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

ACA’s Medicaid Pay Bump Helped But Benefits Now Lost, Study Says

Health status and access to care improved for Medicaid patients when the Affordable Care Act mandated a temporary rate increase for physicians serving newly insured patients covered through that law’s Medicaid expansion.

But when the mandate for increased physician payments ended and state Medicaid programs reverted to their previous, lower payments, many of those benefits were lost.

Or so reports a new study from the National Bureau of Economic Research.

According to the study, even a $10 rate increase improved access to care enough to reduce by 13 percent Medicaid recipients’ complaints about not being about to find a doctor. Utilization also increased. The temporary Medicaid pay increase has even been credited with improving school attendance and reducing chronic absenteeism.

Despite the benefits of the temporary increase in Medicaid payments to physicians, most states returned to lower payments when the mandated ended, most of the gains resulting from the better pay for treating Medicaid patients disappeared, and the disparities between privately insured individuals and Medicaid patients returned to their pre-Affordable Care Act levels.

Researchers estimate that increasing Medicaid payments to physicians by an average of $26 a visit would eliminate disparities in access to care.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve have so many more Medicaid patients than the typical American community.

Learn more from the National Bureau of Economic Resarch study “The Impacts of Physician Payments on Patient Access, Use, and Health” and from the Healthcare Dive report “Even $10 increase in Medicaid payments helps erase disparities in care access, study says.”

PA Safety Net Admin2019-07-24T06:00:47+00:00July 24th, 2019|Affordable Care Act|Comments Off

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals. Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that the current requirement applies only to Medicaid fee-for-service payments even though most Medicaid beneficiaries now receive care through managed care plans, the payments for which are not subject to the same process.

The agency adds that it intends to

…replace the ongoing access reviews required by current regulations with a more comprehensive and outcomes-driven approach to monitoring access across delivery systems, developed through workgroups and technical expert panels that include key State and federal stakeholders.

Because they care for so many Medicaid patients, the adequacy of the rates states pay for Medicaid services is especially important to Pennsylvania safety-net hospitals.

Learn more about CMS’s proposal in its news release on the subject or see the proposed regulation itself. Learn about the process CMS intends to employ to replace its current approach to monitoring access to Medicaid services in this CMS informational bulletin.

PA Safety Net Admin2019-07-18T06:00:42+00:00July 18th, 2019|Federal Medicaid issues|Comments Off

Medicaid DSH Delay Advances in Energy and Commerce Committee

Medicaid disproportionate share cuts would be delayed for two years under a proposal advanced last week by the Health Subcommittee of the House Energy and Commerce Committee.

The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.

The Safety-Net Association of Pennsylvania supports this delay of Medicaid DSH cuts. Earlier this year, SNAP asked members of the state’s congressional delegation to join a campaign in the House of Representatives to delay this cut.

Learn more about the possibility of another delay of Medicaid DSH cuts in the HealthLeaders article “House Panel Advances Surprise Bill Package.”

PA Safety Net Admin2019-07-16T06:00:31+00:00July 16th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

The Role of Medicaid in Addressing Social Determinants of Health

Medicaid can play a major role in addressing the social determinants of health.

Or so argues a recent post on the Health Affairs Blog.

According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care. Medicaid, the post maintains, can play a major role in addressing social determinants of health.

The post outlines the role state Medicaid programs can play in addressing social determinants of health; describes tools for such action such as section 1115 Medicaid demonstration waivers; offers examples of efforts currently under way in some states; and presents suggestions for steps the federal government can take to facilitate such efforts.

Addressing social determinants of health is an especially important issue for Pennsylvania safety-net hospitals because they care for so many more Medicaid-covered low-income patients than the typical hospital in the state.

Learn more from the Health Affairs Blog post “For An Option To Address Social Determinants Of Health, Look To Medicaid.”

PA Safety Net Admin2019-07-12T09:43:03+00:00July 12th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals, social determinants of health|Comments Off

Study Finds Surprise in Sources of Medicaid, CHIP Growth

While enrollment in Medicaid and CHIP has been greatest among low-income families working full-time for small businesses, growth in Medicaid and CHIP enrollment among low-income families employed full-time by big businesses has been rising faster in recent years.

According to a new study published in the journal Health Affairs, Medicaid and CHIP enrollment among low-income families employed full-time by large companies rose from 45 percent to 69 percent between 2008 and 2016. The driving force behind this growing reliance on public insurance appears to be the shift of health insurance costs from companies to employees: employee share of health insurance premiums rose 57 percent during that same period, leaving many families unable to afford even employer-subsidized health insurance.

Learn more about the growing Medicaid and CHIP participation rates among different economic groups in the Health Affairs report “Growth Of Public Coverage Among Working Families In The Private Sector.”

PA Safety Net Admin2019-07-09T06:00:56+00:00July 9th, 2019|Uncategorized|Comments Off

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months.

In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including:

Oversight of state Medicaid claiming and program integrity
Disallowing unallowable claims of federal funding
Increased audits and oversight
Data sharing and partnerships
Education, technical assistance, and collaboration
Reducing improper payments

Initiatives to be introduced in the coming months include (as described in the blog post):

A proposed comprehensive update to Medicaid’s fiscal accountability regulations, to increase states’ accountability for supplemental payments. The update includes additional state reporting, clearer financial definitions, and stronger federal guidance to ensure that states use supplemental payments properly.
A proposed regulation to further strengthen the integrity of the Medicaid eligibility determination process, including enhanced requirements around verification, monitoring changes in beneficiary circumstances, and eligibility redetermination.
Additional guidance on the Medicaid Managed Care Final Rule from 2016 to further state implementation and compliance with program integrity safeguards, such as reporting overpayments and possible fraud.
Release of improvements to the Medicaid and CHIP Scorecard—a dashboard of program measures that increases public transparency about the programs’ administration and outcomes. The improvements include two program integrity measures to enhance transparency and continue to provide states with performance measures related to their Medicaid programs. Examples of such program integrity measures may include measures based on state initiation of collaborative investigations with their UPIC, state participation in the HFPP at any level, and performance data derived from improper payment drivers.
Conduct provider screening on behalf of states for Medicaid-only providers to improve efficiency and coordination across Medicare and Medicaid, reduce state and provider burden, and address one of the biggest sources of error as measured by PERM.
Medicaid provider education through Targeted Probe and Educate—which identifies providers who have high error rates and educates them on billing requirements—to reduce aberrant billing, as well as education provided through Comparative Billing Reports—which show providers their billing patterns compared to their peers.
Audit state claiming of federal matching dollars to address areas that have been identified as high-risk by GAO and OIG, as well as other behavior previously found detrimental to the Medicaid program.

Learn more in the CMS blog article “Medicaid Program Integrity: A Shared and Urgent Responsibility.”

PA Safety Net Admin2019-07-03T10:21:53+00:00July 3rd, 2019|Federal Medicaid issues|Comments Off

DHS Secretary Says No to Medicaid Work Requirements

Pennsylvania will not seek federal permission to create a Medicaid work requirement, Department of Human Services Secretary Teresa Miller told a joint hearing of the State Senate Republican Policy Committee and Health and Human Services Committee this week.

Miller conveyed what a news release described as

…the Wolf Administration’s firm opposition to work requirements for Medicaid recipients and the administration’s work to expand access to education and training programs and services to support employment for people served by DHS’ programs.

In her testimony, Miller explained that

Our goal is always to set policy and implement programs that empower Pennsylvanians to live fulfilling lives, support themselves and their families, contribute to our local economies, and build stronger communities. This is not about opposition to work. We want all people to achieve a better quality of life and not be caught in an intergenerational cycle of poverty. The Wolf Administration is not simply opposed to a work requirement; we are committed to increasing opportunities for meaningful work and providing the whole-person supports we contend are needed.

A Medicaid work requirement could affect the Medicaid eligibility of patients served by Pennsylvania’s safety-net hospitals.

Learn more about Secretary Miller’s testimony in this Department of Human Services news release.

PA Safety Net Admin2019-06-14T06:00:07+00:00June 14th, 2019|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Change Coming to PA’s Medicaid Transportation Program

Pennsylvania’s Medicaid transportation program will soon be undergoing major change.

By law, states must provide free non-emergency medical transportation for their Medicaid recipients. The Pennsylvania Medical Assistance Transportation Program has fulfilled that mandate for the past 35 years, with county governments shouldering primary responsibility for providing or arranging for the transportation for their Medicaid-covered residents.

Under a plan adopted by the Pennsylvania Department of Human Services, which administers the state’s Medicaid program, that would change, with the state currently reviewing proposals from private vendors that would serve as brokers and assume this responsibility for large sections of the state: the eastern, central, and western parts of Pennsylvania.

Changing the program in this manner would enable Pennsylvania to change the classification of medical transportation from an administrative cost to a service cost, which would drawn down more federal Medicaid matching funds and save the state about $10 million a year.

Learn more about what the state is doing, why it is doing it, and why some people believe the new approach may be more expensive and less effective in the Philadelphia Inquirer article “As changes come to Pa. Medicaid transportation program, counties fear bumps in road.”

PA Safety Net Admin2019-06-13T06:00:53+00:00June 13th, 2019|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Opioid Prescriptions Down in PA

Pennsylvania doctors are writing fewer prescriptions for opioids, according to a new analysis by the American Medical Association.

According to the AMA, prescriptions for opioids declined 40 percent in the state between 2013 and 2018 – one of the largest declines in the country.

In a news release, the Pennsylvania Medical Society attributed the decline in part to physician education and in part to the state’s prescription drug monitoring programs.

Learn more from the Central Pennsylvania Business Journal article “Pa. physicians writing fewer opioid prescriptions” and from a news release from the Pennsylvania Medical Society.

PA Safety Net Admin2019-06-11T06:00:52+00:00June 11th, 2019|Uncategorized|Comments Off

PA May Take Over Insurance Exchange

Pennsylvania may soon assume responsibility for providing a health insurance exchange for its residents.

When the Affordable Care Act was adopted in 2010, states were given the option of establishing their own marketplaces for health insurance offered under the reform law or having their citizens use a federal exchange established for the same purpose. Pennsylvania chose to have its residents use the federal exchange, but now, a law changing that is making its way through the state legislature.

Harrisburg, PA capital building House Bill 3, with more than 80 sponsors from both parties, would direct the state to establish its own health insurance exchange and establish a Pennsylvania Health Insurance Exchange Fund to pay for it.

After years of ceding this responsibility to the federal government, some state lawmakers now believe the state can run its own exchange more efficiently and save money by operating the exchange for less than it currently pays the federal government for use of the federal exchange. The bill’s sponsors also believe that taking over the exchange will enable the state to seek a federal reinsurance waiver that should reduce health insurance premiums five to ten percent in Pennsylvania.

House Bill 3 will be considered by the House Insurance Committee.

Learn more about what members of the House seek in the WITF radio article “Plan for Pennsylvania to take over health insurance marketplace gaining ground”; read a co-sponsor memo to state House members asking them to co-sponsor the bill; and read House Bill 3 itself.

PA Safety Net Admin2019-06-10T06:00:10+00:00June 10th, 2019|Affordable Care Act|Comments Off

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