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MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law booksThe Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work.  In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on MA Bulletin Presents New PDL
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PA Health Law Project Newsletter

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

Included in this month’s edition are articles about:

  • changes in federal “public charge” regulations and their implications for immigrants who are currently enrolled in Medicaid or considering applying to participate in the program;
  • the right of participants in programs sponsored by the state’s Department of Drug and Alcohol Programs to continue receiving services while they appeal denials of services or reductions of services;
  • changes in the application process for state-paid home and community-based services; and
  • the continued implementation of the Community HealthChoices program of managed long-term services and supports for low-income seniors.

Go here for articles about these and other subjects.

2019-10-10T06:00:31+00:00October 10th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Law Project Newsletter
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Shifting PA Medicaid to a PDL

Pennsylvania’s planned shift to a preferred drug list for its Medicaid program is the subject of a new analysis of the projected impact of such a change.

Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program.  That PDL would apply to both the fee for service and managed care Medicaid programs.

During this year’s budget proceedings, Pennsylvania’s Human Services Code was amended to require an analysis of “the projected cost to the medical assistance managed care organization [sic] and the projected supplemental rebates that could be obtained” by moving to a PDL.

That analysis has now been completed.  It concluded that the state

…will save $85 million annual through implementation of a Statewide PDL.  The Statewide PDL will allow the Department [of Human Services] to receive an additional $261 million in pharmacy rebates, which will more than offset the estimated increase to managed care organization (MCO) expenditures of $176 million, considering their additional costs and loss of market share rebates.

The analysis commissioned by DHS is now available.  To learn more about the implications of a state-wide PDL for the state, for Medicaid managed care organization, and for Medicaid beneficiaries, read “Fiscal Impact Analysis of Medical Assistance Program Uniform Statewide Preferred Drug List, 2019 Report.”

The PDL will take effect on January 1, 2020 and has been posted on a DHS web site here.

 

2019-10-09T06:00:03+00:00October 9th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on Shifting PA Medicaid to a PDL
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New in Medicaid Medical Transportation: Uber and Lyft

State Medicaid programs focused on ensuring that beneficiaries keep their doctor appointments are increasingly looking to ride-sharing services to supplement the providers already participating in their medical transportation programs.

Today, Lyft is working with approximately 35 state Medicaid programs while Uber, at least so far, participates only in Arizona’s program.

While ride-sharing is not going to replace other medical transportation programs – for one thing, most Uber and Lyft cars are not equipped to serve individuals with serious disabilities – they can help supplement services that today typically require patients to reserve rides days ahead of time and then share van rides with other patients.

To facilitate the use of ride-sharing services, several state governments have eased regulations that require people who drive Medicaid beneficiaries to undergo first-aid training and drug testing.

While ride-sharing is not yet a formal part of Pennsylvania’s Medical Assistance Transportation Program, pilot programs using such services are currently under way in Allegheny County and Philadelphia.

Learn more about how ride-sharing is moving into the Medicaid medical transportation industry in the Kaiser Health News article “Uber And Lyft Ride-Sharing Services Hitch Onto Medicaid.”

2019-10-08T06:00:17+00:00October 8th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on New in Medicaid Medical Transportation: Uber and Lyft
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Safety-Net Hospitals Rally to Fill Void When Safety-Net Hospital Closes

When a safety-net hospital in Philadelphia closed recently, many predicted a crisis.

But there was no crisis.

Instead, patients previously served by Hahnemann University Hospital, a Pennsylvania safety-net hospital that served especially large numbers of Medicaid and uninsured patients, are now being served by other safety-net hospitals in Philadelphia:  mostly, Jefferson Health, the University of Pennsylvania Health System, Einstein Healthcare Network, and Temple University Hospital.  All report increased volume in their emergency rooms, more ambulance arrivals, and more inpatient admissions, but at least so far, they also report that they are comfortably handling the increased patient volume created when Hahnemann closed its emergency room and discharged its last patients in July.

Learn more in the Philadelphia Inquirer article “Hahnemann’s end was expected to be a crisis. But that’s not what happened, Philly health officials say.”

2019-10-07T06:00:40+00:00October 7th, 2019|Pennsylvania safety-net hospitals|Comments Off on Safety-Net Hospitals Rally to Fill Void When Safety-Net Hospital Closes
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SNAP Asks PA Delegation to Support Another Medicaid DSH Cut Delay

In a letter to members of Pennsylvania’s congressional delegation, SNAP has asked those members to support another two-year delay of Medicaid disproportionate share (Medicaid DSH) cuts mandated by the Affordable Care Act.

Safety-Net Association of Pennsylvania logoIn the message, SNAP notes the important role Medicaid DSH payments play in helping private safety-net hospitals care for the many uninsured patients who continue to turn to them for care.

If the cut is not delayed, Pennsylvania will see its Medicaid DSH allotment from the federal government fall 40 percent in FY 2020 and 80 percent annually from FY 2021 through FY 2025.

See SNAP’s message to PA delegation members here.

 

2019-10-04T06:00:52+00:00October 4th, 2019|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off on SNAP Asks PA Delegation to Support Another Medicaid DSH Cut Delay
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SNAP Thanks PA Delegation for Supporting Short-Term Medicaid DSH Cut Delay

SNAP has written to members of Pennsylvania’s congressional delegation to thank them for voting for a temporary delay of Medicaid disproportionate share (Medicaid DSH) cuts mandated by the Affordable Care Act.

Safety-Net Association of Pennsylvania logoThe Medicaid DSH delay was included in a continuing resolution that Congress passed to fund the federal government temporarily while legislators continue to negotiate an FY 2020 federal budget.  The continuing resolution and the Medicaid DSH cut delay run through November 21.

Medicaid DSH cuts mandated by the Affordable Care Act have already been delayed several times by Congress, but if not delayed again, Pennsylvania will see its federal Medicaid DSH allotment fall 40 percent in FY 2020 and 80 percent a year from FY 2021 through FY 2025.

See SNAP’s thank you note to Pennsylvania’s congressional delegation here.

 

2019-10-03T06:00:35+00:00October 3rd, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on SNAP Thanks PA Delegation for Supporting Short-Term Medicaid DSH Cut Delay
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ACA May be Improving, Saving Lives

The insurance expansion made possible by the Affordable Care Act may be improving and even saving lives, some studies and anecdotal evidence suggest.

While observers warn that it is difficult to attempt to render a final verdict on the reform law’s insurance expansion and its impact, various studies and observations point to encouraging developments.  Among them:

  • High blood pressure is being detected at a higher rate now among people who bought insurance as a result of the ACA than it was prior to the law’s passage.
  • Fewer 19-26 year-olds, now permitted to remain on their parents’ health insurance, are choosing not to see a doctor about their asthma because of the cost of seeking care.
  • Women in Michigan report having an easier time obtaining birth control pills.
  • Participants in a Michigan program are reporting an increased likelihood of learning they have chronic medical conditions than was the case before they were insured.
  • People between their mid-50s and mid-60s living in states that expanded their Medicaid programs, and who took advantage of that expansion, had a lower death rate than similar people in non-expansion states.

Pennsylvania is among the 37 states (including the District of Columbia) that took advantage of the Affordable Care Act to expand its Medicaid program.

Learn more about some of the documented and observed benefits of the Affordable Care Act’s improved access to health insurance in the Washington Post article “With the Affordable Care Act’s future in doubt, evidence grows that it saves lives.”

2019-10-02T15:52:54+00:00October 2nd, 2019|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off on ACA May be Improving, Saving Lives
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Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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