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

Court Rejects 340B Cuts

A federal court has ruled that the Centers for Medicare & Medicaid Services overstepped its authority in reducing Medicare payments for prescription drugs covered by the section 340B prescription drug discount program.

While the court conceded that CMS has the authority to address 340B payments, it found that CMS’s drastic payment cuts, introduced in FY 2018, “…fundamentally altered the statutory scheme established by Congress…” for determining 340B payment rates.

The court suggested that CMS either change its methodology for determining 340B payments to justify the specific cuts it proposes or raise its objections with Congress, which created the program and has the authority to change it.

According to documents submitted to the court by the parties that filed the suit, eligible hospitals have seen their 340B payments reduced $1.6 billion since the cuts began in FY 2018. The court asked the federal government and those who filed the suit to suggest remedies for compensating participating hospitals for their losses.

The ruling has major implications for the Pennsylvania safety-net hospitals, most of which participate in the 340B program.

Learn more about the 340B litigation, the court’s ruling, and its impact in the New York Times story “Court Rejects Trump’s Cuts in Payments for Prescription Drugs.”

PA Safety Net Admin2019-01-11T06:00:43+00:00January 11th, 2019|Medicare, Pennsylvania safety-net hospitals|Comments Off

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report.

According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially.

The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices.

Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices.

Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit.”

PA Safety Net Admin2019-01-09T15:54:59+00:00January 9th, 2019|Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

Report Looks at Work Requirements

As a growing number of states consider implementing work requirements as a condition for Medicaid eligibility, the Urban Institute has released a report that describes work requirements in various government cash assistance, nutrition assistance, and housing assistance programs and considers the degree to which those requirements have achieved their policy objectives.
The report also describes the applications that eight states have submitted to the federal government seeking permission to introduce a work requirement in their Medicaid programs.
Go here to see the Urban Institute report Work Requirements in Social Safety Net Programs: A Status Report of Work Requirements in TANF, SNAP, Housing Assistance, and Medicaid.

PA Safety Net Admin2018-01-10T06:00:29+00:00January 10th, 2018|Federal Medicaid issues|Comments Off

New Medical Assistance Bulletin Addresses Hospital Uncompensated Care

The Pennsylvania Department of Human Services has issued a new Medical Assistance Bulletin titled “Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans.”
According to the document,

The purpose of this Medical Assistance (MA) Bulletin is to remind hospitals of the requirements for the Hospital Uncompensated Care Program (Program) and reinforce the responsibility of hospitals to actively engage patients when determining eligibility for the Program.

See the entire Bulletin here.

PA Safety Net Admin2018-01-08T06:00:47+00:00January 8th, 2018|Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients.
Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs.
Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH. The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients.
The Affordable Care Act calls for reducing Medicaid DSH payments to hospitals. Many hospitals and hospital groups oppose this cut and are asking Congress to block its implementation. Pennsylvania’s safety-net hospitals benefit considerably from Medicaid DSH payments.
The Commonwealth Fund recently published a commentary calling for delaying scheduled Medicaid DSH cuts. Go here to see the article “Keep Harmful Cuts in Federal Medicaid Disproportionate Share Hospital Payments at Bay.”

PA Safety Net Admin2017-12-27T06:00:23+00:00December 27th, 2017|Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News.
Included in this edition are articles about:

The January 1 introduction of Community HealthChoices, a mandatory program of managed long-term services and supports, in southwestern Pennsylvania
the January 1 implementation of the federal ordering, referring, or prescribing rule that requires that all such actions involving Pennsylvania Medicaid patients be undertaken by providers enrolled with the state to serve Medicaid patients
various Medicare issues

Find these stories here in the latest edition of Health Law News.

PA Safety Net Admin2017-12-26T06:00:24+00:00December 26th, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Medicaid Directors Meet

The National Association of Medicaid Directors held its fall conference recently outside Washington, D.C.
This is an important event at which policy-makers and policy experts meet to discuss Medicaid programs, trends, challenges, and opportunities.
Many of the materials used during that conference are now publicly available, including video clips from speeches by CMS Administrator Seema Verma and others and presentations on a number of subjects, including:

Medicaid’s role in supporting community engagement and economic mobility
busting the silos of physical and behavioral health care
alternative payment models and addressing the social determinants of health
early intervention in behavioral health
the opioid epidemic
pediatric innovations in Medicaid

Go here for links to the speeches and presentations offered at the conference.

PA Safety Net Admin2017-12-21T06:00:05+00:00December 21st, 2017|Federal Medicaid issues|Comments Off

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.
The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights from the December 2017 MACStats: Medicaid and CHIP Data Book. MACStats pulls together Medicaid and CHIP data from multiple sources that often can be difficult to find. The collection is published annually and individual tables are updated throughout the year. The Commission then reviewed the draft March report chapter on telemedicine in Medicaid, and later in the day the Commission returned to the topic of prescription drugs, to explore potential recommendations on the Medicaid drug rebate program.

The final December sessions covered MACPAC’s annual analysis of disproportionate share hospital payments (a required element of its March reports), and findings from interviews with four states to better understand how they are implementing Section 1115 Medicaid-expansion waivers.

The following presentations, many with supporting documents, were offered during the MACPAC meeting:

PA Safety Net Admin2017-12-19T06:00:26+00:00December 19th, 2017|Federal Medicaid issues|Comments Off

House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program.
That means Medicare, Medicaid, and possibly even Social Security.
Ryan said that

We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.

Medicare and Medicaid cuts would be very harmful to Pennsylvania safety-net hospitals.
Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying about entitlement cuts in this Washington Post story.

PA Safety Net Admin2017-12-14T06:00:33+00:00December 14th, 2017|Federal Medicaid issues, Medicare|Comments Off

ED Myths Exposed

Hospital building The uninsured do not use emergency rooms more than the insured.
And the expansion of health insurance coverage increases rather than decreases ER use.
So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.” Find the study here.

PA Safety Net Admin2017-12-13T06:00:10+00:00December 13th, 2017|Uncategorized|Comments Off

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