In a joint letter with 10 other organizations, SNAP urges the state legislature to use 100 percent of Tobacco Settlement Fund money for health-related services and programs in FY 2020.
The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs.
Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests.
According to a recent post on the CMS blog (in CMS’s own words),
Learn more in the CMS blog entry “CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs.”
The Trump administration is considering changing how the federal government measures inflation for the purpose of calculating the federal poverty level.
Such a change, if implemented, could potentially reduce inflation-related increases in the federal poverty level, which in turn could limit the ability of some individuals and families to qualify, or continue to qualify, for a variety of public safety-net services – including, potentially, Medicaid.
Among the possible alternatives to the current methodology for calculating inflation is the Chained Consumer Price Index for All Urban Consumers. The Obama administration also explored substituting this index for the current inflation factor.
Any change that makes it more difficult for people to qualify for Medicaid could be particularly damaging to Pennsylvania safety-net hospitals, which are generally located in communities with especially large numbers of low-income residents. If patients lose their Medicaid eligibility because the criteria for participating in the program change, that could leave such hospitals serving even more uninsured patients and providing even more uncompensated care than they already do.
The federal Office of Management and Budget has issued a request for comment about various inflation factor calculation alternatives. Go here to see OMB notice Request for Comment on the Consumer Inflation Measures Produced by Federal Statistical Agencies. Comments are due in late June. Learn more from the New York Times article “Trump Administration Seeks to Redefine Formula for Calculating Poverty.”
The majority members of the Senate Finance Committee have published a report on supplemental Medicaid payments.
According to the new document,
This report seeks to increase educational understanding of Medicaid supplemental payments, as well as outline the reporting mechanisms for these payments to ensure adequate stewardship of taxpayer dollars.
The report consists of descriptions of the different types of supplemental Medicaid payments that states make to some providers, including:
It also describes the magnitude of these payments, noting that supplemental Medicaid payments accounted for $50 billion of the $600 billion spent on Medicaid by the federal and state governments in 2016, the most recent year for which comprehensive data is available. In addition, it outlines how those payments are distributed while also considering how these payments affect the overall adequacy of Medicaid payments to providers; this varies from state to state.
Finally, the report reviews how the states finance their Medicaid programs, including through provider taxes, intergovernmental transfers, and certified public expenditures, and how states report their supplemental Medicaid payments to the federal government.
All Pennsylvania safety-net hospitals receive supplemental payments from the state and consider those payments essential resources supporting their ability to serve the residents of the low-income communities in which they are generally located.
To learn more, see the report “Greater Transparency of Supplemental Payments Needed,” which was prepared by the majority staff of the Senate Finance Committee.
Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act.
And Medicaid-covered admissions and ER visits are up, according to a new analysis.
The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent.
The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise.
While the Affordable Care Act is likely the cause of most of these changes, other contributing factors include the emergence of urgent care facilities, telemedicine, and free-standing ERs as well as new payment models and rules.
The study’s findings are especially good news for Pennsylvania safety-net hospitals because they care for so many more low-income patients than other hospitals and have benefited from the Affordable Care Act’s expansion of access to insurance, whether through Medicaid expansion or the private health insurance market.
Learn more in the JAMA Network Open article “US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act.”
The Pennsylvania Health Law Project has published its March-April 2019 newsletter.
Included in this month’s edition are articles about:
Go here for articles about these and other subjects.
Safety-net hospitals are among the leading beneficiaries of changes implemented this year in Medicare’s hospital readmissions reduction program.
According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.
While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.
Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”
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.”