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

PA to Experiment with Global Budgets for Rural Areas

Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals.

The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals.

According to a Pennsylvania Department of Health news release,

The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the global budget will include multiple-payers, including private and public insurers.

The global budgeting project is a joint venture of the state’s Department of Human Services, Department of Health, Insurance Department, the Pennsylvania Office for Rural Health, the federal Center for Medicare and Medicaid Innovation, and the participating hospitals and health insurers.

The five hospitals that will participate in the model’s launch are Barnes-Kasson County Hospital, Endless Mountain Health Systems, Geisinger Jersey Shore Hospital, UPMC Kane, and Wayne Memorial Hospital. The five participating insurers are Gateway Health Plan, Geisinger Health Plan, Highmark Blue Cross and Blue Shield, UPMC, and the state’s Medicaid program. The state hopes to bring additional hospitals and additional insurers into the program in the future.

The federal government’s Center for Medicare and Medicaid Innovation is investing $25 million over five years to fund a rural health redesign center to support the project’s launch.

The project is needed, according to the state, because “Nearly half of all rural hospitals in Pennsylvania are operating with negative margins and are at-risk of closure.”

Learn more about this initiative from this Pennsylvania Department of Health news release.

PA Safety Net Admin2019-03-08T06:00:58+00:00March 8th, 2019|Uncategorized|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the February 2019 edition of its newsletter.

Included in this edition are articles about:

Governor Wolf’s proposed FY 2020 Medicaid budget
Medicare Part D co-pay problems for some dual-eligibles
new Medicare Part D monitoring for prescription drug abuse
Community HealthChoices

Find these stories and others in the latest edition of the Pennsylvania Health Law Project’s Health Law PA News.

PA Safety Net Admin2019-03-04T06:00:14+00:00March 4th, 2019|Pennsylvania Medicaid, Pennsylvania proposed FY 2020 budget, Pennsylvania state budget issues|Comments Off

Safety-Net Hospitals Struggle in Medicare Joint Replacement Model

Non-safety-net hospitals are outperforming safety-net hospitals in the Medicare’s Comprehensive Care for Joint Replacement model, which was introduced in 2016.

According to a new study published in Health Affairs,

…in comparison to non-safety-net hospitals, 42 percent fewer safety-net hospitals qualified for rewards based on their quality and spending performance (33 percent of safety-net hospitals qualified, compared to 57 percent of non-safety-net hospitals), and safety-net hospitals’ rewards per episode were 39 percent smaller ($456 compared to $743). Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years.

What might be done to address this disparity? The study suggests that

Medicare and hospital strategies such as those that reward high-quality care for vulnerable patients could enable safety-net hospitals to compete effectively in CJR.

Learn more in the Health Affairs article Performance of Safety-Net Hospitals in Year 1 of the Comprehensive Care for Joint Replacement Model.

PA Safety Net Admin2019-03-01T06:00:22+00:00March 1st, 2019|Medicare|Comments Off

DHS Highlights Proposed FY 2020 Initiatives

Governor Wolf’s proposed FY 2020 budget for the Department of Human Services includes a number of initiatives designed to improve existing programs, enhance health status, and improve access to health services. As highlighted in a recent release from DHS, those initiatives include:

increasing Pennsylvania’s minimum wage
helping parents find lasting careers
evidence-based home visiting
high-quality child care
expanding access to affordable child care
personal care homes/day treatment programs
disability advocacy program
helping people access services

All of these proposals are subject to review and consideration by the state legislature as part of the process of developing and adopting a state spending plan for the 2020 fiscal year. Learn more from the DHS release “DHS 2019-20 Budget Initiatives.”

PA Safety Net Admin2019-02-25T06:00:57+00:00February 25th, 2019|Pennsylvania proposed FY 2020 budget|Comments Off

States Taking Different Paths to Pay for Medicaid Expansion

With the federal share of Medicaid expansion falling to 90 percent next year, states that expanded their Medicaid programs under the Affordable Care Act are now exploring new ways to raise the money to pay for the 10 percent for which they will soon by responsible.

Some are implementing hospital or insurer taxes while others are increasing existing taxes on hospitals and health insurers. New Hampshire is directing part of the proceeds from a liquor tax for this purpose and other states have introduced cigarette taxes. Some are charging premiums to Medicaid beneficiaries and introducing work requirements for their Medicaid population so they can reduce overall enrollment. Many are using money from their general revenues.

This all comes at a time when many states are finding that their budget situations have improved and are better than they have been in years.

Learn more about how states are dealing with this challenge, and whether they are finding that it is worth it, in the Washington Post article “States scramble to head off future Medicaid shortfalls.”

PA Safety Net Admin2019-02-22T06:00:26+00:00February 22nd, 2019|Affordable Care Act, Federal Medicaid issues|Comments Off

Health Care Lobbying Rose in 2018

Hospitals and health systems spent $99.7 million lobbying in Washington, D.C. last year, just barely more than in 2017 but much less than in 2009, when the focus of health care lobbying was the Affordable Care Act, then just a proposal and not a law.

The issues on which they spent the most money lobbying were the 340B program, site-neutral Medicare payments for outpatient services, safety-net hospitals, Medicare-for-all proposals, and Medicaid funding.

Learn more about what hospitals spent their lobbying money on, who were the biggest lobbying spenders, and where industry groups figure in the overall spending in the Healthcare Dive article “Hospital lobbying in 2018 — by the numbers.”

PA Safety Net Admin2019-02-20T06:00:09+00:00February 20th, 2019|Uncategorized|Comments Off

New Report Looks at Medicaid and Social Determinants of Health

A new report outlines how state Medicaid programs can improve the health of Medicaid beneficiaries through a more concerted approach to addressing social determinants of health.

The report, from the Institute for Medicaid Innovation, focuses on how state Medicaid programs, through alternative payment models and especially through managed care organizations, have implemented new programs designed to address social determinants of health such as inadequate social supports and housing, food insecurity, lack of transportation, and others. It also highlights federal regulations that facilitate the implementation of new ways to address social determinants of health and presents brief case studies in which states, state Medicaid programs, and Medicaid managed care organizations tackle social determinants of health.

Such approaches are especially relevant to Pennsylvania safety-net hospitals because they care for so many more Medicaid patients than the typical community hospital.

Learn more from the Institute for Medicaid Innovation report “Innovation and Opportunities to Address Social Determinants of Health in Medicaid Managed Care.”

PA Safety Net Admin2019-02-06T06:00:55+00:00February 6th, 2019|social determinants of health|Comments Off

MACPAC: Slow Medicaid DSH Cuts

Slow the pace of scheduled cuts in Medicaid disproportionate share hospital payments (Medicaid DSH), the non-partisan agency that advises Congress and the administration will tell Congress in its next report of policy recommendations.

The Medicaid and CHIP Payment and Access Commission voted 16-1 recently to recommend to Congress that Medicaid DSH cuts, mandated by the Affordable Care Act but delayed three times by Congress, be reduced in size and spread out over a longer period of time.

Currently, Medicaid DSH allotments to the states are scheduled to be reduced $4 billion in FY 2020 and then $8 billion a year in FY 2021 through FY 2025. MACPAC recommends that the cuts be reduced to $2 billion in FY 2020, $4 billion in FY 2021, $6 billion in FY 2022, and $8 billion a year from FY 2023 through FY 2029.

MACPAC commissioners also voted to urge Congress to restructure the manner in which Medicaid DSH allotments to the states are calculated based on the number of low-income individuals who reside in the states.

Most Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider them a vital resource in helping to underwrite the uncompensated care they provide to uninsured patients.

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 array of issues affecting Medicaid and the State Children’s Health Insurance Program.

Learn more about MACPAC’s actions on Medicaid DSH in the Fierce Healthcare article “MACPAC calls for Congress to delay cuts to safety-net hospitals.”

PA Safety Net Admin2019-02-04T06:00:11+00:00February 4th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them.

At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission.

According to a presentation delivered at a MACPAC meeting last week:

Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists.
Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole.
Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept Medicaid patients than physicians in states with low managed care penetration (78.5 percent).
There is no meaningful differential in acceptance rates among physicians in Medicaid expansion states and states that did not expand their Medicaid programs under the Affordable Care Act.
Physician acceptance rates have not changed since adoption of the Affordable Care Act in either Medicaid expansion nor non-Medicaid expansion states.
The higher the ratio of Medicaid-to-Medicare physician payments in an individual state, the more likely that physicians in those states will accept Medicaid patients. The difference is especially great among general practitioners and ob/gyns.

Learn more from the MACPAC presentation “Physician Acceptance of New Medicaid Patients.”

PA Safety Net Admin2019-01-31T06:00:14+00:00January 31st, 2019|Uncategorized|Comments Off

MACPAC Meets

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.

Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP.

Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following a break for lunch, the Commission was briefed on a new report by Mathematica Policy Research, under contract to MACPAC, regarding beneficiary enrollment in the Financial Alignment Initiative, which is testing new approaches to integrating care for people who are dually eligible for Medicaid and Medicare. Later, staff presented an analysis of the factors affecting physician decisions to accept new Medicaid patients.

Friday’s sessions opened with a panel of experts discussing how utilization management policies are applied to medication-assisted treatment (MAT). Under the SUPPORT for Patients and Communities Act (P.L. 115-271), MACPAC is required to study utilization management policies related to MAT and report on these by late October 2019. The meeting concluded with its third and final session on hospital payment: how to account for third-party payments in the DSH definition of Medicaid shortfall.

Supporting the commissioners’ deliberations were the following presentations prepared by MACPAC staff.

Because SNAP members 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 array of issues affecting Medicaid and the State Children’s Health Insurance Program.

PA Safety Net Admin2019-01-29T06:00:09+00:00January 29th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

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