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

Shift to HealthChoices Hits Bumps in the Road

Pennsylvania’s switch to HealthChoices to serve nearly the entire state Medicaid population is running into short-term obstacles in parts of the state.
Some recipients, for example, failed to choose a participating managed care plan, were assigned to plans, and now are confused about where to go and how to obtain care. In other instances, physicians are still negotiating with those plans or waiting to be credentialed for participation.
Some Pennsylvania safety-net hospitals, because of where they are located and their especially large numbers of Medicaid patients, may experience these problems more than the average hospital.
Read more about the challenges Medicaid recipients are encountering during this transition in this Erie-Times News article .

PA Safety Net Admin2012-11-08T06:00:02+00:00November 8th, 2012|Pennsylvania Medicaid policy|Comments Off

MedPAC Mulls Outpatient Payments

MedPAC members continue to debate whether equalizing the payments for outpatient services delivered in physicians’ offices and in hospital outpatient facilities and departments makes for good public policy. Currently, hospitals receive additional payments for outpatient evaluation and management (E&M).
Some commissioners and advocates argued at MedPAC’s November 2 meeting that the federal government should pay for Medicare services based on the services themselves, not on where they are provided. Others maintained that hospitals have inherently greater costs because of the additional service capacity they bring and that it is appropriate for Medicare to help pay for that capacity because it enables hospitals to meet the needs of many Medicare patients.
This is an important issue for many Pennsylvania safety-net hospitals. In recent years, many of these hospitals have invested heavily in developing their capacity to serve more patients on an outpatient basis.
MedPAC (Medicare Payment Advisory Commission) advises Congress on Medicare reimbursement issues. Its recommendations, while considered influential, are not binding on Congress.
Learn more about this issue in this article from CQ HealthBeat as presented by the Commonwealth Fund. In addition, the presentation that MedPAC’s staff made to commission members can be downloaded here, from MedPAC’s web site.

PA Safety Net Admin2012-11-07T06:00:14+00:00November 7th, 2012|Uncategorized|Comments Off

Medicaid Primary Care Pay Raise Set; OB/GYNs, ER Docs Excluded

When the Affordable Care Act’s mandatory rate increase for primary care services provided to Medicaid patients takes effect on January 1, ob/gyns and emergency room physicians will not be among the beneficiaries of the temporary raise in pay.
Under a new regulation issued last week, only family doctors, internists, and pediatricians will receive the pay increase, which was established as a short-term (two years) incentive to attract more physicians to serve Medicaid patients in anticipation of the significant increase in enrollment expected when many states expand their Medicaid eligibility criteria in 2014.
When working under the supervision of eligible primary care physicians, nurse practitioners and physician assistants also will receive the enhanced Medicaid payments.
State Medicaid payments for primary medical care typically fall well below comparable Medicare rates. Under the reform law, Medicaid payments for such services will be raised to Medicare levels for two years, with the federal government footing the bill for the difference.
Because they serve so many Medicaid patients and the state’s outpatient fees are so much lower than those paid by Medicare, Pennsylvania’s safety-net hospitals and the primary care physicians they employ should benefit greatly from this new policy.
Read more about who will and won’t benefit from the primary care fee increase and how it will be implemented in this Kaiser Health News article .

PA Safety Net Admin2012-11-05T06:00:03+00:00November 5th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

DPW Issues Prior Authorization Bulletins

The Pennsylvania Department of Public Welfare has issued two new Medical Assistance Bulletins addressing prior authorization for specific prescription drugs: one for botulinum toxins and the other for angiotensin modulator combinations .

PA Safety Net Admin2012-11-01T10:22:04+00:00November 1st, 2012|Uncategorized|Comments Off

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.
Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.
At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.
The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.
Many physicians serving communities with large numbers of Medicaid patients, and those employed by Pennsylvania’s safety-net hospitals, are expected to benefit from this pay increase. Currently, Medicaid primary care physician payments in Pennsylvania are just 56 percent of comparable Medicare payments.
Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News article.

PA Safety Net Admin2012-10-29T06:00:15+00:00October 29th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Lawsuit Challenges Social Services Block Grants and the End of General Assistance Payments

A lawsuit has been filed in Pennsylvania’s Commonwealth Court challenging the state’s termination of General Assistance payments to low-income Pennsylvanians and the redirection of some state social services funding into block grants for selected counties.
General Assistance grants are small sums of money that were paid monthly to low-income Pennsylvanians. Many were thought to use this money for food, medicine, and other necessities.
Pennsylvania’s counties have long received social services funding from the state. Now, some counties have voluntarily agreed to accept less money in exchange for greater flexibility in how they spend it. Some of the services provided with this money are delivered by hospitals, including the state’s private safety-net hospitals.
The legal challenge is on procedural rather than policy grounds, with the plaintiffs alleging that the legislation that ended the General Assistance grants and created the social services block grant program violated a provision in the state constitution that requires legislation to address only a single issue.
Read more about the General Assistance and social services block grant lawsuit in this Philadelphia Inquirer article .

PA Safety Net Admin2012-10-26T06:00:16+00:00October 26th, 2012|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

Pennsylvanians Who Lost Medicaid Eligibility Given Path to Restoration

More than 100,000 Pennsylvanians who were dropped from the state’s Medical Assistance rolls in the latter part of 2011 will receive a new opportunity to regain eligibility.
Under an agreement between the Pennsylvania Department of Public Welfare and lawyers for advocacy groups, 100,000 people who lost their eligibility will receive a letter describing their right of appeal. Those who appeal successfully will be restored to the state’s Medicaid rolls and could have their medical bills resolved for the period during which they were off those rolls.
Read more about why these 100,000 people lost their eligibility and how advocates won this opportunity for restoration in this Philadelphia Inquirer article .

PA Safety Net Admin2012-10-24T09:33:38+00:00October 24th, 2012|Pennsylvania Medicaid policy|Comments Off

Philadelphia Hospitals Hoping for Medicaid Expansion

Hospitals in the greater Philadelphia want the state to expand its Medicaid program as envisioned in the Affordable Care Act, the Philadelphia Business Journal reports.
According to a spokesman for the Delaware Valley Healthcare Council, Philadelphia-area hospitals are concerned that the state might not expand Medicaid eligibility. That expansion, mandated by the 2010 health care reform law, was made optional earlier this year by a Supreme Court decision.
Read more about why Philadelphia-area hospitals – many of which are safety-net hospitals – are eager for the state to embrace the reform law’s Medicaid eligibility expansion in this Philadelphia Business Journal article .

PA Safety Net Admin2012-10-22T06:00:32+00:00October 22nd, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Medicare DSH Cuts Loom for PA Safety-Net Hospitals

Safety-net hospitals across the country will soon lose important funding that helps them care for many of their low-income and uninsured patients: their Medicare disproportionate share hospital payments (Medicare DSH).
Come 2014, the Affordable Care Act mandates a significant cut in hospitals’ Medicare DSH payments. The underlying rationale for this cut is that once the health care reform law’s individual insurance mandate takes effect and states begin greatly expanding Medicaid eligibility (a reform law mandate made optional by this year’s Supreme Court decision), hospitals will have fewer such patients and less need for supplemental DSH funding.
But as a Kaiser Health News article points out, hospital officials are concerned that the funding will phase out before the expanded insurance phases in, leaving them with fewer resources to care for their low-income, still-uninsured patients.
Pennsylvania’s safety-net hospitals, which care for large numbers of low-income and uninsured patients, figure to suffer considerably under such circumstances.
Learn more about the phase-down of Medicare DSH payments and the challenges hospitals will face in its wake in this Kaiser Health News article .

PA Safety Net Admin2012-10-17T06:00:13+00:00October 17th, 2012|Health care reform|Comments Off

New Medicare Wrinkle May Hurt Safety-Net Hospitals

A new Medicare program that bases payments to hospitals in part on patient satisfaction with those hospitals could be especially harmful to the nation’s safety-net hospitals.
The Medicare value-based purchasing program, which took effect on October 1, will withhold one percent of all hospitals’ Medicare payments and then redistribute that money based on hospitals’ compliance with selected standards-of-care requirements and on the results of surveys of hospitalized Medicare patients. The withheld one percent will then be redistributed to hospitals that perform well based on these criteria. Beginning in 2017, two percent of hospitals’ Medicare payments will be withheld and eventually redistributed in this manner.
Learn more about the Medicare value-based purchasing program and how hospitals are preparing for the survey component of its payment adjustments in this Wall Street Journal article .

PA Safety Net Admin2012-10-16T06:00:55+00:00October 16th, 2012|Health care reform|Comments Off

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