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

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

Senators Seek 340B Reprieve

A bipartisan group of senators has written to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer expressing concern about cuts in Medicare Medicare prescription drug payments to qualified providers as a result of new regulations governing the section 340B prescription drug discount program. Those cuts have been adopted by regulation by the Centers for Medicare & Medicaid Services and will take effect beginning on January 1, 2018.
Under the regulation adopted by CMS, Medicare payments for prescription drugs dispensed on an outpatient basis to low-income patients will be reduced to qualified providers by $1.6 billion in the coming year. While acknowledging problems with how the 340B program has evolved over the years, the senators ask their leaders to partner “…with CMS and other stakeholders to ensure the 340B program continues to support safety-net providers in helping low-income individuals access quality health care services with proper oversight and transparency.”
All Pennsylvania safety-net hospitals participate in the 340B program.
Neither Pennsylvania senator signed the letter.
See the letter here.

PA Safety Net Admin2017-12-12T06:00:31+00:00December 12th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs.
So concludes a new study in Annals of Internal Medicine.
According to the report,

Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.

This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce.
Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize access to care in some communities. That, in turn, could have implications for Pennsylvania safety-net hospitals and the communities they serve.
Learn more about the study, its findings, and its implications by going here to see the Annals of Internal Medicine report “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities.”

PA Safety Net Admin2017-12-07T06:00:27+00:00December 7th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts.
But that may be changing.
The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients.
Because they serve so many low-income patients, Pennsylvania safety-net hospitals are especially interested in policy changes that might enable them to serve such patients more effectively.
The Commonwealth Fund has taken a closer look at how the 2016 Medicaid managed care regulation may facilitate addressing the psycho-social needs of Medicaid beneficiaries. Go here to see its report “Addressing the Social Determinants of Health Through Medicaid Managed Care.”

PA Safety Net Admin2017-12-05T06:00:32+00:00December 5th, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

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