SNAP asks PA’s congressional delegation to join a letter asking House leadership to advance legislation delaying Affordable Care Act-mandated cut in Medicaid DSH payments scheduled to take effect later this year.
Prevent Medicaid DSH cuts: that is the message the Safety-Net Association of Pennsylvania conveyed to Pennsylvania’s congressional delegation this week.
In a message sent to every member of the U.S. House of Representatives from Pennsylvania, SNAP asked members to sign onto a letter to House Speaker Nancy Pelosi asking her to delay Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to take effect in October of this year.
If implemented, the cut would hurt 179 of Pennsylvania’s 213 hospitals, including all safety-net hospitals, and cost the state approximately $240 million in Medicaid DSH revenue in FY 2020 and $480 million a year in FYs 2021 through 2025.
See the letter requesting action on Medicaid DSH cuts here and SNAP’s message to Pennsylvania’s congressional delegation here.
Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress. That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments.
Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall: the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care. Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients.
If this proposal were to be adopted, it has the potential of changing Medicaid DSH allocations among the states and change the distribution of Medicaid DSH funds within individual states, although the Congressional Budget Office estimates that it would have little impact on either measure.
Complicating the MACPAC recommendation is last year’s federal court ruling that third-party payments could not be deducted from hospitals’ Medicaid shortfall totals because the Centers for Medicare & Medicaid Services lacks the authority to implement such a policy. Making such a change therefore would require action by Congress.
Learn more about the MACPAC recommendation and its potential implications for hospitals and their Medicaid DSH payments in the Fierce Healthcare article “’Medicaid shortfall’ definition should change when tallying DSH payments, MACPAC says.”
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 Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon.
First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and raise the cap on rebates. The Commission then revisited hospital payment policy, with a draft chapter and recommendation on how to treat third-party payment in the definition of Medicaid shortfall when determining disproportionate share hospital payments. Next, commissioners considered two recommendations proposed as part of a June chapter on improving the effectiveness of Medicaid program integrity. The final morning session addressed the Commission’s proposed recommendation on therapeutic foster care.
The Commission returned from lunch for two presentations discussing preliminary findings of forthcoming congressionally mandated reports. The first afternoon session presented initial findings from a MACPAC review of state Medicaid utilization management policies related to medication-assisted treatment, to be issued in October. The session immediately following presented preliminary findings for a January 2020 study on Medicaid standards for institutions for mental diseases. Both reports are required as part of the SUPPORT for Patients and Communities Act (P.L. 115-271). Votes on June 2019 recommendations closed out the day.
Friday’s sessions opened with a review of the fifth draft chapter slated for June, on Medicaid in Puerto Rico. The second session of the morning reviewed a proposed rule issued by the Centers for Medicare & Medicaid Services in March to promote interoperability in federal health care programs. The April meeting closed with a review of evaluations of integrated care for dually eligible beneficiaries.
Supporting the discussion were the following presentations:
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, MACPAC’s deliberations are especially relevant to them because its recommendations often find their way into future Medicaid and CHIP policies.
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.
Debt service on the state’s borrowing against future proceeds from the national master tobacco settlement agreement should be paid using state sales and use tax revenue, SNAP has declared in a new position statement.
Last year the state borrowed $1.5 billion against future proceeds from the tobacco settlement. Some tobacco settlement money is used to help hospitals with the cost of uncompensated care they provide via tobacco uncompensated care payments and tobacco extraordinary expense payments made to hospitals that meet specific criteria: how much uncompensated care they provide, the proportion of their patients insured by Medicaid, and the proportion of low-income seniors they serve. All Pennsylvania safety-net hospitals qualify for these payments.
Because the state’s borrowing against future tobacco settlement proceeds was never intended to result in a reduction of these payments in the future, SNAP has issued a position statement endorsing the Wolf administration’s suggestion, in its proposed FY 2020 budget, to pay debt service on its tobacco borrowing with sales and use tax revenue.
Medicaid DSH cuts should be delayed, House Speaker Nancy Pelosi (D-CA) told a gathering of hospital officials.
According to Speaker Pelosi,
DSH cuts threaten to erode the health of community hospitals, safety-net hospitals and rural hospitals, [affecting] the health of not only the families that rely on Medicaid, but any person who relies on these hospitals for care.
SNAP members all receive Medicaid DSH payments and would be harmed if the scheduled cut takes effect on October 1.
Learn more about Speaker Pelosi’s remarks in the Becker’s Hospital Review article “House speaker urges Congress to ease Medicaid payment cuts to hospitals serving low-income patients.”
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.