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

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

Chatter About Medicaid Block Grants Grows

A week after a published report suggested that the Trump administration might be working on a plan to introduce Medicaid block grants, the Washington Post reports that those efforts are under way in earnest.

According to the Post,

A small group of people within the Centers for Medicare and Medicaid Services is working on a plan to allow states to ask permission for their federal Medicaid dollars to be provided in a single lump sum instead of the way they are currently awarded as a percentage of states’ total costs.

While many, including members of Congress, insist that the administration cannot move forward with such a proposal without legislation, others suggest that the administration may offer states the opportunity to participate in Medicaid block grants voluntarily, by seeking a federal waiver. What remains to be seen is whether the prospect of greater flexibility to shape their own Medicaid programs is sufficient to entice states to participate in an approach that almost certainly would result in less federal money for those programs.

Learn more about what the administration is considering and how policy-makers, industry leaders, and others are reacting to the prospect of a push toward Medicaid block grants from the Washington Post story “The Health 202: The Trump administration is working on Medicaid block grants?”

PA Safety Net Admin2019-01-25T06:00:23+00:00January 25th, 2019|Federal Medicaid issues|Comments Off

SNAP Comments on Proposed Federal Managed Care Reg

The Safety-Net Association of Pennsylvania has submitted formal comments to the Centers for Medicare & Medicaid Services in response to CMS’s proposed changes in federal Medicaid managed care regulations.

Safety-Net Association of Pennsylvania logo SNAP’s letter addressed three aspects of the proposed regulation: payment rate ranges, directed Medicaid payments, and Medicaid pass-through payments. The overall theme underlying SNAP’s comments was that the proposed changes represent positive steps but could be taken further to provide additional flexibility for Pennsylvania’s Medicaid program to take stronger steps to ensure the ability of Pennsylvania safety-net hospitals to serve their communities.

SNAP expressed support for CMS’s restoration of the use of actuarial rate ranges in setting Medicaid managed care rates but urged CMS to make those rate ranges even broader or even eliminate them provided that negotiated rates still meet formal criteria for actuarial soundness.

SNAP endorsed CMS’s expanded parameters for the use of Medicaid directed payments through managed care but encouraged CMS to expand those parameters even further than it has proposed.

And SNAP called on CMS to restore the ability of states to use pass-through payments in Medicaid managed care programs, as they can do through Medicaid fee-for-service programs, so long as those payments remain actuarially sound.

Learn more about SNAP’s perspective by reading the association’s comment letter to CMS in response to the proposed Medicaid managed care regulation.

PA Safety Net Admin2019-01-18T17:52:53+00:00January 18th, 2019|Uncategorized|Comments Off

SNAP Comments on Proposed Federal Medicaid Managed Care Regulation (Letter)

In a letter to the Centers for Medicare & Medicaid Services, SNAP responds to a proposed federal Medicaid managed care regulation by expressing support for its partial restoration of rate ranges in Medicaid managed care payments; urges CMS to restore states’ ability to make managed care pass-through payments to ensure access to Medicaid services; and expresses support for CMS’s expansion of the use of directed payments in Medicaid managed care. SNAP also urges CMS to expand even further the use of rate ranges and directed payments.

PA Safety Net Admin2020-09-01T18:11:02+00:00January 14th, 2019|Advocacy|Comments Off

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

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