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

Will PA Expand Medicaid Program?

With President Obama re-elected and Congress unlikely to repeal the Affordable Care Act, Pennsylvania officials now face a major decision: will they expand the state’s Medicaid programs as the law originally intended?
The original health care reform law made that expansion mandatory, but earlier this year, the Supreme Court left the expansion decision to individual states. While some governors have already declared their intention to expand their Medicaid programs and others have announced that they will not, Pennsylvania Governor Tom Corbett has not yet announced a decision.
Why would the state choose to expand its Medicaid program, considering that it will end up costing taxpayers more money? On the other hand, why would it choose to leave billions of federal dollars on the table?
Because they serve so many low-income, uninsured patients who might benefit from an easing of Medicaid eligibility criteria, Pennsylvania’s private safety-net hospitals have a major stake in this decision.
Read more about the decision now facing the Corbett administration in this CQ HealthBeat article presented by the Commonwealth Fund. For a closer look at the Pennsylvania perspective, read this PA Independent article .

PA Safety Net Admin2012-11-15T06:00:12+00:00November 15th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

PA Faces Decision on Insurance Exchanges

Pennsylvania must inform the federal government by November 16 whether it intends to create a state health insurance exchange as envisioned in the Affordable Care Act.
If the state decides not to create its own exchange, the federal government will create an exchange for it.
While some observers believe the state has intentionally not invested a great deal of time and effort in developing the exchange – or spent any of the $33 million the federal government gave it for this purpose – state officials insist that they are moving ahead with the work but have been hampered by a lack of direction from the federal government. In August, state insurance commissioner Michael Consedine wrote to U.S. Health and Human Services secretary Kathleen Sebelius seeking such direction but has not yet received a response.
Other states are in the same situation as Philadelphia – so many states, in fact, that many observers believe the federal government will extend the deadline for states to declare their intentions.Read more about this situation and what it means for Pennsylvania in this Allentown Morning Call article .

PA Safety Net Admin2012-11-13T06:00:49+00:00November 13th, 2012|Health care reform|Comments Off

Post-Election Diagnosis for Health Care

While President Obama’s re-election probably spells the end of talk of repealing the Affordable Care Act, many questions remain about how – and how completely – the health care reform law passed in 2010 will be implemented.
In the days following the election, observers are asking these and other questions.
In the article “Federal Deficit Talks Could Impact Obama’s Moves on Health Law,” Kaiser Health News speculates about the future of some of the more controversial and expensive aspects of the Affordable Care Act, including creation of the Independent Payment Advisory Board; the extensive insurance subsidies for which many Americans will be eligible; the future of the medical device tax; and the law’s provisions that limit the degree to which insurers can charge higher rates for older people.
The Stateline web site looks at the decisions ahead for state governments in the article “Obama Win Means Big Health Care Decisions for States.” Many governors still have not declared whether their state will expand their Medicaid programs – a move required by the Affordable Care Act but made optional by the Supreme Court in a June 2012 decision.
The first issue that will be addressed, though, is state decisions on whether to create their own health insurance exchanges, a key part of the reform law, or let the federal government create those exchanges for them. States are required to inform the federal government of their intentions by November 16, although it now appears they will be given more time. Pennsylvania is among the states that have not yet declared their intentions.
Meanwhile, looming over the health care industry is the prospect of sequestration, part of last year’s deficit reduction compromise, that leaves Medicaid untouched but will require a cut of two percent in all Medicare payments beginning on January 1 unless Congress acts to prevent these cuts. Read more about this in an article from The Hill titled “Sequester Would Cut $11 Billion from Medicare.”
These and other issues are of particular importance to Pennsylvania’s safety-net hospitals because of the especially large numbers of low-income and publicly insured patients they serve.

PA Safety Net Admin2012-11-09T10:42:28+00:00November 9th, 2012|Health care reform|Comments Off

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

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