SNAP expresses its support for the Wolf administration’s FY 2020 budget proposal to fund debt service for the monetization of the state’s future proceeds from the national master tobacco settlement agreement with sales and use tax revenue.
Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members.
As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020,
MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an enrollee’s condition. Items and services may include, but are not limited to: meals furnished to the enrollee beyond a limited basis, transportation for non-medical needs, pest control, air quality equipment and services, and benefits to address social needs, so long as such items and services have a reasonable expectation of improving or maintaining the health or overall function of an individual as it relates to their chronic condition or illness.
The CMS final call letter offers permission to Medicare Advantage plans to offer such services; it does not require them to do so.
Such a policy change could be highly beneficial to many of the low-income patients served by Pennsylvania safety-net hospitals, which have long sought help with addressing the social determinants of health that often bring patients to them but limit their ability to recover from their illnesses and injuries.
Learn more from the Commonwealth Fund report “New Medicare Advantage Benefits Offer Social Services to People with Chronic Illness” and see CMS’s “Announcement of Calendar Year (CY) 2020 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter.”
Social determinants of health could have their own ICD-10 codes if a new initiative from the American Medical Association and United Healthcare succeeds.
The two are working together to develop new ICD-10 codes that would take into consideration social determinants of health such as housing and food security, access to transportation, and ability to pay for medicine.
The project launches at a time when research suggests that social determinants of health can affect nearly 80 percent of health care outcomes.
Pennsylvania safety-net hospitals struggle more than other hospitals, and must work harder to address, the social determinants of health that play such a major role in the health and well-being of the residents of the low-income communities they serve.
Learn more in the Health Analytics IT article “AMA, UnitedHealth Partner for Social Determinants ICD-10 Project.”
More foreign-born, U.S.-trained doctors would be permitted to remain in the U.S. if they practice in medically underserved areas under a bill unveiled last week in Congress.
Introduced with bipartisan support, the legislation would extend for two years the current “Conrad 30” program that allocates 30 slots to each state so foreign-born doctors can work in medically underserved areas under J-1 visas. The program, which already exists but will soon expire, permits such physicians to remain in the U.S. for three years after their training ends to work in underserved areas. The legislation also would establish criteria under which more than 30 such physicians can be employed in a given state.
Some Pennsylvania safety-net hospitals are located in and around medically underserved areas.
To learn more, see the Senate news release from the bill’s sponsors describing their proposal and why they are offering it or see the bill itself.
Providers can now see the maximum prices for 340B-covered drugs on a new web site established by the federal Health Resources & Services Administration.
The web site, mandated by Congress after the U.S. Department of Health and Services’ Inspector General found that some providers are being overcharged, will enable 340B-eligible providers to identify the maximum price they can be charged for covered drugs. This, HRSA believes, will help providers avoid being overcharged in the future.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it a vital tool in helping them serve their low-income communities.
Learn more in the Becker’s Hospital Review article “HRSA launches 340B ceiling price website” and visit the new web site itself (registration required).
Two key House subcommittees will not hold hearings on the controversial 340B prescription drug discount program in the near future.
The chairs of the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee and its Health Committee have both suggested that House Democrats understand the importance and value of the 340B program and see other health care issues as greater priorities.
This marks a serious departure from the last session of Congress, which saw a number of hearings on the 340B program and doubts cast about the program’s objectives and future.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it a vital resource in their efforts to serve their communities.
Learn more from the Lexology article “340B Program Gets Relief from Congressional Scrutiny.”
At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal.
According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured. Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance. Some would purchase insurance with limited benefits and individual plan premiums would rise while others would go uninsured.
In addition, repeal of the Affordable Care Act would lead to an 82 percent increase in hospital uncompensated care, to more than $50 billion. About half of the states would see the amount of uncompensated care provided by their hospitals double, the Urban Institute estimates.
Repeal of the Affordable Care Act would pose an especially great financial challenge for Pennsylvania safety-net hospitals because they care for so many Medicaid- and CHIP-covered and low-income patients who might lose their coverage if the reform law is repealed. About 700,000 new people have enrolled in the state’s Medicaid program since the state implemented the Affordable Care Act’s optional Medicaid expansion.
Learn more from the Healthcare Dive article “Killing ACA would lead to huge spikes in uncompensated care” and from the Urban Institute report State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA.
The White House has proposed removing non-emergency transportation from the list of mandatory Medicaid benefits.
The proposed FY 2020 budget released last week explained that
Statute allows, but does not require, States to provide non-emergency medical transportation (NEMT). Instead, these services were made mandatory Medicaid benefits by regulation. Further, a Government Accountability Office study found Medicaid NEMT spending totaled $1.5 billion in 2013, and NEMT programs face multiple challenges, including difficulties in obtaining costs and maintaining program integrity. To address these issues, this proposal would update regulations to clarify the NEMT benefit is strictly optional.
Medical transportation has long been viewed as vital means for helping Medicaid patients keep doctors’ appointments and recover from their illnesses and injuries and for overcoming some social determinants of health. Loss of this tool would be harmful for Pennsylvania safety-net hospitals and the patients and communities they serve.
Changes could come in Medicaid DSH and UPL payments if new MACPAC recommendations are adopted.
Last week the Medicaid and CHIP Payment and Access Commission released its annual report to Congress, with most of the report focusing on its analysis and recommendations for policy updates involving Medicaid disproportionate share hospital payments (Medicaid DSH) and Medicaid upper payment limit payments (UPL payments).
With Affordable Care Act-mandated cuts in Medicaid DSH payments scheduled to start in FY 2020 – this coming October – MACPAC recommended that these cuts be reduced and phased in over a longer period of time “…to give states and hospitals more time to respond to the cuts…”
MACPAC also recommended that Congress and the administration revise the current methodology for distributing Medicaid DSH money to the states to “…provide a stronger link between the distribution of those allotments and measures of hospital uncompensated care…”
The commission also addressed UPL payments, expressing concern about “…the discrepancy between reporting by states to show that they are complying with the UPL and the spending data they report to claim federal matching funds” and recommending “…instituting better data and process controls to ensure that state reporting on compliance with UPL lines up with those amounts they are claiming, and existing limits are enforced.
Medicaid DSH and UPL payments are especially important to SNAP and Pennsylvania safety-net hospitals because of the significant number of low-income, Medicaid-covered, and uninsured patients they serve.
Learn more from MACPAC’s news release summarizing its recommendations and the entire MACPAC annual report.
The Medicaid and CHIP Payment and Access Commission last week discussed possible changes in how “Medicaid shortfall” is defined for the purpose of determining how much Medicaid disproportionate share money (Medicaid DSH) safety-net hospitals should receive.
The discussion came in the wake of a court decision last year that ruled that third-party payments toward Medicaid-covered services could not be included in hospitals’ Medicaid shortfall calculations.
MACPAC commissioners discussed several statutory changes that would seek to minimize the impact of the court ruling:
MACPAC is an advisory body whose recommendations to Congress are not binding but its views are respected and often find their way into future public policy.
This subject is important to Pennsylvania safety-net hospitals because all of them receive Medicaid DSH payments.
Learn more about MACPAC’s deliberations on Medicaid shortfalls and Medicaid DSH from the Fierce Healthcare article “MACPAC considers recommending change to definition of ‘Medicaid shortfall’ at safety net hospitals.”