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

Largest PA Health Insurers to Underwrite Members’ Coronavirus Testing

Some of Pennsylvania’s largest health insurers will waive co-pays for coronavirus testing for their members.

The insurers – Aetna, Capital Blue Cross, Cigna, Geisinger, Highmark, Independence Blue Cross, Pennsylvania Health & Wellness, United Healthcare, and UPMC Health Plan – will cover such tests when they are medically ordered and performed by approved medical labs.

Not all insurers serving Pennsylvanians will do the same. Among those that may not are short-term and limited duration plans.

Learn more about the role some Pennsylvania health insurers will play in coronavirus testing in the Philadelphia Business Journal article “Wolf: Major Pennsylvania health insurers to cover coronavirus testing.”

PA Safety Net Admin2020-03-10T10:13:39+00:00March 10th, 2020|Uncategorized|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The February 2020 MACPAC meeting opened with a continuation of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from Michigan, New Jersey, and North Carolina joined the Commission to discuss how their states are addressing maternal morbidity and mortality.^* The Commission plans to include a chapter on maternal health in its June 2020 report to Congress. Commissioners later turned their attention to policy options for improving enrollment in the Medicare Savings Program.

The Commission later took a deep dive into value-based payment in Medicaid managed care. This three-part session began with findings from a series of interviews with state officials, managed care organizations, and other stakeholders aimed at understanding how states use managed care to promote payment reform, conducted by MACPAC contractor Bailit Health. Then, representatives from three of these organizations shared their reactions to the findings and talked about how value-based payment models are working in practice.^* The session concluded with Commissioners’ perspectives on the study’s findings and the panelists’ reactions to them, and possible next steps.

The final session of the afternoon continued a line of inquiry begun at the October 2019 meeting: third-party liability coordination between Medicaid and TRICARE. MACPAC estimates that almost 1 million Medicaid enrollees have primary coverage through TRICARE, which provides health benefits for military personnel, military retirees, and their dependents. Commissioners explored making recommendations in the June report to improve coordination between the two programs.

On Friday, the Commission returned to the theme of improving care for dually eligible beneficiaries, looking more closely at the rise of so-called dual-eligible special needs plan (D-SNP) look-alikes and how changes in the Medicare Advantage market are affecting efforts to integrate care. Commissioners also reviewed a rule proposed in February that would, among other things, restrict the growth of look-alikes.

Following that session, the Commission discussed draft recommendations to improve integration of Medicare and Medicaid benefits for dually eligible beneficiaries. The February meeting wrapped up with a discussion of a forthcoming rule expected to affect the Medicaid eligibility determination process.

Supporting the discussion were the following briefing papers:

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program. Find its web site here.

PA Safety Net Admin2020-03-06T06:00:04+00:00March 6th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its February 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

Governor Wolf’s proposed FY 2021 Medicaid budget.
Challenges Pennsylvania Medicaid recipients have encountered obtaining services from their HealthChoices managed care plan and how to address them.
Implementation of the federal “public charge” regulation and whom it does – and does not – affect.

Read about these subjects and more in the Pennsylvania Health Law Project’s February 2020 newsletter.

PA Safety Net Admin2020-03-05T06:00:11+00:00March 5th, 2020|Federal Medicaid issues, HealthChoices, Pennsylvania Medicaid, Pennsylvania proposed FY 2021 budget|Comments Off

PA Introduces Testing for Coronavirus

Pennsylvania’s Department of Health now has the capacity to test for coronavirus and can perform six such tests a day.

Until Monday, the state needed to send any samples it wanted tested to the Centers for Disease Control and Prevention in Atlanta, which meant a two- to three-day wait for results. State turnaround will be 24 hours.

One by one, states are developing this capacity and hospitals and health systems, too, will no doubt be doing the same in the coming weeks. First, though, their testing must be approved by the federal Food and Drug Administration. Until then, they will have to rely on the state lab in Chester County.

Learn more about Pennsylvania’s new ability to perform coronavirus tests in the Pittsburgh Tribune-Review article “Pennsylvania Health Department begins testing for coronavirus.”

PA Safety Net Admin2020-03-04T13:00:36+00:00March 4th, 2020|Uncategorized|Comments Off

MFAR Backlash Continues

Diverse health care and government interests are rallying around their opposition to the proposed Medicaid fiscal accountability rule.

Bookshelf with law books The regulation, proposed by the Centers for Medicare & Medicaid Services in November would impose new limits on the ability of states to finance their share of their Medicaid spending, potentially jeopardizing provider payments and the ability of high-volume Medicaid providers to operate without suffering great losses.

In all, CMS received more than 4200 written comments in response to the proposed regulation, most of them expressing opposition. Among those doing so were state governments, the National Governors Association, hospitals and hospital associations, nursing home operators, and health advocacy organizations. Also among them was the Safety-Net Association of Pennsylvania. In summarizing its opposition, SNAP wrote in a formal comment letter to CMS on behalf of Pennsylvania safety-net hospitals that

SNAP is concerned that this proposed regulation would inappropriately restrict the state’s ability to finance the non-federal share of the Medicaid program, would impose significant additional regulatory burdens – the cost of which would far outstrip their benefit – would inappropriately introduce subjectivity into the application of previously clear and objective regulatory standards, and is beyond the scope of the statutory authority granted to CMS.

See SNAP’s entire letter here.

Learn more about the Medicaid fiscal accountability rule, what it seeks to do, and why so many oppose in the Stateline article “Medical Groups Slam Trump Medicaid Rule.”

PA Safety Net Admin2020-03-04T06:00:15+00:00March 4th, 2020|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

SNAP Rallies PA Delegation to Oppose MFAR

A proposed federal Medicaid regulation could limit Pennsylvania’s ability to finance its Medicaid program and jeopardize supplemental payments to the state’s private safety-net hospitals, so SNAP has asked members of the state’s congressional delegation to sign a letter to CMS Administrator Seema Verma asking her to reconsider the potentially damaging Medicaid fiscal accountability regulation.

Safety-Net Association of Pennsylvania logo In its letter to members of the state’s congressional delegation, SNAP wrote on behalf of private Pennsylvania safety-net hospitals that

The proposed Medicaid fiscal accountability regulation (MFAR) would, if implemented, impose new limits on how states may raise their share of funds to support their Medicaid programs. If adopted, the commonwealth would face a serious challenge raising the money it needs to finance its share of the cost of its Medicaid program. In addition, MFAR would take a great deal of states’ Medicaid policy-making authority away from state governments and give it instead to the federal Department of Health and Human Services.

Two members of the state’s congressional delegation, Representatives Brendan Boyle (D-Montgomery/Philadelphia) and Mike Kelly (R-Butler/Crawford/Erie/Lawrence/Mercer), have written a bipartisan letter to be sent to CMS Administrator Seema Verma asking her to reconsider the troubling aspects of MFAR. SNAP wrote to members of the state’s congressional delegation asking them to sign onto the letter.

Go here to see the full SNAP letter to the delegation.

PA Safety Net Admin2020-03-03T06:00:10+00:00March 3rd, 2020|Federal Medicaid issues, Pennsylvania Medicaid policy, Uncategorized|Comments Off

Azar: Budget Proposes Reducing Medicaid Matching $

The federal government would reduce its financial commitment to state Medicaid programs under the FY 2021 budget the Trump administration proposed earlier this month.

While testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services and Education, Health and Human Services Secretary Alex Azar acknowledged that the administration’s proposed FY 2021 would eliminate the enhanced rate at which the federal government matches state funds used to serve individuals who enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion provision. That enhanced rate calls for the federal government to pay 100 percent of the costs associated with the Medicaid population during the first year of Medicaid expansion, eventually scaling down to 90 percent after 2020. Nationally, the federal government’s matching rate for the pre-expansion population is 57 percent; that matching rate would not be affected by this proposal.

This aspect of the administration’s proposed FY 2021 budget has mostly flown under the radar since the budget’s release and has received little public attention.

In explaining the proposal, Azar said that enhanced funding for the Affordable Care Act’s Medicaid expansion population was biased against the disabled, women, and children.

Such a policy change could be a blow to safety-net hospitals in states like Pennsylvania, which added more than a half-million people to its Medicaid program through the Affordable Care Act’s Medicaid expansion provision.

Learn more about what Secretary Azar said about federal matching funds for state Medicaid programs in the McKnight’s Long-Term Care News article “Official confirms Trump budget proposed to eliminate enhanced Medicaid match.”

PA Safety Net Admin2020-02-28T06:00:34+00:00February 28th, 2020|Affordable Care Act, Federal Medicaid issues|Comments Off

SNAP Rallies PA Delegation to Oppose Proposed Medicaid Fiscal Accountability Regulation (Letter)

SNAP asks members of Pennsylvania’s congressional delegation to sign onto a bipartisan letter written by delegation members Brendan Boyle (D) and Mike Kelly (R) asking the Centers for Medicare & Medicaid Services Administration to reconsider a proposed regulation that could limit the state’s ability to finance its share of its Medicaid spending and appropriately reimburse providers of high volumes of Medicaid-covered services.

PA Safety Net Admin2020-09-01T17:59:31+00:00February 27th, 2020|Advocacy|Comments Off

HealthChoices MCO Seeks to Address Social Determinants of Health

A managed care plan that participates in Pennsylvania’s Medicaid program is slowly dipping its toe into an effort to address the social determinants of health in Philadelphia.

United Healthcare, with 57,000 Medicaid members in the city, has placed six homeless members with multiple health problems into apartments in the city – it plans to add four more – and is spending between $1200 and $1800 a month on rent and wrapround services. Its theory: with one percent of the population accounting for 22 percent of annual health care spending nation-wide, helping some of that one percent could improve lives while saving a great deal of money.

Pennsylvania’s Department of Human Services has awarded nearly $9 million in grants since 2016 to groups attempting to address the social determinants of health and to help the more than 300,000 Medicaid participants in north Philadelphia.

Learn more about what United Healthcare is doing and why it is doing it in the Philadelphia Inquirer article “United Healthcare tackles homelessness as a root cause of poor health, and Philly is a test case.”

PA Safety Net Admin2020-02-25T06:00:04+00:00February 25th, 2020|Pennsylvania Medicaid, social determinants of health|Comments Off

Fitch: Medicaid Block Grants, MFAR Threaten States, Providers

Medicaid block grants and the proposed Medicaid fiscal accountability regulation (MFAR) pose new financial threats to providers and states, according to Fitch Ratings, the financial rating company.

MFAR poses the greater threat, Fitch believes, noting in a new analysis that it could

…reduce total Medicaid spending nationally by $37 billion and $44 billion annually…and by $23 billion to $30 billion for hospitals alone. States, and to some extent providers, would respond to MFAR’s implementation with measures to mitigate the negative fiscal implications.

Bookshelf with law books Block grants, through what has been named the Healthy Adult Opportunity program, also pose a threat, with Fitch explaining that

Capping federal Medicaid contributions, even for a subset of beneficiaries, poses risks to state budgets and those entities reliant on state funding, including local governments and providers. States would need to find revenue or cost savings, either in Medicaid or elsewhere, to offset reduced federal contributions.

Because Pennsylvania safety-net hospitals care for more Medicaid patients than the typical hospital, both proposed policy changes have a potentially greater impact on them.

Last month SNAP conveyed its opposition to the proposed MFAR regulation in a formal comment letter to the Centers for Medicare & Medicaid Services in response to the regulation’s publication late last year. Pennsylvania Governor Tom Wolf has already rejected the idea of using block grants in the state’s Medicaid program.

Learn more about the potential impact of the proposed Medicaid fiscal accountability regulation and Medicaid block grants in the Fitch Ratings analysis “Fitch Rtgs: Medicaid Changes Will Affect States, NFP Healthcare Providers.”

PA Safety Net Admin2020-02-20T06:00:08+00:00February 20th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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