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Medicaid Enrollment on the Rise

More people are enrolling in Medicaid, and much of the increase is driven by the COVID-19 emergency.

Or so reports the organization Families USA in a new study.

Pennsylvania State MapAccording to the study,

Over half of the 38 states reporting monthly enrollment through May or later have seen greater than 7% growth in enrollment since February. For the eight states reporting August enrollment, their average enrollment growth since February is approximately 11%.

But the implications are even greater, according to the analysis, which found that in large part because of COVID-19 job loss,

Medicaid enrollment among the 38 states reporting has already increased by 4.3 million people and is poised to increase much more in the near future. Analysis by Health Management Associates projects that up to 27 million people will lose their job-based insurance this year and that Medicaid will see an increase in enrollment of up to 18 million people by the end of 2020, depending on the severity of the economic downturn.

The effects of COVID-19 job loss and accompanying loss of insurance already appears to be visible in Pennsylvania, where Medicaid enrollment rose from 2.84 million in March of 2020 to 2.89 million in April, 2.94 million in May, and 2.977 million in June.  Growing Medicaid enrollment poses a challenge for Pennsylvania’s safety-net hospitals because they care for so many low-income patients and payments from the state’s Medicaid program often do not cover the cost of the care they provide.

Learn more about the nation-wide trend in the Families USA report “Rapid Increases in Medicaid Enrollment: A Review of Data from Six Months.

 

Eliminate Medicaid DSH Cut, SNAP Asks PA Delegation

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states, and the Safety-Net Association of Pennsylvania has written to the state’s congressional delegation asking its members to convey this message to congressional leaders.

Safety-Net Association of Pennsylvania logoThe cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to the delegation, SNAP wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured, including nearly 700,000 Pennsylvanians – a number thought to be rising because of the job loss associated with COVID-19. When these people are sick or injured, most will turn to the state’s 41 private safety-net hospitals for care. These hospitals depend heavily on their Medicaid DSH payments to underwrite the cost of care for their uninsured patients, so they have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never permitted those cuts to go into effect. The most recent delay expires after November 30..

Because they serve so many uninsured and underinsured patients, Medicaid DSH payments from the state are especially important for Pennsylvania’s safety-net hospitals.

Learn more from SNAP’s Medicaid DSH letter to Pennsylvania’s congressional delegation.

2020-09-15T06:00:16+00:00September 15th, 2020|Affordable Care Act, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off on Eliminate Medicaid DSH Cut, SNAP Asks PA Delegation

COVID-19 Update: Friday, September 11

The following is the latest coronavirus information from the state and federal governments as of 1:30 p.m. on Friday, September 11.

Pennsylvania State Government

Department of State

The Department of State has suspended the initial medical history and physical examination required for prescribing buprenorphine via telemedicine to treat opioid use disorder for the duration of the COVID-19 disaster declaration.

Department of Health

The Department of Health has revised its health alert Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (COVID-19) in a Healthcare Setting to add information on extended-use eye protection and to update language regarding the use of respirators.

The Department of Health has clarified that it does not need to approve a skilled nursing facility’s testing plan before it is used by the facility and providers should defer to the CMS-reported county positivity rate if there is a conflict between CMS and Department of Health data.  Learn more here.

Department of Health – by the numbers

  • This week’s joint news release from Governor Wolf and the Department of Health revealed that during the week of August 28 to September 3, the number of COVID-19 cases rose 30 percent over the previous week, the state-wide rate for positive tests rose from 3.2 percent to four percent, and community transmission was high in Columbia and Centre counties.
  • Since that time, the number of daily cases has differed significantly from day to day, from some of the state’s highest to some of its lowest numbers in the past six weeks.
  • In recent days the number of COVID-19 cases in Pennsylvania surpassed 142,000 and the number of COVID-19 deaths rose past 7800.
  • Despite this, the number of Pennsylvanians currently hospitalized with COVID-19 continues a very slow decline, as does the number of such patients breathing with the help of a ventilator.
  • The number of health care workers in the state who have contracted COVID-19 just surpassed 10,000.
  • More than 21,700 residents of long-term-care facilities and 4700 people who work in those facilities have contracted COVID-19 in 947 such facilities in 61 of the state’s 67 counties.
  • 22 percent of the beds in Pennsylvania’s acute-care hospitals are currently unoccupied, as are  26 percent of adult ICU beds, 13 percent of pediatric ICU beds, 35 percent of pediatric beds, and 42 percent of airborne isolation rooms.

Federal Update

Provider Relief Fund

  • Reminder: Applications are currently open for Phase 2 general distribution funding for Medicaid, Medicaid managed care, the Children’s Health Insurance Program (CHIP), dental providers, certain Medicare providers, hospitals that have changes in ownership, and assisted living facilities.  All groups have until September 13, 2020 to submit their tax identification number for validation and apply for funding from the phase 2 general distribution.  Go here for more information.
  • HHS has updated its Provider Relief Fund FAQ with one modified question marked 9/4/2020 on page 32 of the document. The revised response addresses the tax treatment by parent companies of grants awarded to subsidiaries with separate National Provider Identifiers.

American Medical Association

  • The American Medical Association has published an update of the Current Procedural Terminology (CPT) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic. Learn more from this AMA announcement.

Department of Health and Human Services

  • HHS has published a request for information seeking stakeholder input regarding the ability of CLIA-accredited commercial, academic, medical center, and public health laboratories to feasibly perform more COVID-19 testing if additional testing instruments were made available to them. Interested parties have ten days to submit written comments.
  • HHS has issued new guidance authorizing state-licensed pharmacists to order and administer, and state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer, COVID-19 vaccinations to persons ages three or older, subject to certain requirements. See HHS’s announcement of the new guidance and go here to see the guidance itself.

Centers for Medicare & Medicaid Services

  • CMS has posted the document “New COVID 19 Testing and Reporting Requirements” that collects and summarizes the latest testing, training, and data-reporting requirements for nursing homes.
  • In late August, CMS published a regulation that required nursing homes to test their staff for COVID-19; that regulation included other testing and reporting requirements as well. The frequency of such testing was to be tied to the degree of community spread of COVID-19, with the details of how that would work to be announced later.  CMS has now published the county-by-county positivity rates on which the frequency of nursing home testing will be based.  Find those rates here.
  • CMS has updated its tip sheets to help providers understand its public reporting strategy for quality programs during the COVID-19 emergency.  Find tip sheets for the following types of providers:
    • For long-term-care hospitals, here and here.
    • For skilled nursing facilities, here and here.
    • For inpatient rehabilitation faculties, here and here.
    • For home health providers, here and here.
  • CMS has published updated provider-specific fact sheets on new COVID-19-related waivers and flexibilities for home health agencies, ambulances, and durable medical equipment.

CMS COVID-19 Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information related to its response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Call

Tuesday, September 22 at 5:00 – 6:00 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 2409459

To join call, go  here.

Lessons from the Front Lines: COVID-19

Friday, September 18 at 12:30 – 2:00 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 4446447

To join call, go  here.

Home Health and Hospice Call

Tuesday, September 22n at 3:00 – 3:30 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 1169237
To join call, go  here.

Nursing Homes Call

Friday, September 18 at 12:30 – 2:00 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 4446447

To join call, go here.

Dialysis Organizations Call

Wednesday, September 23 at 5:30 – 6:00 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 7026727
To join call, go  here.

Thursday, September 24 at 3:00 – 3:30 PM Eastern

Toll-free attendee dial-in: 833-614-0820; Access Passcode: 5872398
To join call, go  here.

Conference lines are limited, so CMS encourages interested parties to join via audio webcast.  To listen to the audio files and read the transcripts for these and past COVID-19 Stakeholder calls, visit CMS’s Podcast and Transcripts page.

Centers for Disease Control and Prevention

Food and Drug Administration

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

2020-09-14T06:00:55+00:00September 14th, 2020|Coronavirus, COVID-19, Uncategorized|Comments Off on COVID-19 Update: Friday, September 11

SNAP Asks PA Delegation to Help Prevent Attempt to Undermine 340B

Pharmaceutical companies are attempting to prevent safety-net hospitals and others from receiving the full benefits of the section 340B prescription drug discount program and the Safety-Net Association of Pennsylvania has asked of the state’s congressional delegation to sign a congressional letter to Health and Human Services Secretary Alex Azar asking to him intervene and stop the pharmaceutical companies.

Safety-Net Association of Pennsylvania logoIn asking members of the delegation to sign onto the bipartisan letter, SNAP notes that

The 340B program is essential for Pennsylvania’s safety-net hospitals, other qualified Pennsylvania providers, and others like us throughout the country, enabling us to obtain discounts on prescription drugs we dispense on an outpatient basis to qualified, low-income patients. The program greatly enhances the ability of hospitals to serve their low-income patients and does not cost taxpayers a single dime, but in recent weeks several pharmaceutical companies have taken steps to prevent hospitals from receiving the prescription drug discounts that Congress clearly intended when it created the 340B program nearly 30 years ago.

Learn more about the 340B problem and what SNAP and others are asking Secretary Azar to do to help in this SNAP message to members of Pennsylvania’s congressional delegation.

2020-09-09T16:05:44+00:00September 9th, 2020|340b, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off on SNAP Asks PA Delegation to Help Prevent Attempt to Undermine 340B

SNAP Asks PA Congressional Delegation to Help Fight Cuts to 340B Program (Letter)

SNAP asked members of PA’s congressional delegation to sign a bipartisan letter to Health and Human Services Secretary Azar asking the Secretary to prevent pharmaceutical companies from denying access to discounted prescription drugs made available through the federal section 340B prescription drug discount program.

2021-05-27T14:13:55+00:00September 9th, 2020|Advocacy|Comments Off on SNAP Asks PA Congressional Delegation to Help Fight Cuts to 340B Program (Letter)

COVID-19 Update: Friday, September 4

The following is the latest coronavirus information from the state and federal governments as of 1:30 p.m. on Friday, September 4.

Pennsylvania Update

Independent Fiscal Office

The Independent Fiscal Office reports that Pennsylvania collected $2.55 billion in General Fund revenue for August, an increase of $355.5 million (16.2 percent) over August 2019 collections.  The IFO estimates that roughly $235 million of the $355.5 million increase was associated with extended tax due dates related to the COVID-19 pandemic.  Personal income tax revenue, sales, use, and hotel occupancy revenue, and corporate net income tax revenue all exceeded estimates.  See the IFO’s full August report here.

Department of Health

The Department of Health has revised its guidance for skilled nursing facilities with a recommended testing plan for facilities not experiencing a COVID-19 outbreak, safe access for compassionate care, access to the facility for resident advocates, and a revised timeline for lifting restrictions after a mitigated outbreak.  See a news release describing the new guidance and go here to see the guidance itself.

Department of Health – by the numbers

  • In the past three days the number of COVID-19 cases in Pennsylvania surpassed 135,000 and the number of COVID-19 deaths rose past 7700.
  • Thursday marked the first time since late July that the state registered more than 1000 new cases in a single day.
  • Despite this, the number of Pennsylvanians currently hospitalized with COVID-19 is, with one exception, lower than it has been since before June.
  • Fewer of these patients are on ventilators today than at any time in the past three months.
  • More than 9800 health care workers in the state have contracted COVID-19.
  • More than 21,300 residents of long-term-care facilities and 4600 people who work in those facilities have contracted COVID-19 in 942 such facilities in 61 of the state’s 67 counties.
  • 26 percent of the beds in Pennsylvania’s acute-care hospitals are currently unoccupied, as are  22 percent of adult ICU beds, 15 percent of pediatric ICU beds, 38 percent of pediatric beds, and 41 percent of airborne isolation rooms.

Department of State

Because of the challenges of finding continuing education opportunities to fulfill professional requirements during the COVID-19 emergency, the Department of State has authorized the granting of continuing education credits for nursing home administrators, physical therapists, social workers, marriage and family therapists, professional counselors, speech language pathologists, and audiologists who serve as poll workers in this November’s election.  See the Department of State notice here.

Federal Update

Provider Relief Fund

  • Reminder: Applications are currently open for Phase 2 general distribution funding for Medicaid, Medicaid managed care, the Children’s Health Insurance Program (CHIP), dental providers, certain Medicare providers, and assisted living facilities.  All groups have until September 13, 2020 to submit their tax identification number for validation and apply for funding from the phase 2 general distribution.  Go here for more information.
  • HHS announced that assisted living facilities may apply for funding under the Provider Relief Fund phase 2 general distribution allocation. Go here to see HHS’s announcement.
  • HHS has announced some of the details of an upcoming $2 billion Provider Relief Fund performance-based incentive payment distribution to nursing homes. HHS will measure nursing homes against a baseline level of infection in the community where individual facilities are located.  Learn more from HHS’s announcement of this distribution.
  • HHS has updated its Provider Relief Fund FAQ with new and modified questions.
    • Changes marked 9/1/2020 can be found on pages 22, 23, 29, and 32. The new information focuses largely on the newly announced distribution for assisted living facilities, criteria for eligibility, and applying to participate in the distribution.
    • One change, marked 9/2/2020 and on page 23, describes how HHS identified assisted living facilities that are eligible to receive distributions from the Provider Relief Fund.
    • Five changes, marked 9/3/2020 and found on pages 2, 9, and 17, address HHS requests for additional financial information, how to report Provider Relief Fund grants on Medicare cost reports, and the responsibility of parent organizations to send to their subsidiaries grants intended for those subsidiaries.

Find all of these changes in the Provider Relief Fund FAQ.

American Medical Association

The American Medical Association has updated codes and guidelines for office and other outpatient evaluation and management (E/M) services. Some of the changes were introduced earlier this year in response to the COVID-19 emergency.  The AMA has recommended to CMS that it implement these changes on January 1, 2021.  Learn more in this AMA news release.

Centers for Medicare & Medicaid Services

  • CMS has updated the article “Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment” in its online publication MLN Matters to reflect an update that includes additional COVID-19 codes. Some of those codes took effect on August 10 and others take effect on October 1.
  • CMS has updated the article “Update to the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for Vaping Related Disorder and Diagnosis and Procedure Codes for the 2019 Novel Coronavirus (COVID-19)” in its online publication MLN Matters to include new procedure codes.

Department of Health and Human Services

Centers for Disease Control and Prevention

Food and Drug Administration

The FDA has issued guidance to health care providers on the use of convalescent plasma for treating patients with COVID-19.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

(To receive this daily update directly, sign up for our mailing list at   info@pasafetynet.org.)

2020-09-08T06:00:08+00:00September 8th, 2020|COVID-19, DSH hospitals|Comments Off on COVID-19 Update: Friday, September 4

COVID-19 Update: Tuesday, September 1

The following is the latest coronavirus information from Pennsylvania’s state government as of 3:30 p.m. on Tuesday, September 1.

Governor Wolf

Governor Wolf has signed a second renewal of his 90-day disaster declaration for the COVID-19 pandemic.  This declaration provides for increased support for state agencies involved in the continued response to the virus and recovery during reopening, including expediting supply procurement and lifting certain regulations to allow for efficient and effective mitigation.  The disaster declaration also has facilitated waivers and extensions to support Pennsylvanians, Pennsylvania businesses, and Pennsylvania caregivers during the pandemic.  Learn more from the governor’s news release announcing the signing and see the emergency declaration itself.

Governor Wolf asked the General Assembly to pass legislation for paid sick and family leave for workers who need to miss work for an illness or to take care of a loved one.  Such leave could be used to recover from an illness, such as COVID-19, for medical appointments, to care for a family member, or to seek help from abuse or violence.

Department of Human Services/Department of Health

Department of Human Services Secretary Teresa Miller and Department of Health Secretary Dr. Rachel Levine announced that all assisted living residences, personal care homes, and private intermediate-care facilities in the state have completed universal baseline COVID-19 testing.  One hundred percent of the 1363 DHS-licensed personal care homes, assisted living residences, and private intermediate-care facilities in Pennsylvania completed universal baseline testing by the August 31 deadline.  This effort was assisted by the Regional Response Health Collaborative (RRHC) Program launched in late July to provide clinical support, technical assistance, and education to long-term-care facilities as they work to prevent and mitigate spread of COVID-19.  Learn more from this Wolf administration news release.

Department of Health – by the numbers

  • The weekly COVID-19 status report released by Governor Wolf and the Department of Health found 353 fewer new cases of COVID-19 during the week of August 21-27 than during the week of August 14-20.
  • The rate of positive tests declined from 3.4 percent to 3.2 percent, the fifth consecutive week the rate has declined.
  • Counties that still have troubling positive test rates are Columbia (13.5 percent), Armstrong (8.3 percent), Perry (6.9 percent), Northumberland (6.7 percent), Potter (5.9 percent), Beaver (5.7 percent), Dauphin (5.3 percent), Fulton (5.3 percent), and York (5.0 percent).
  • The past week saw 20 percent fewer COVID-19 deaths in Pennsylvania than the previous week.
  • The state’s contact tracing efforts found that 50 percent of the people who had new cases of COVID-19 and who also reported visiting a business during the previous two weeks said they visited a restaurant, 12 percent said they had visited a bar, 12 percent said they visited a gym or fitness center, and nine percent said they visited a salon or barber shop.
  • More than 9600 health care workers in the state have contracted COVID-19.
  • The number of Pennsylvanians hospitalized with COVID-19 and on ventilators declined slightly in the past week.
  • 24 percent of the beds in Pennsylvania’s acute-care hospitals are currently unoccupied, as are  25 percent of adult ICU beds, 17 percent of pediatric ICU beds, 37 percent of pediatric beds, and 43 percent of airborne isolation rooms.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

(To receive this daily update directly, sign up for our mailing list at   info@pasafetynet.org.)

2020-09-02T06:00:24+00:00September 2nd, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Tuesday, September 1

COVID-19 Update: Friday, August 28

The following is the latest COVID-19 information from Pennsylvania’s state government as of 2:00 p.m. on Friday, August 28.
Governor Wolf
Governor Wolf announced that the state is awarding $10 million in grants to 23 recipients to support the rapid advancement of vaccines, treatments, and therapies in response to the COVID-19 pandemic.  Find a list of grant recipients here.
Governor Wolf announced that the state will distribute more than $117 million in CARES Act funding to child care providers across Pennsylvania.
Department of Health – by the numbers

  • The number of new COVID-19 cases has remained generally steady for the past two weeks, although today’s figure is the highest in nearly two weeks.
  • COVID-19 death totals continue to fluctuate from day to day.
  • More than 9500 health care workers in the state have contracted COVID-19.
  • The number of Pennsylvanians hospitalized with COVID-19 is higher than it was a week ago.
  • The number of Pennsylvanians on ventilators has generally been declining but is up in recent days.
  • More than 25,000 residents and staff of 925 long-term-care facilities in 61 of the state’s 67 counties have now contracted COVID-19.
  • 22 percent of the beds in Pennsylvania’s acute-care hospitals are currently unoccupied, as are  24 percent of adult ICU beds, 13 percent of pediatric ICU beds, 36 percent of pediatric beds, and 43 percent of airborne isolation rooms.

Resources to Consult
Pennsylvania Department of Human Services
Main COVID-19 Page
COVID-19 Provider Resources
Press Releases
Pennsylvania Department of Health
Main COVID-19 Page
PA Health Alert Network
Centers for Disease Control and Prevention
Main COVID-19 Page
FAQ
(To receive this daily update directly, sign up for our mailing list at   info@pasafetynet.org.)

2020-08-31T15:36:29+00:00August 31st, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Friday, August 28

CMS Provides Guidance on Medicaid DSH Calculations

State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services.

In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date,  CMS will enforce its own interpretation of the policy.

In new guidance, CMS presents two methodologies for accounting for its mid-year policy change and reminds stakeholders about its new methodology for calculations after June 2, 2017. Pennsylvania’s Department of Human Services and its Office of Medical Assistance Programs have not yet indicated how they will respond to the options CMS has presented.

Learn more from this Medicaid notice and from its accompanying CMS informational bulletin “Treatment of Third Party Payers (TPP) in Calculating Uncompensated Care Costs (UCC).”

2020-08-31T19:55:39+00:00August 27th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on CMS Provides Guidance on Medicaid DSH Calculations
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