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

Insurance Commissioner Explains Why PA Rejected Health Exchange

Writing in the Pottstown Mercury, Pennsylvania Insurance Commissioner Michael Consedine has outlined why the Corbett administration chose not to develop the health insurance exchange that is one of the centerpieces of the 2010 Affordable Care Act.
Mr. Consedine’s explanation mirrors that offered last month by Pennsylvania Governor Tom Corbett: the federal government did not provide enough information and guidance to enable the state to develop its own exchange. (Go here for a summary of Governor Corbett’s op-ed piece and a direct link to that piece.)
As a result of this decision, Pennsylvania will use a health insurance exchange developed for it by the federal government.
Read Mr. Consedine’s guest column in the Pottstown Mercury here.

PA Safety Net Admin2013-01-03T06:00:13+00:00January 3rd, 2013|Health care reform, Uncategorized|Comments Off

Medicare Reveals First Results of Quality Program

Slightly more than half of all U.S. hospitals will receive enhanced payments from Medicare and slightly fewer than half will see their payments reduced slightly as a result of the first reporting period for Medicare’s new value-based purchasing program.
The largest bonus will be awarded to Treasure Valley Hospital, in Utah. Each of its Medicare payments will rise 0.83 percent. The largest penalty will be assessed to Auburn Community Hospital, in Syracuse, which will see its Medicare payments reduced 0.9 percent. Two-thirds of all hospitals will see their payments rise or fall less than 0.25 percent.
Medicare’s value-based purchasing program, created by the Affordable Care Act, seeks to enhance provider accountability for the care they deliver. Seventy percent of a hospital’s score is based on its performance according to 12 basic standards of care and the rest of the score is based on the results of patient satisfaction surveys.
The program will be expanded in the coming years to encompass more standards of care. A companion program, based on Medicare readmissions within 30 days of patient discharge, is already under way and rewarding top performance and penalizing underperforming hospitals.
According to the figures released, 51 percent of Pennsylvania hospitals will receive bonuses through the value-based purchasing program and 49 percent will be penalized. Between the two programs – the value-based purchasing program and the readmissions reduction program – 20 percent of Pennsylvania hospitals will see a net increase in payments and the remaining 80 percent either broke even or will see their payments reduced.
Read more about the quality program in this Kaiser Health News report , which also offers links to lists of the results for every hospital in the country for both the Medicare value-based purchasing and readmissions reduction programs.

PA Safety Net Admin2012-12-31T06:00:30+00:00December 31st, 2012|Uncategorized|Comments Off

GAO Finds Problems With Medicaid DSH Payments

The U.S. Government Accountability Office (GAO) is now reviewing audits of states’ Medicaid disproportionate share payments (Medicaid DSH) to hospitals and is raising questions about states’ compliance with federal requirements for those payments.
Based on its analysis of state Medicaid DSH audits, GAO found that states are making Medicaid DSH payments to hospitals that exceed those hospitals’ uncompensated care costs and are inaccurately calculating those hospital uncompensated care costs. The GAO also found that states are not always targeting their Medicaid DSH payments to the hospitals that provide the most uncompensated care.
States are required to submit audits and data as a condition of receiving Medicaid DSH funds from the federal government. Currently, the Centers for Medicare & Medicaid Services (CMS) is not acting on the information it receives but will begin doing so after a transition period that ends when 2014 audits are completed. In anticipation of that time, GAO is reviewing the information CMS receives for state compliance with six federal standards for Medicaid DSH payments.
This data also may eventually be used to help implement the Medicaid DSH payment reduction mandated under the Affordable Care Act.
According to the report, Pennsylvania did not provide some of the required data, so in several instances in which the document provides specific information about individual state performance, it has nothing about Pennsylvania. It does note, however, that in FY 2007, six hospitals in the state received Medicaid payments greater than their Medicaid costs.
Because Pennsylvania’s safety-net hospitals care for so many uninsured and low-income patients and receive higher Medicaid DSH payments than other hospitals, they are far more dependent on these payments than other hospitals and will need to watch this situation closely in the future.
Learn more about GAO’s examination of Medicaid DSH payments – why it is undertaking this review, what it found, and how its findings may be used in the future – in the report More Transparency of and Accountability for Supplemental Payments are Needed, which can be found here , on GAO’s web site.

PA Safety Net Admin2012-12-28T06:00:33+00:00December 28th, 2012|Health care reform, Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

SNAP Seeks Provider Fee Help from PA Congressional Delegation

In a message to members of Pennsylvania’s congressional delegation, the Safety-Net Association of Pennsylvania (SNAP) has asked elected officials in Washington, D.C. to protect the state’s ability to levy assessments on providers to help fund the commonwealth’s Medicaid program. The proceeds from the state’s current provider assessments, SNAP notes, have made a major difference in ensuring the ability of Pennsylvania’s safety-net hospitals to continue serving their many Medicaid patients.
Read SNAP’s message to the Pennsylvania congressional delegation here Safety-Net Association of Pennsylvania logo .

PA Safety Net Admin2012-12-26T15:00:08+00:00December 26th, 2012|Safety-Net Association of Pennsylvania|Comments Off

Corbett Explains ‘No’ Decision on Health Exchanges

In an op-ed piece in Sunday’s Philadelphia Inquirer, Pennsylvania Governor Tom Corbett presented the reasons he decided to let the federal government develop the state’s health insurance exchange – a key part of the Affordable Care Act – instead of having his own administration develop the exchange.
Read Governor Corbett’s op-ed piece here .

PA Safety Net Admin2012-12-24T11:08:31+00:00December 24th, 2012|Health care reform|Comments Off

Medicaid Enrollment Down in Philadelphia Area

Medicaid enrollment in southeastern Pennsylvania fell 10,000 people between June and September of this year, with most of that loss occurring in Philadelphia.
Read more about this change in Medical Assistance enrollment, and the HealthChoices plans in which active participants are enrolled, in this report from the Delaware Valley Healthcare Council.

PA Safety Net Admin2012-12-21T06:00:46+00:00December 21st, 2012|Pennsylvania Medicaid policy|Comments Off

DPW Announces Fee Schedule Changes

The Pennsylvania Department of Public Welfare has issued a Medical Assistance Bulletin detailing changes in the fee-for-service fee schedule. The changes take effect immediately.

Read the bulletin with the changes here .

PA Safety Net Admin2012-12-19T06:00:54+00:00December 19th, 2012|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Welfare Secretary Testifies About Medicaid Expansion

Declaring that “We in the commonwealth have never witnessed a law so vast, with such demands on state resources, and lack of federal guidance,” Pennsylvania Department of Public Welfare Secretary Gary Alexander told the House Energy and Commerce Committee last week that while Pennsylvania has not ruled out expanding its Medicaid program in accordance with the Affordable Care Act, “Under the constraints of the health care reform law, I do not think we can afford the expansion.”
Mr. Alexander made these remarks at a hearing of the committee’s Health Subcommittee, which was taking testimony on the Medicaid expansion component of the 2010 health care reform law.
While the Kaiser Foundation on Medicaid and the Uninsured says that expansion would cost Pennsylvania $2 billion through 2022, the Corbett administration has put a $4 billion price tag on such expansion.
The Safety-Net Association of Pennsylvania (SNAP) supports Medicaid expansion in the state.
Read more about Mr. Alexander’s testimony in this Pittsburgh Post-Gazette article and this Central Penn Business Journal article, which also includes a direct link to the secretary’s testimony.

PA Safety Net Admin2012-12-18T06:00:03+00:00December 18th, 2012|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

Medicaid at Risk in Fiscal Cliff Talks

If Medicaid is a health care program for at-risk low-income people, it appears that Medicaid itself is at risk during the current fiscal cliff talks in Washington, D.C.
While Medicaid was left untouched by last year’s sequestration bill, it is now viewed by growing numbers of policy-makers as a potential source of savings to help stave off the fiscal cliff.
Several aspects of Medicaid, in particular, appear to be vulnerable in the coming weeks. They include Medicaid provider taxes, which are incurring growing opposition in Washington and which, if ratcheted back, could save more than $25 billion; supplemental payments for Medicaid primary care providers, scheduled to take effect on January 1, which if eliminated would save $13 billion; better management of dual eligibles, which could save $12 billion; and medical equipment spending, where a competitive bidding program similar to that currently being introduced for Medicare could save $5 billion.
While all of these cuts would hurt Pennsylvania’s safety-net hospitals, those hospitals would particularly be affected by any reduction in either the rate at which the federal government matches the state’s Medicaid expenditures or in its ability to levy provider taxes, which are a key contributor to the financial foundation of the state’s Medicaid program.
Learn more about how Medicaid figures in the current fiscal cliff talks and how policy-makers are increasingly looking to Medicaid for savings in this Politico article .

PA Safety Net Admin2012-12-17T06:00:28+00:00December 17th, 2012|Uncategorized|Comments Off

Safety-Net Hospitals and Readmissions

Safety-net hospitals are 30 percent more likely to have readmission rates that exceed the national average – always a problem, but a greater problem than ever now that Medicare is penalizing hospitals for readmissions through its new Hospital Readmissions Reduction Program.
A recent Commonwealth Fund study quantified the degree to which safety-net hospitals’ readmissions exceed national averages, citing as the reason for those reasons that

Safety-net hospitals care for a disproportionate share of vulnerable populations who are low-income, uninsured, underinsured, or on Medicaid. They have substantially higher rates of chronic health problems, disability, mental illness, and substance abuse, compared with the general population. Safety-net hospital patients also have disproportionate personal and social needs that adversely affect their health and act as barriers to accessing and fully benefiting from care. These include homelessness, unsafe housing, and unstable employment. In particular, vulnerable populations are more likely to lack social support systems (e.g., family members at home) and housing stability, which contribute to a disproportionate risk of readmission after hospital discharge.

The report also offers strategies to help safety-net hospitals reduce their readmissions and avoid the Medicare financial penalties they now face for those readmissions.
Find “Higher Readmissions at Safety-Net Hospitals and Potential Policy Solutions” here , on the web site of The Commonwealth Fund.

PA Safety Net Admin2012-12-13T06:00:01+00:00December 13th, 2012|Uncategorized|Comments Off

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