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

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

PA Senate to Move on Medicaid Expansion

Pennsylvania state Senate leaders plan to bring a vote to expand the state’s Medicaid program to the Senate floor this week.
The bill, according to Senate leaders, will include conditions that will make it more palatable to more conservative Republicans and the governor. Democrats are already thought to support Medicaid expansion.
While the bill is considered likely to enjoy solid support in the Senate, it is not clear whether the state House is as interested in Medicaid expansion as envisioned under the federal Affordable Care Act.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about the Senate bill, who is behind it, and what the bill says in this Centre Daily Times article .

PA Safety Net Admin2013-06-24T06:00:32+00:00June 24th, 2013|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

PA Health Law Project Issues Newsletter

The Pennsylvania Health Law Project has released its latest newsletter.
Among the issues addressed in the letter are the prospects for Medicaid expansion in Pennsylvania and increased state oversight of the state’s private Medicaid managed care organizations. The newsletter also describes an effort by the U.S. Department of Health and Human Services to encourage all qualified health plans offered through health insurance exchanges to include “essential community providers” in their provider networks.
Find the newsletter here , on the web site of the Pennsylvania Health Law Project.

PA Safety Net Admin2013-06-20T06:00:15+00:00June 20th, 2013|Pennsylvania Medicaid policy|Comments Off

MedPAC: Readmissions Penalties Unfairly Target Safety-Net Hospitals

Medicare penalties for hospital readmissions are inappropriately hurting hospitals that serve especially large numbers of low-income patients.
That was the message MedPAC conveyed to Congress last week.
The agency, which advises Congress on Medicare reimbursement matters, expressed concern earlier this year about the effect of Medicare’s hospital readmissions reduction program on safety-net hospitals, and it articulated that concern more formally in its June report to Congress.
As reported by Kaiser Health News,

MedPAC found that hospitals where fewer than 3 percent of Medicare patients were low income received an average penalty of 0.21 percent. Hospitals where more than 18 percent of Medicare patients were low income had an average penalty more than twice that, 0.45 percent.

As an alternative to the current approach, MedPAC has proposed setting readmission rate targets for hospitals and then exempting from penalties hospitals that meet their targets.
Read more about MedPAC’s report to Congress in this Kaiser Health News article or read the entire MedPAC report, Report to the Congress: Medicare and the Health Care Delivery System, which can be found here, on MedPAC’s web site.

PA Safety Net Admin2013-06-19T06:00:51+00:00June 19th, 2013|Uncategorized|Comments Off

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