts in Medicare disproportionate share hospital payments (Medicare DSH) and Medicaid DSH for two years.
H.R. 1920, the DSH Reduction Relief Act of 2013, would delay cuts mandated by the Affordable Care Act.
SNAP’s letter to the delegation notes that

These DSH cuts are scheduled to begin…before the Affordable Care Act’s Medicaid and insurance expansion provisions can even begin to have an effect; as you know, moreover, there currently is no plan to expand Medicaid eligibility in Pennsylvania. In addition, the administration recently announced a one-year delay in the reform law’s employer health insurance mandate. Together, Medicare DSH and Medicaid DSH cuts will amount to millions of dollars worth of reductions in payments that safety-net hospitals like ours need to serve their communities, and they would be coming at a time of great ambiguity as implementation of this aspect of the Affordable Care Act gets under way.

Read SNAP’s letter to the PA congressional delegation here .

PA Safety Net Admin2013-07-15T06:00:17+00:00July 15th, 2013|Health care reform|Comments Off

SNAP Registers Views on Proposed Medicaid DSH Regulation

In response to a requirement in the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has published a proposed regulation describing how it envisions reducing future Medicaid disproportionate share (Medicaid DSH) spending.
In response to that proposed regulation, SNAP has submitted a formal comment letter to CMS expressing support for some aspects of the proposal, offering recommendations for improving CMS’s proposed methodology, and conveying support for the administration’s budget proposal to delay all Medicaid DSH cuts for one year.
Read SNAP’s Medicaid DSH comment letter here .

PA Safety Net Admin2013-07-11T06:00:49+00:00July 11th, 2013|Health care reform|Comments Off

Closer Scrutiny Needed for Medicaid Managed Care?

With Medicaid expansion about to begin in many states and managed care expected to be a major tool in that expansion, advocates are suggesting that states need to do a better job of monitoring the performance of the managed care plans that serve their Medicaid population.
Currently, according to advocates, different states monitor their Medicaid managed care plans for different aspects of their performance and some states do a better job than others. With relatively few federal standards, state-to-state comparisons either are difficult or impossible.
Thirty-six states and the District of Columbia have at least some Medicaid patients enrolled in managed care plans, and together, those plans receive about one out of every four dollars that the states and the federal government spend on Medicaid.
With nearly all of the state’s Medicaid recipients now in managed care plans, this issue is of special interest to Pennsylvania’s safety-net hospitals.
Read more about the issue, the challenges, and why this issue is now receiving attention in this Kaiser Health News report .

PA Safety Net Admin2013-07-10T06:00:18+00:00July 10th, 2013|Pennsylvania Medicaid policy|Comments Off

Feds Take Over PA Fair Care

Pennsylvania has turned over to the federal government control of its health insurance program for people with pre-existing medical conditions.
PA Fair Care currently insures about 7000 Pennsylvanians whose pre-existing conditions make the cost of private health insurance prohibitive. Created under the Affordable Care Act, the program was intended to serve as a bridge to the availability of insurance through health insurance exchanges in 2014.
But when federal funding for the program fell short for the current fiscal year and the state was faced with the prospect of absorbing some of its costs, Pennsylvania exercised its option to turn PA Fair Care over to the federal government.
Read more about PA Fair Care and why the federal government will now run it in this Kaiser Health News article .

PA Safety Net Admin2013-07-05T06:00:42+00:00July 5th, 2013|Uncategorized|Comments Off

PA Considering Medicaid Observation Rate

The Pennsylvania Department of Public Welfare is considering instituting a Medicaid observation rate for some hospital services.
According to a recently published Pennsylvania Bulletin,

The Department is considering the establishment of an observation rate for hospital cases for which an inpatient admission is not medically necessary but medical observation of a patient is required. The Department is currently considering developing criteria under which observation services provided by a hospital may be compensable under the MA Program. The Department intends to establish a comprehensive rate to cover observation services determined to be compensable under the Program.

DPW will accept written comments about this proposal for the next 30 days.
Read the Pennsylvania Bulletin notice here .

PA Safety Net Admin2013-07-02T06:00:31+00:00July 2nd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid policy, Proposed FY 2014 Pennsylvania state budget|Comments Off

DPW Seeks to Renew Philadelphia Assessment

The Pennsylvania Department of Public Welfare has announced its intention to seek renewal of the Philadelphia hospital assessment first authorized in 2008.
The purpose of the assessment is to generate additional revenue to fund state Medicaid expenditures for hospital outpatient and emergency department services in Philadelphia and to provide additional funding to support the city’s public health clinics.
Read the Pennsylvania Bulletin announcement of DPW’s intention here .

PA Safety Net Admin2013-07-02T06:00:20+00:00July 2nd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

Meet the New Secretary

The Central Penn Business Journal has published an interview with new Department of Public Welfare Secretary Beverly Mackereth.
Among other issues, Secretary Mackereth addresses Pennsylvania’s high Medicaid costs, Medicaid expansion in the state, and her department’s preparations for implementation of various facets of the Affordable Care Act.
Read the complete interview here .

PA Safety Net Admin2013-06-28T06:00:49+00:00June 28th, 2013|Uncategorized|Comments Off

Primary Docs Can Get Medicaid Pay Raise

The Affordable Care Act calls for selected primary care providers to receive an increase in their Medicaid fees during calendar years 2013 and 2014.
The pay raise, which seeks to bring Medicaid fees to the same level as Medicare rates, is intended to induce more primary care providers to serve Medicaid patients in anticipation of the increase in Medicaid enrollment expected when the Affordable Care Act takes full effect.
Eligible providers must complete a form attesting to their eligibility for the pay raise and the Pennsylvania Department of Public Welfare has issued the form and instructions for completing it. Find both the form and the instructions here .

PA Safety Net Admin2013-06-27T06:00:15+00:00June 27th, 2013|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

DPW Announces Revisions of Medicaid Fee Schedule

The Pennsylvania Department of Public Welfare (DPW) has published a notice of its intention to implement changes in the Medicaid fee schedule and to update selected prior authorization requirements.
Those notices are published here, in the June 22 edition of the Pennsylvania Bulletin, and the changes took effect on June 24.
DPW also published a Medical Assistance Bulletin on the procedure code updates and a table showing the updates. Find the bulletin here and the table here.

PA Safety Net Admin2013-06-26T06:00:45+00:00June 26th, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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