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

The Language of Medicaid

Enhanced medical homes. Global bundling. Risk-based managed care.
The list goes on.
Current efforts to find new, better, and more economical ways to serve the Medicaid population have given rise to a new language: the language of Medicaid in the 21st century. Some of the terms used in today’s policy discussions are old, some are new, and some are not nearly as self-explanatory as they might seem.
The Kaiser Commission on Medicaid and the Uninsured has compiled a glossary of these terms – a useful tool in an environment in which the federal government and state governments are constantly producing proposals for new ways to address enduring challenges. Find the Kaiser Medicaid glossary here .

PA Safety Net Admin2012-06-05T06:00:35+00:00June 5th, 2012|Uncategorized|Comments Off

DPW Launches “Open Government” Web Site

The Pennsylvania Department of Public Welfare (DPW) has launched a new “transparency portal” on its web site through which the public can obtain a broad array of DPW information and data.
The available information includes facility and program audits, Medical Assistance fee schedules and payments, and individual provider reimbursement data.
The reimbursement data is especially broad, offering detailed information about state Medical Assistance payments to individual providers.
Read a DPW news release about the new DPW web site feature here and visit the site itself through this link .

PA Safety Net Admin2012-06-01T14:58:49+00:00June 1st, 2012|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

HealthChoices Expands, ACCESS Plus Contracts

Effective July 1, the Pennsylvania Medical Assistance program’s HealthChoices mandatory managed care program will expand to seven new counties: Bedford, Blair, Cambria, Franklin, Fulton, Huntingdon, and Somerset. At the same time, the state’s ACCESS Plus Medicaid managed care program will cease operations in those same counties.
Further information can be found in a May 25 Department of Public Welfare (DPW) Medical Assistance Bulletin, which can be found here.

PA Safety Net Admin2012-05-31T06:00:15+00:00May 31st, 2012|Meetings and notices|Comments Off

Medical Assistance Primary Care Rates to Rise

Rates for primary care services covered by Pennsylvania’s Medical Assistance program will rise upon implementation next year of a new federal regulation recently published in draft form by the Centers for Medicare & Medicaid Services (CMS).
Under the proposed regulation, Pennsylvania must pay Medicare-level rates for Medicaid-covered primary care services in 2013 and 2014. Medicare rates are higher for such services than Pennsylvania’s Medical Assistance rates, and under the proposed regulation the federal government, not the state, will pay for the difference between Medicare and Medicaid rates.
This new policy was mandated by the Affordable Care Act. In addition to raising fee-for-service rates, Pennsylvania will be expected to revise agreements with its contracted HealthChoices plans to ensure that they, too, pay the better rates.
The higher rates should be especially beneficial for Pennsylvania safety-net hospitals because of the large numbers of Medicaid patients they serve.
Proponents of the higher rates believe they will improve access to primary care services for the Medicaid population and possibly reduce future Medicaid costs by helping recipients get more timely care and thereby avoid more serious illnesses.
Learn more about the proposed Medicaid rate increase in a Commonwealth Fund blog entry and find the entire proposed regulation here . Interested parties have until June 11 to submit written comments to CMS.

PA Safety Net Admin2012-05-30T06:00:45+00:00May 30th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

PA Sets Terms of New Telemedicine Expansion

The Pennsylvania Department of Public Welfare (DPW) has announced that it is expanding its use of telemedicine to serve the state’s Medical Assistance population. Telemedicine is widely considered an especially useful tool for serving rural patients.
Under the new approach, the program will expand the types of medical specialists who may engage in telemedicine, remove the requirement that referring physicians participate in telemedicine consultations, and establish specific technologies for use in such consultations.
DPW has issued a new Medical Assistance Bulletin presenting more information about its new approach.
Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30 describes the new program and outlines procedures for engaging in telemedicine consultations. This bulletin can be found here. A fee schedule and provider codes can be found here.

PA Safety Net Admin2012-05-25T06:00:47+00:00May 25th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Medical Assistance Expands Use of Telemedicine

Pennsylvania’s Medical Assistance program has unveiled plans to make greater use of telemedicine in the future.
According to a news release from the governor’s office, the program will expand the types of medical specialists who may engage in telemedicine, remove the requirement that referring physicians participate in telemedicine consultations, and establish specific technologies for use in such consultations.
Learn more about this Medical Assistance initiative by going here and reading the governor’s news release.

PA Safety Net Admin2012-05-23T13:22:36+00:00May 23rd, 2012|Pennsylvania Medicaid policy|Comments Off

Medical Malpractices Cases, Verdicts Down in PA

Ten years after the state Supreme Court instituted changes in how and where medical malpractice cases could be filed, the number of cases filed and the number of verdicts issued has declined.
Currently, cases must be certified as having potential merit before they are filed. Also, plaintiffs must file in the county where the alleged malpractice occurred. Previously, those with weaker cases often filed in counties where juries are considered more lenient.
Read more about how and why in this Pittsburgh Post-Gazette article .

PA Safety Net Admin2012-05-21T09:07:34+00:00May 21st, 2012|Pennsylvania Medicaid laws and regulations|Comments Off

PA Hospitals Doing Better, PHC4 Reports

The financial performance of Pennsylvania’s acute-care hospitals improved in 2011, according to the Pennsylvania Health Care Cost Containment Council.
While hospitals’ uncompensated care rose 11.2 percent, to $990 million, the state-wide average operating margin rose from 4.37 percent to 5.58 percent, according to Financial Analysis 2011, Volume One, Acute Care Hospitals. Hospitals’ net income rose $769 million, to $2.69 billion, with 72 percent of that improvement coming from operating income.
Find PHC4’s news release and the report itself, which includes an industry-wide analysis as well as detailed information about the financial performance of every Pennsylvania acute-care hospital, here on PHC4’s web site.

PA Safety Net Admin2012-05-18T06:00:04+00:00May 18th, 2012|Uncategorized|Comments Off

MAAC to Meet

The next meeting of Pennsylvania’s Medical Assistance Advisory Committee (MAAC) will be held on Thursday, May 24 in Harrisburg. The MAAC advises the Pennsylvania Department of Public Welfare on Medicaid policy. Its meetings are open to the public.

PA Safety Net Admin2012-05-17T06:00:41+00:00May 17th, 2012|Meetings and notices|Comments Off

Readmissions and Poverty

At a time when Medicare and many state Medicaid programs are attempting to penalize hospitals when patients are readmitted shortly after they were discharged, researchers have found that some of those readmissions are linked to factors beyond hospitals’ control.
According to research presented recently at the American Heart Association’s Quality of Care & Outcomes Research Scientific Sessions 2012, differences in regional readmission rates are more closely tied to socioeconomic factors and access to care than they are to hospitals’ performance.
Researchers found that nine percent of regional variation in hospital readmission rates can be tied to patients’ poverty. Access to care, based on the availability of doctors and hospital beds, can be tied to 17 percent of regional variation in readmission rates.
The Safety-Net Association of Pennsylvania (SNAP) has long maintained that the low-income patients safety-net hospitals serve in especially large numbers come to them fundamentally sicker than typical hospital patients and require more resources and more effort to treat. This research appears to support this contention.
Read more about the research in this news release from the American Hospital Association.