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

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

Medicaid DSH Cut Delayed

Scheduled cuts in Medicaid DSH payments to hospitals will be delayed until at least late May under new federal spending legislation.

The cuts in Medicaid disproportionate share allotments to the states, mandated by the Affordable Care Act and delayed several times by Congress – including twice in FY 2020 alone under continuing resolutions to fund the federal government – are among a number of so-called “extenders” included in spending bills passed by Congress this week and sent to the president for his signature.

Authorization for delaying the cut in allotments to the states, which would have resulted in reduced Medicaid DSH payments for many hospitals – including private safety-net hospitals – would expire on May 22. Congress is expected to address Medicaid DSH, along with surprise medical bills, the price of prescription drugs, and other health care matters, before that time.

SNAP has argued against Medicaid DSH cuts for a number of years, doing so most recently in an October 2019 message to members of Pennsylvania’s congressional delegation in which it wrote that

Should the Medicaid DSH cut take effect, Pennsylvania would lose 40 percent of its federal Medicaid DSH allotment in FY 2020 and 80 percent of its allotment each year from FY 2021 to FY 2025. Such devastating cuts could jeopardize access to care for the state’s uninsured and jeopardize the ability of the state’s safety-net hospitals to serve them. It is essential, for the sake of Pennsylvania’s health care safety net and the communities and patients that safety net serves, that the Medicaid DSH cut continue to be delayed.

Learn more about the delay in Medicaid DSH cuts and other aspects of this recent health care spending legislation in the Becker’s Hospital Review article “Congress unveils $1.3T spending deal: 5 healthcare takeaways.”

PA Safety Net Admin2019-12-19T06:00:58+00:00December 19th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid|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 Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources.

Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session addressed payment error rates in Medicaid, with a briefing on the annual Department of Health and Human Services Agency Financial Report (AFR). Fiscal year 2019 was the first time that the AFR incorporated eligibility errors since the Patient Protection and Affordable Care Act’s Medicaid eligibility and enrollment changes took effect in 2014.

After lunch, MACPAC staff summarized themes from expert roundtables convened in November, one to explore Medicaid policy on high-cost specialty drugs and another on the need for more actionable Section 1115 demonstration evaluations. Then, the Commission turned its attention to Medicaid estate recovery policies. The final session of the day looked at issues associated with reforming the current Medicaid financing structure to better respond to economic downturns.

At Friday’s opening session, the Commission considered policy options to increase participation in Medicare Savings Programs, which provide Medicare cost-sharing assistance to beneficiaries who are dually eligible for Medicaid and Medicare. Afterward, the Commission continued its examination of care integration for dually eligible beneficiaries, this time focusing on policy options to reduce barriers to integrated care. The Commission then switched gears for a briefing on a new MACPAC analysis of Medicaid’s role in financing maternity care. The December meeting concluded with a review of the draft chapter for the Commission’s March report to Congress analyzing disproportionate share hospital (DSH) payments.

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 Admin2019-12-17T06:00:54+00:00December 17th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

Prescription Drug Bill Would Kill Two Years of Medicaid DSH Cuts

Two years of Medicaid DSH cuts would be eliminated under a new prescription drug bill released last week by the Senate Finance Committee.

The Prescription Drug Pricing Reduction Act includes a provision that would eliminate two years of Affordable Care Act-mandated cuts in the allocation of federal money to the states for Medicaid disproportionate share hospital payments (Medicaid DSH). Those cuts have been delayed several times by Congress but were scheduled to begin in October of 2019 and run through federal FY 2025, only to be delayed again twice by continuing resolutions adopted by Congress to fund the federal government in the absence of enacted appropriations bills.

Under this proposal, the first two years of Medicaid DSH cuts would be eliminated entirely and the cut then would take effect from FY 2022 through FY 2025 – only four of the six years worth of cuts anticipated by the Affordable Care Act.

The legislation also would bring other changes to the Medicaid DSH program, including new reporting requirements on the non-Medicaid DSH supplemental payments hospitals receive from their state governments; changes in Medicaid shortfall and third-party payment policies; and a GAO study and report on hospital uncompensated care costs.

All Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider them critical to serving the many Medicaid-covered and uninsured residents of the low-income communities in which they are located.

Go here to see the proposed legislation.

PA Safety Net Admin2019-12-10T12:24:38+00:00December 10th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

PA Rural Hospitals to Get Boost From State

A new law seeks to stabilize the financial condition of Pennsylvania’s rural hospitals.

Harrisburg, PA capital building Senate Bill 314, passed by the legislature and signed by Governor Wolf, establishes a new Rural Health Redesign Center Authority and Pennsylvania Rural Health Redesign Center fund that will seek to support the delivery of health care by rural hospitals in the state by, as a legislative co-sponsorship memo explained,

creating an annual, prospective budget with regular, predictable payments;
improving the ability to develop and carry out expanded and innovative community health services; and
providing the capacity to pursue programs addressing key needs such as behavioral health and substance abuse and cooperative EMS.

The new approach will shift participating hospitals from fee-for-service to global payments. Eligible hospitals will receive monthly global budget payments from payers based on historic revenue data that is adjusted for care delivery changes and inflation.

Learn more from the Becker’s Hospital Review article “Pennsylvania governor signs law providing regular, predictable payments to rural hospitals” and from the co-sponsorship memo that accompanied the bill’s introduction in Pennsylvania’s General Assembly.

PA Safety Net Admin2019-12-05T06:00:13+00:00December 5th, 2019|Uncategorized|Comments Off

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

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