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

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2020 newsletter.

Included in this month’s edition are articles about:

the transition to a new Medicaid prescription drug list (PDL);
the rollout of a new electronic visit verification system for Medicaid-paid home health services; and
progress in the state’s effort to introduce major changes in its Medical Assistance transportation program (MATP).

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

PA Safety Net Admin2020-02-05T06:00:12+00:00February 5th, 2020|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Says No to Medicaid Block Grants

Pennsylvania is not interested in pursuing the new Medicaid block grants being offered by the administration, leading state officials said last week.

In a news release, Governor Wolf said that

I expanded Medicaid in Pennsylvania to allow for more than 700,000 people to have reliable health care access. Pennsylvania will not go backwards. I will not risk jeopardizing our progress by going along with another short-sighted, insensitive plan to cut Medicaid…

Department of Human Services Secretary Teresa Miller, who oversees the Pennsylvania Medicaid program that serves approximately 2.8 million people, echoed this sentiment:

Changing any part of Medicaid to a block grant structure is the federal government permitting states to grow health inequities experienced by the poorest Americans. This cruel policy will directly target people who have the most opportunity to see their life and circumstances improved by consistent access to necessary health care and will keep people trapped in the cycle of poverty.

Learn more about why Pennsylvania will not pursue a Medicaid block grant in the Wolf administration news release “Pennsylvania Will Not Participate in Trump Administration Scheme to Cut Medicaid.”

PA Safety Net Admin2020-02-04T06:00:35+00:00February 4th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

SNAP Asks Feds to Withdraw Medicaid Financing Regulation

CMS should withdraw its proposed Medicaid fiscal accountability regulation, SNAP has suggested in a formal comment letter to the federal agency in response to a new regulation it proposed in November.

Safety-Net Association of Pennsylvania logo According to the comment letter SNAP submitted to the Centers for Medicare & Medicaid Services,

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.

Learn more about SNAP’s views on the proposed Medicaid fiscal accountability regulation and why SNAP believes CMS should withdraw it in SNAP’s formal comment letter.

PA Safety Net Admin2020-02-03T06:00:47+00:00February 3rd, 2020|Federal Medicaid issues, Safety-Net Association of Pennsylvania|Comments Off

SNAP Asks CMS to Withdraw Proposed Medicaid Fiscal Accountability Regulation (Letter)

SNAP asks the Centers for Medicare & Medicaid Services to withdraw a proposed Medicaid fiscal accountability regulation that grants too much authority to federal regulators, limits states’ ability to finance their share of Medicaid spending, introduces ill-defined standards to the evaluation of state applications to modify their Medicaid programs, and imposes major new regulatory burdens on hospitals and state Medicaid programs.

PA Safety Net Admin2020-09-01T18:00:50+00:00January 31st, 2020|Advocacy|Comments Off

Supreme Court Lifts Public Charge Rule Ban

The U.S. can now reject visa and green card applicants based on their financial prospects after a new Supreme Court ruling this week.

This ruling has potential long-term implications for health care providers.

Last August a new Department of Homeland Security regulation took effect that authorized the federal government to reject immigrants’ applications for visas and green cards if their financial situation and employment prospects suggested that they might become a “public charge” and dependent on government safety-net programs like Medicaid and food stamps. A number of groups sued to prevent the rule’s implementation and federal courts imposed an injunction against its enforcement but now the Supreme Court has lifted the last of these injunctions.

The Supreme Court’s ruling, however, did not address the merits of the public charge rule. Instead, the court concluded that the lower courts that imposed the injunctions had overstepped their authority. As a result, lower courts will continue to hear individual suits challenging the rule. Meanwhile, the State Department and Department of Homeland Security will enforce it.

In 2019 the State Department rejected 12,000 visa applications. In 2016, it rejected only 1000.

The public charge regulation poses a challenge to health care providers amid anecdotal evidence that some immigrants who already are in the U.S. legally and were enrolled in Medicaid withdrew from the program and others who also are in the U.S. legally and are eligible for Medicaid are choosing not to apply for benefits out of a mistaken fear that they or members of their families could be deported. Over time these practices, if they continue, could leave health care providers with more unpaid bills and a greater uncompensated care burden as they care for individuals who are qualified for Medicaid but decline to enroll in the program and cannot pay their medical bills.

Implementation of the public charge regulation may prove especially challenging for Pennsylvania safety-net hospitals located in areas with large numbers of low-income immigrants. These hospitals could be at risk for rising amounts of uncompensated care.

Learn more about the public charge issue, the Supreme Court’s decision, and what might happen next in the New York Times article “Supreme Court Allows Trump’s Wealth Test for Green Cards.”

PA Safety Net Admin2020-01-29T06:00:41+00:00January 29th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid Transportation Program Defies Fixing

Pennsylvania is trying to fix its Medical Assistance Transportation Program – but that is proving harder than proponents of change envisioned.

For years, county governments ran their own programs, which provided free non-emergency transportation to doctor offices for Medicaid patients. About 55,000 Pennsylvanians served by Medicaid use this program.

But with a growing trend among states of dividing a state into regions and awarding regional contracts to transportation brokers and amid objections from county governments, the General Assembly directed the state’s departments of Aging, Human Services, and Transportation to look into the matter.

And in the report those departments filed with the legislature, they say they do not know what to do.

Learn more about the challenges facing the Medical Assistance Transportation Program, the options, and the strengths and weaknesses of those options in the Philadelphia Inquirer article “Pennsylvania wants to fix its Medicaid transit program, but there’s no easy way to do it, report says.”

PA Safety Net Admin2020-01-10T06:00:02+00:00January 10th, 2020|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Interview With Seema Verma

In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma. Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more. Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma.”

PA Safety Net Admin2020-01-09T06:00:16+00:00January 9th, 2020|Affordable Care Act, Federal Medicaid issues, Health care reform|Comments Off

PA Introduces Medicaid PDL on January 1

Beginning tomorrow, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon: the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1. Here’s why.”

PA Safety Net Admin2019-12-31T06:00:53+00:00December 31st, 2019|Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November-December 2019 newsletter.

Included in this month’s edition are articles about:

Changes in care coordination in the Community HealthChoices program in southeastern Pennsylvania beginning on January 1.
Changes in the delivery of Medicaid-covered intensive behavioral health services in homes, schools, and the community for children and adolescents.
The switch from Medicaid to Medicare as primary payer for medication-assisted treatment for opioid use disorder for dually eligible (Medicare and Medicaid) patients.
Pennsylvania’s request for a delay in implementation of electronic visit verification for Medicaid-covered personal assistance services and home health aides.
The delay in implementation of the new public charge rule and its implications for taking advantage of Medicaid benefits among potentially affected individuals.

Read about these subjects and more in the Pennsylvania Health Law Project’s November-December newsletter.

PA Safety Net Admin2019-12-23T06:00:51+00:00December 23rd, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do.

At last count, various parts of Congress were considering four major surprise medical bill proposals: one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees. Some have been around for some time while one emerged only in the past week.

The Commonwealth Fund has prepared a summary of the four proposals that includes a chart that compares where they stand on six major aspects of surprise billing legislation:

The medical settings to which the legislation would apply.
Whether they hold consumers harmless for surprise bills.
Whether they ban balance-billing.
How – or if – they establish standard rates.
How they resolve disputes between insurers and providers.
How they interact with existing state surprise medical bill laws.

An effort by Pennsylvania’s General Assembly to address surprise medical bills met with a similar fate.

Learn more from the Commonwealth Fund report “Update on Federal Surprise Billing Legislation: Understanding a Flurry of New Proposals.”

PA Safety Net Admin2019-12-20T06:00:10+00:00December 20th, 2019|Uncategorized|Comments Off

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