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

CMS Guidance on MCO Payments is Good News for PA Hospitals

New guidance from the Centers for Medicare & Medicaid Services on the use of directing additional Medicaid resources to hospitals through Medicaid managed care organizations is good news for Pennsylvania safety-net hospitals.
Such payments have been routed through the state’s Medicaid managed care plans for several years, but as the state and hospital industry continue negotiating renewal of the state’s hospital tax – its “Quality Care Assessment” – it was not entirely clear whether the federal government would permit continued use of this mechanism.
An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Go here to see the CMS memo “Delivery System and Provider Payment Initiatives under Medicaid Managed Care Contracts.”

PA Safety Net Admin2017-11-16T14:19:15+00:00November 16th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors.
According to the news release, those changes include:

re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state
giving states greater freedom to innovate
offering new guidelines for how states can align their individual programs with federal Medicaid objectives
new guidance on section 1115 waivers
longer section 1115 waivers with simpler review processes
CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries
Medicaid and CHIP “scorecards” that track and publish state and federal Medicaid and CHIP outcomes

Pennsylvania safety-net hospitals serve more Medicaid patients than the typical hospital and would therefore be affected more by any major changes in how Medicaid operates.
Go here to see CMS administrator Verma’s full new release and to find links to relevant documents, web sites, and Ms. Verma’s speech about the changes. Go here to read a Washington Post report on Ms. Verma’s speech and here to see a Kaiser Health News report.

PA Safety Net Admin2017-11-08T06:00:43+00:00November 8th, 2017|Federal Medicaid issues|Comments Off

PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania.
The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019.
Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018.
Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid.
Learn more about the program’s delay in southeastern Pennsylvania in this Philadelphia Inquirer article.

PA Safety Net Admin2017-11-07T10:18:34+00:00November 7th, 2017|Pennsylvania Medicaid policy, Uncategorized|Comments Off

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council has released its annual report on hospital performance for discharges between October of 2015 and September of 2016.
The report, which details the performance of all of the state’s acute-care hospitals and some children’s and specialty hospitals, looks at hospital-specific outcomes for 16 individual medical conditions and surgical procedures.
Among the measures reported by PHC4 are number of cases, risk-adjusted mortality, risk-adjusted 30-day readmissions, and case-mix-adjusted average hospital charges.
Among its findings, PHC4 reported that mortality and readmission rates decreased in most categories and did not increase significantly in any.
The PHC4 report comes in different volumes for different parts of the state. Find a description of the reports, a summary of their findings, and the three reports themselves here, on PHC4’s web site.

PA Safety Net Admin2017-10-27T06:00:30+00:00October 27th, 2017|Uncategorized|Comments Off

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey.
The survey also found that:

More than half of the uninsured are insured through their employer.
Nearly one in four insured through their employer are underinsured.
More than one in four Medicaid recipients were underinsured.
Half of the underinsured report problems paying their medical bills.
Individuals with higher deductibles are more likely to report problems paying their medical bills.
More than 45 percent of the underinsured report skipping care they need because of cost.
Low-income people and those with chronic health problems are more likely to be underinsured.

Learn more about the survey’s findings, its implications, and possible means of addressing these problems in the Commonwealth Fund report How Well Does Insurance Coverage Protect Consumers from Health Care Costs?, which can be found here.

PA Safety Net Admin2017-10-25T06:00:08+00:00October 25th, 2017|Uncategorized|Comments Off

Wolf Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.

Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.

PA Safety Net Admin2017-10-23T10:00:53+00:00October 23rd, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

A New Twist on Telehealth

Residents of urban areas often have the same access-to-care problems as rural residents, although the latter receive far more attention.
So concludes a new report published on the Health Affairs Blog.
According to the analysis, urban and rural residents have similar access problems – and among urban residents, the problems in some instances are even greater. One distinction:

…while rural America has access problems because there are not enough doctors, urban America has access problems because there are not enough appointments.

One potential solution to this problem, the report suggests, is focusing on access instead of geography and making telehealth services more available to rural and urban residents alike. To date, most telehealth efforts have focused on serving residents of rural areas only.
Doctor giving patient an ultrasound Pennsylvania has safety-net hospitals in both urban and rural areas and many of the communities they serve have access-to-care problems that might benefit from greater access to telehealth services.
Learn more about the issue and this new perspective in the article “Giving Urban Health Care Access Issues The Attention They Deserve in Telemedicine Reimbursement Policies,” which can be found here, on the Health Affairs Blog.

PA Safety Net Admin2017-10-18T06:00:12+00:00October 18th, 2017|Uncategorized|Comments Off

Wolf Nominates Four for Health-Related Posts

Pennsylvania Governor Tom Wolf has nominated four acting department secretaries to assume those positions permanently.
His nominees are:

Rachel Levine, to be Secretary of the Department of Health
Teresa Miller, to be Secretary of the Department of Human Services
Jennifer Smith, to be Secretary of Drug and Alcohol Programs
Jessica Altman, to be state Insurance Commissioner

Learn more about the nominations and the nominees in this Central Penn Business Journal article.

PA Safety Net Admin2017-10-17T06:00:49+00:00October 17th, 2017|Uncategorized|Comments Off

340B Changes Would Hurt Hospital Margins

Proposed changes in the federal section 340B prescription drug discount program would hurt hospital margins.
So says Moody’s Investors Service, the credit rating agency.
According to Moody’s, the margins of non-profit hospitals are already under pressure because revenue increases are not keeping pace with prescription drug costs. Reductions of payments under the 340B program recently proposed by the Centers for Medicare & Medicaid Services would make a challenging situation worse, Moody’s speculates.
Under the 340B program, eligible hospitals purchase prescription drugs at a discount, supply them to eligible outpatients, and use the savings they gain to provide additional services and outreach to the low-income residents of their communities.
Skeptics maintain that hospitals simply pocket the savings.
Under the regulation proposed by CMS, federal payments to 340B-eligible hospitals would be greatly reduced.
All Pennsylvania safety-net hospitals participate in the 340B program and benefit considerably for it.
Learn more about the issue and Moody’s report on the potential impact of changes in the program in this Healthcare Finance News article.

PA Safety Net Admin2017-10-10T06:00:45+00:00October 10th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

House Committee to Hold 340B Hearing

The House Energy and Commerce Committee’s oversight subcommittee will hold a hearing on Wednesday about the 340B Drug Pricing Program.
At the hearing, titled “Examining How Covered Entities Utilize the 340B Drug Pricing Program,” the subcommittee hopes

…to hear directly from entities participating in the program to get a better understanding of how the program is used, including how much money is saved, the types of drugs purchased and prescribed within the program, how entities track their savings, and how those savings are used to improve patient care.

All Pennsylvania safety-net hospitals participate in the 340B program.
Learn more about the hearing and the witness list from the subcommittee’s news release on the subject.

PA Safety Net Admin2017-10-09T06:00:52+00:00October 9th, 2017|Uncategorized|Comments Off

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