The National Health Law Program has prepared a useful Q&A about how the Affordable Care Act and its Medicaid expansion will affect Medicare disproportionate share (Medicare DSH) and Medicaid disproportionate share (Medicaid DSH) payments, both of which are so important to Pennsylvania’s safety-net hospitals.
Download that summary here
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The value-based purchasing program that Medicare plans to unroll in October could result in reduced payments to the nation’s safety-net hospitals.
A report published in the Archives of Internal Medicine found that safety-net hospitals receive lower scores in measures that Medicare will use as part of its new value-based purchasing program. Those scores are based on data from the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey.
As a result of those lower scores, the article “Patient Experience in Safety-Net Hospitals: Implications for Improving Care and Value-Based Purchasing” concluded that safety-net hospitals could receive lower Medicare payments that could affect their financial health.
Read a Kaiser Health News on the new study here and the Archives of Internal Medicine report itself here
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Pennsylvania has reduced its Medicaid dental benefits to basic services – mostly, cleanings, fillings, and extractions.
It has eliminated root canal and periodontal procedures and limits dentures. The changes are expected to save $42 million this year.
Most states do not pay for any dental care.
Read more about the changes in Pennsylvania’s Medicaid dental benefits and their impact on beneficiaries here.
The Pennsylvania Health Law Project has just published its June/July “Health Law PA News” newsletter. The latest edition includes articles about the recently passed state Medical Assistance budget, the implications of the Supreme Court’s Affordable Care Act decision for Pennsylvania, changes in state human resources funding, a delay in HealthChoices expansion in western Pennsylvania, and the lawsuit to compel the state to reinstitute the AdultBasic program.
Read the newsletter here
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Federal officials have asked the Pennsylvania Department of Public Welfare why the state dropped 130,000 people from its Medicaid rolls between August of 2011 and January 2012 and what the state is doing about the administrative challenges state officials say is one of the reasons for the precipitous drop.
In response to previous federal inquiries about the large numbers of recipients whose Pennsylvania Medical Assistance eligibility was revoked, state officials pointed to a backlog of cases to review. State and federal officials met to review the situation in April, and the latest federal correspondence with the state seeks answers to questions federal officials posed at the April meeting.
Read more about the problem, the interaction between state and federal officials, and the current status of this situation in this Philadelphia Inquirer article
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Low-income and disabled Pennsylvanians who lost General Assistance payments when the state ended the cash assistance aspect of that program may still receive Medical Assistance but face a new process for applying for eligibility.
The current, one-page application form that was completed by providers has been expanded to a longer, more detailed form that seeks more information about the medical condition of the applicant.
Read more about the changes in the state program and the changes providers now face in this Philadelphia Inquirer article
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Pennsylvania’s Commonwealth Court has ruled that a lawsuit that seeks restoration of the state’s AdultBasic program may proceed.
The program, which served 41,000 low-income working adults who qualified neither for Medicare nor Medicaid, expired in 2011 and the resources previously expended on it, from the state’s proceeds from the national tobacco settlement, were directed elsewhere.
Read more about the court case and the court’s rationale for allowing the suit to continue in this Legal Intelligencer article
published in the Pittsburgh Post-Gazette.
The state budget passed in Harrisburg last week represents both a victory for Pennsylvania’s safety-net hospitals and an affirmation of the manner in which the Safety-Net Association of Pennsylvania (SNAP) has pursued its advocacy on behalf of the state’s safety-net hospitals.
Under this budget, and despite still-difficult economic times, safety-net hospitals came away almost entirely unharmed by state spending cuts.
The genesis of this success can be traced back to February, when Governor Corbett unveiled his proposed budget. After years of SNAP’s vigorous advocacy that emphasized urging state officials to direct the state’s scarce resources to their primary partners in caring for Medical Assistance patients – Pennsylvania’s private safety-net hospitals – this year’s budget proposal did exactly that. Instead of the usual proposals to cut Medicaid disproportionate share (Medicaid DSH) and other supplemental payments that only safety-net hospitals receive, the administration proposed spreading the potential financial pain to all hospitals, as exemplified by its original proposal to cut fee-for-service hospital base rate payments four percent while leaving the most critical supplemental payments untouched.
This proposal gave every hospital in the state, not just safety-net hospitals, a stake in opposing the proposed cuts. This brought the entire hospital industry together to oppose those cuts. This unified effort proved successful – vindication, we believe, of SNAP’s long-time approach to advocating the distinct interests of Pennsylvania’s safety-net hospitals.
The new state budget passed in Harrisburg last weekend restored cuts to key payments to Pennsylvania’s safety-net hospitals.
Although the budget proposed by Governor Corbett in February called for a four percent cut in fee-for-service hospital base rate payments, that cut was restored – as were mid-year cuts to OB/NICU, burn center, and trauma center payments, which were restored to their FY 2012 enacted levels.
In addition, the budget increased payments to critical access hospitals and restored payments to academic medical centers and physician practice plans.
The budget also restored funding for separate fee-for-service payments for normal newborn care, thereby rescinding at least for FY 2013 an expedited regulation promulgated by the Department of Public Welfare that would have eliminated payments for such services.
For further information about Pennsylvania’s FY 2013 Medical Assistance budget and its implications for Pennsylvania’s safety-net hospitals, please contact Michael Chirieleison, SNAP’s president, at 717-234-6970 or mike@debrunner.us.
The Supreme Court has upheld the constitutionality of the 2009 Affordable Care Act – including the much-disputed mandate that everyone obtain health insurance.
The court’s only disagreement with the reform law was with its provision requiring states to expand Medicaid eligibility as a future condition of obtaining federal Medicaid matching funds. The court ruled that expanding Medicaid eligibility should be optional and that states that choose not to expand their Medicaid programs would still receive the federal matching funds to which they have always been entitled.
In the wake of this decision, SNAP is very concerned about the interplay between the loss of the mandated Medicaid expansion and the Affordable Care Act’s requirement that Medicare DSH and Medicaid DSH payments be cut significantly in the coming years. Those cuts were predicated on the Medicaid expansion adding as many as 20 million people to the ranks of the insured, which was expected to provide additional revenue to hospitals that would help offset a reduction in their Medicare DSH and Medicaid DSH revenue.
For now, all eyes will be on Pennsylvania state officials as they decide what to do in light of the greatly enhanced federal matching funds still available for states that choose to expand Medicaid eligibility.