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

Progress Continues Toward Launch of PA Health Insurance Exchange

Pennsylvania remains on target to launch its own health insurance exchange in time for the 2021 open enrollment season.

Pennsylvania State Map The shift away from using the federal exchange and developing a state-based exchange was approved by the state legislature earlier this year. That shift took a major step forward recently when the state hired a contractor to create the site’s platform.

State officials estimate that once the state’s site is up and running it will costs $25 million a year to operate; currently, Pennsylvania pays $95 million a year to participate in the federal exchange. In addition, the state will be able to collect the three percent of premiums that insurers pay to appear on the federal site. Those seeking insurance on the new state site should benefit, too, with state officials estimating that purchasing reinsurance will enable consumers to save five to ten percent on premiums.

For an update on the status of the development of Pennsylvania’s health insurance exchange, see the Fierce Healthcare article “Pennsylvania takes another step toward launching state-based insurance exchange.”

PA Safety Net Admin2019-12-04T06:00:23+00:00December 4th, 2019|Uncategorized|Comments Off

High-Deductible Plans Driving Rise in Hospital Bad Debt

Hospital bad debt rose in 2018 after several years of decline, and according to Moody’s, high-deductible health insurance is one of the major drivers of that increase.

According to the bond rating agency, non-profit hospitals are seeing growing amounts of bad debt as they struggle, often unsuccessfully, to collect from patients whose high deductibles leave them on the hook for meaningful amounts of care.

Kaiser Health News reports that 28 percent of covered workers, nearly half of them working for companies with fewer than 200 employees, now have health plan deductibles of at least $2000. That proportion of individuals with such high deductibles has nearly quadrupled in the last decade.

Bad debt can be an especially challenging problem for Pennsylvania safety-net hospitals because they care for so many low-income patients who, even when they have health insurance, often struggle to find the money to pay their share of the costs their plans do not cover.

Learn more about the bad debt challenge facing hospitals in the Healthcare Dive article “Nonprofit bad debt climbs again amid steeper deductibles, Moody’s says.”

PA Safety Net Admin2019-12-03T06:00:46+00:00December 3rd, 2019|Pennsylvania safety-net hospitals|Comments Off

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20.

A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress. If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025.

Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals.

Medicaid DSH payments are a vital tool for helping safety-net hospitals care for the low-income residents of their communities. All Pennsylvania safety-net hospitals receive such payments.

The current cut is only temporary and expires when the continuing resolution expires after December 20.

PA Safety Net Admin2019-11-25T06:00:13+00:00November 25th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues|Comments Off

Administration Shares Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”

The statement, an annual OMB document, organizes the priorities as follows:

Facilitating patient-centered markets
Fixing health care financing through protecting private insurance and Medicare
Fixing health care financing through reforming the individual market
Fixing health care financing through making the ACA and Medicaid fiscally sustainable
Bringing value to health care through price and quality transparency
Bringing value to health care through patient-centered health IT
Bringing value to health care through deregulation, especially for coordinated care
Bringing value to health care through tackling the high cost of prescription drugs
Bringing value to health care through accelerated drug and device approval and reimbursement

Promoting health and protecting life

Addressing impactable health challenges: kidney health
Addressing impactable health challenges: combatting the opioid crisis
Protecting conscience and life at all stages
Reducing the disease and death associated with tobacco use

Promoting independence

Returning TANF to promoting work, marriage and family
Supporting adoption
Empowering Americans to improve their nutrition
Promoting flexibility for states, grantees, and regulated entities

Learn more about the regulatory directions the administration intends to take for the rest of its 2020 fiscal year in the newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” Go here to see the complete list of regulations that the Department of Health and Human Services intends to pursue in FY 2020, including 55 by the Centers for Medicare & Medicaid Services (CMS).

PA Safety Net Admin2019-11-22T06:00:11+00:00November 22nd, 2019|Affordable Care Act, Federal Medicaid issues, Medicare|Comments Off

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019.

According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments. The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments. Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion.

CMS maintains that the improper Medicaid payment rate will decline in future years because it has introduced more rigorous enforcement of Affordable Care Act requirements to determine and periodically redetermine eligibility for Medicaid participants. Because each state is reviewed for improper payments only every three years, the agency maintains, it will take time before the full impact of the more rigorous review of beneficiary eligibility will be seen in annual statistics

Learn more about improper Medicaid and CHIP payments in the CMS fact sheet “2019 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs.”

PA Safety Net Admin2019-11-20T06:00:41+00:00November 20th, 2019|Federal Medicaid issues|Comments Off

DHS Unveils Strategic Plan

Pennsylvania’s Department of Human Services has a new strategic plan for 2019 through 2022.

While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas:

Provide every child with a strong foundation for physical and behavioral well-being
Bend the health care cost curve
Drive innovative whole-person care
Holistically assess needs and connect to resources
Address the social determinants of health
Expand health care beyond the doctor’s office and into the places people live, work, and play
Coordinate physical health care, behavioral health care, and long-term services and supports
Promote health equity
Lead the health care system toward value-based purchasing coordinated across payers
Serve more people in the community
Enhance access to health care and services that help Pennsylvanians lead healthy, productive lives
Coordinate services seamlessly across programs and agencies
Expand services and supports for individuals with mental illness
Expand services and supports for individuals with substance use disorder

Learn more about what Pennsylvania has in mind for its Medicaid program in the coming years, and for the Pennsylvania safety-net hospitals that serve so many participants in that program, by reading DHS’s new strategic plan for 2019 through 2022.

PA Safety Net Admin2019-11-14T06:00:50+00:00November 14th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2019 newsletter.

Included in this month’s edition are articles about:

the state’s release of a request for applications for insurers to serve participants in Pennsylvania’s HealthChoices physical health care program
Pennsylvania’s new Medicaid preferred drug list
legislation to expand the state’s Medical Assistance for Workers Program
the expansion of the state’s Living Independence for the Elderly (LIFE) program to 14 new counties over the next 18 months.

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

PA Safety Net Admin2019-11-13T06:00:20+00:00November 13th, 2019|HealthChoices, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PHC4 Reports on Hospital Mortality, Admission Rates, and Performance

Mortality rates, admission rates, and other aspects of hospital performance are the subject of a new report by the Pennsylvania Health Care Cost Containment Commission.

The report presents information on hospital volume and outcomes for 17 different medical conditions and surgical procedures from October 2017 through September 2018. It also compares hospital performance over the five-year period from 2013 through 2018 on an aggregate state-wide basis and for individual hospitals.

Overall, the report found decreases in hospital mortality for most of the 17 conditions, with respiratory failure, sepsis, colorectal procedures, and intestinal obstructions experiencing the biggest decreases (by percentage). Hospital admissions for chest pain, chronic obstructive pulmonary disease, and pneumonia experienced the biggest declines while admissions for respiratory failure and sepsis experienced significant increases (in numbers).

For state-wide and hospital-specific data on hospital performance on 17 medical conditions and procedures, see the new PHC4 documents that together constitute its Hospital Performance Report 2018.

PA Safety Net Admin2019-11-12T13:58:38+00:00November 12th, 2019|Uncategorized|Comments Off

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states.

The report includes:

data about changes in the uninsured rate
demographic information about the uninsured
information about the cost of hospital uncompensated care
perspectives on hospital Medicaid shortfalls
a comparison of hospital uncompensated care costs when calculated using different methodologies
data about hospitals that provide “essential community services”
information about scheduled Medicaid DSH allotment reductions

All Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider the program an essential tool for serving their communities.

MACPAC will issue a more complete report to Congress in March of 2020.

Learn more about how MACPAC views Medicaid DSH at a time when the program is scheduled to change – and when some want even more change – in the new MACPAC document “Required Analyses of Disproportionate Share Hospital (DSH) Allotments.”

PA Safety Net Admin2019-11-08T06:00:38+00:00November 8th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|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 Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed.

After lunch, MACPAC staff briefed the Commission on challenges states face as they prepare for mandatory reporting of quality measures for children enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) and behavioral health measures for adults enrolled in Medicaid. Immediately following that session, the Commission reviewed a new MACPAC-commissioned study on the effects of federal legislation that provided new buprenorphine prescribing authority for nurse practitioners and physician assistants.

After a brief break, MACPAC staff updated the Commission on the status of the Transformed Medicaid Statistical Information System (T-MSIS). The final Thursday session discussed disproportionate share hospital (DSH) allotments as required in MACPAC’s annual March reports to Congress.

MACPAC’s Friday agenda opened with a session on improving Medicaid policies related to third-party liability: specifically, coordination of benefits with TRICARE, the health coverage program for active duty military and their dependents. There are close to 1 million Medicaid beneficiaries with TRICARE coverage but Medicaid’s ability to collect from TRICARE is limited. The final session of the October meeting addressed Medicaid and maternal health.

Supporting the discussion were the following briefing papers:

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. MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals because those hospitals care for especially large numbers of Medicaid patients. Find MACPAC’s web site here.

PA Safety Net Admin2019-11-07T06:00:58+00:00November 7th, 2019|DSH hospitals, Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

SNAPShots

SNAPShots

About PA Safety Net Admin

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us