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

Suit Claims Low Medicaid Rates are Discriminatory

A lawsuit filed in state courts in California argues that the state’s low Medicaid payments amount to discrimination against the state’s large Hispanic Medicaid population.
California pays among the lowest rates in the country to physicians, making health care inaccessible for some, and the suit maintains that this is a civil rights issue in which low rates amount to discrimination.
The suit is based on state anti-discrimination and equal protection laws, and many other states have similar laws on the books. Observers question whether the low rates constitute discrimination against the suit’s Hispanic plaintiffs because the low rates affect the state’s entire Medicaid population, but health advocates around the country will be watching the suit’s progress closely as they consider whether it offers a model for how they, too, might seek redress over the low Medicaid payments that are common in so many states – payments typically much lower than those paid by Medicare.
Pennsylvania safety-net hospitals will be following this lawsuit closely.
For a closer look at the lawsuit, the situation in California, the suit’s legal implications, and how others view it, see this Stateline article.

PA Safety Net Admin2017-10-05T06:00:43+00:00October 5th, 2017|Uncategorized|Comments Off

House Members Seek Delay of DSH Cuts

221 members of the House of Representatives have written to House leaders asking them to delay cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to begin on October 1.
The cuts, mandated by the Affordable Care Act, have already twice been delayed by Congress, both times for two years, and now, a majority of House members have written to House speaker Paul Ryan and minority leader Nancy Pelosi asking them to advance legislation to delay Medicaid DSH cuts once again.
The purpose of Medicaid DSH payments is to help hospitals that serve especially large numbers of low-income patients to absorb some of the losses they incur serving uninsured and underinsured people. Pennsylvania safety-net hospitals receive, and greatly benefit from, Medicaid DSH payments.
See the letter to House leaders here and see NAUH’s letter to House members here.

PA Safety Net Admin2017-10-04T14:33:14+00:00October 4th, 2017|Federal Medicaid issues|Comments Off

PA Drug Monitoring Program Showing Results

Pennsylvanians are having a harder time inappropriately obtaining prescriptions for opioids and other dangerous prescription drugs because of continued implementation of the state’s prescription drug monitoring program.
Under the program, introduced last year, anyone who can prescribe Schedule II-V class drugs must query a state database before doing so and report any prescriptions they write by the end of the next business day.
The idea is to prevent people from going from doctor and doctor and pharmacy to pharmacy seeking prescriptions for dangerous drugs, and it appears to be working. The state’s Department of Health reports that the number of people who visited five or more doctors to obtain prosecutions for drugs covered by the program fell 86 percent in a year and the practice of visiting ten or more doctors in search of such drugs disappeared entirely.
Learn more about Pennsylvania’s prescription drug monitoring program, how it works, and whether it is working in this Erie Times-News article.

PA Safety Net Admin2017-10-03T06:00:57+00:00October 3rd, 2017|Uncategorized|Comments Off

U.S. House Committee Looks at 340B

Are hospitals using the savings generated by their participation in the section 340B prescription drug discount program to help their low-income and uninsured patients?
That’s what the U.S. House Energy and Commerce Committee’s Health Subcommittee is asking.
Earlier this year the committee requested such information from the Health Services and Resources Administration, which runs the 340B program, and now it’s asking hospitals as well.
Specifically, the subcommittee sent five-page letters to 19 providers that participate in the 340B program asking them about:

the quantity of 340B-purchased drugs they dispense to Medicare beneficiaries, Medicaid beneficiaries, and those with private insurance
the quantity of 340B-purchased drugs they dispense to uninsured patients
their savings from the 340B program and how they calculate those savings
how much charity care they provide
how they use 340B savings to serve vulnerable populations

The letters address many other 340B-related issues as well.
Most Pennsylvania safety-net hospitals participate in the 340B program and view it as a critical tool in their ability to meet the needs of their many low-income patients.
Learn more about the Health Subcommittee’s letter by reading this news release describing this initiative and go here to view the letters the subcommittee sent to selected 340B providers.

PA Safety Net Admin2017-09-22T06:00:05+00:00September 22nd, 2017|Uncategorized|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.
Among the issues MACPAC commissioners discussed during their two-day meeting were:

delivery system reform incentive payment programs
Medicaid enrollment and renewal processes
managed care oversight
monitoring and evaluating section 11115 demonstration waivers
Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues. It is a non-partisan agency of the legislative branch of government.
Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.

PA Safety Net Admin2017-09-21T06:00:10+00:00September 21st, 2017|Federal Medicaid issues|Comments Off

PA Medicaid Director Honored

Leesa Allen, deputy secretary of the Pennsylvania Department of Human Services’ Office of Medical Assistance Programs and state Medicaid director, has been appointed to the board of directors of the National Association of Medicaid Directors.

See the Wolf administration’s news release about Ms. Allen’s appointment here.

PA Safety Net Admin2017-09-20T06:00:15+00:00September 20th, 2017|Pennsylvania Medical Assistance|Comments Off

State Withholding Some Provider Medicaid Payments

With the state budget still lacking a plan to raise revenue to underwrite expenses, the Wolf administration is beginning to withhold payments to the state’s creditors.
Including those who provide services to the more than 2.8 million Pennsylvanians enrolled in the state’s Medicaid program.
Last week the Wolf administration announced that it withhold $1.2 billion in Medicaid provider payments.
Unless the problem is resolved, more state payments could be withheld in the coming weeks.
Learn more about what the Wolf administration is doing and how it might affect Medicaid and Medicaid providers in this Philadelphia Inquirer article.

PA Safety Net Admin2017-09-18T06:00:56+00:00September 18th, 2017|Pennsylvania proposed FY 2018 budget|Comments Off

Overutilization of ERs May Not be as Great as Perceived

Far fewer hospital emergency room visits are for medical problems better addressed in other settings, according to a new study.
In a review of six years worth of data encompassing 424 million ER visits, researchers found that only 3.3 percent of those visits were truly “avoidable,” with the avoidable visits mostly involving problems ERs are not equipped to address, such as dental and mental health issues.
This finding flies in the face of the conventional wisdom that people turn too quickly to hospital ERs for routine medical problems or use ERs because they lack access to more appropriate care.
Learn more about the study and its findings in this Fierce Healthcare article or go here for a link to the study “Avoidable emergency department visits: a starting point,” which was published in the International Journal for Quality in Health Care.

PA Safety Net Admin2017-09-06T17:11:15+00:00September 6th, 2017|Uncategorized|Comments Off

Leave 340B Alone, CMS Advisory Group Says

The Centers for Medicare & Medicaid Services should not significantly reduce Medicare payments for some prescription drugs.
Or so says one of CMS’s own advisory panels.
The agency’s Advisory Panel on Outpatient Prospective Payment reached this conclusion after listening to testimony from hospital industry stakeholders who told of the savings the federal government’s 340B prescription drug discount program produces and how those savings enable hospitals in low-income areas to help low-income patients who would not otherwise be able to afford their drugs and help improve access to care for low-income patients with very limited health care options.
The panel’s recommendation came just a month after CMS proposed reducing Medicare reimbursement for 340B drugs from its current level, average sales price plus six percent, to average sales price less 22.5 percent..
Critics of the program maintain that it is abused by hospitals, which are not required to reinvest their 340B savings in health care for the poor. Program supporters maintain that hospitals do use those savings for this very purpose.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it an essential part of their overall effort to serve the many low-income residents of the communities they serve.
CMS called for the change in the 340B program in a proposed regulation published in July. Interested parties have until September 11 to comment on the proposal.
Learn more about this issue and the CMS advisory panel’s recommendation in this Fierce Healthcare article.

PA Safety Net Admin2017-09-01T06:00:36+00:00September 1st, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

SNAP Writes to House Ways and Means Committee About Medicaid DSH Audits

The federal government should give states the option of monitoring Medicaid disproportionate share payments (Medicaid DSH) to hospitals through prospective DSH limit calculations rather than through retroactive DSH audits.

SNAP recently shared this view with the House Ways and Means Committee’s Health Subcommittee in response to that subcommittee’s request for suggestions from stakeholders on ways to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.

According to SNAP, retroactive DSH audits are cumbersome, burdensome, and expensive, give rise to many disputes and appeals, and in the end yield results very similar to much simpler prospective DSH limit calculations performed by the very state governments that distribute Medicaid DSH funds.

See SNAP’s comments to the Ways and Means Committee here.

PA Safety Net Admin2017-08-29T17:00:02+00:00August 29th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

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