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Governor Proposes FY 2018 Budget

On Tuesday Pennsylvania Governor Tom Wolf unveiled his proposed FY 2018 budget to the state’s General Assembly.
This budget proposal includes a number of provisions with potential implications for Pennsylvania’s safety-net hospitals.
The Safety-Net Association of Pennsylvania has prepared a detailed review of those provisions. Officials of safety-net hospitals who would like to receive a copy of this memo may request one by using the “contact us” link on the upper right-hand corner of this screen.
Find a news release from the governor’s office that outlines the proposed budget here and go here (scroll to the bottom of the screen) for links to budget overviews, the entire budget itself, the Wolf administration’s presentation on its plan to consolidate Pennsylvania’s Department of Human Services, Department of Health, Department of Aging, and Department of Drug and Alcohol Services into a single new Department of Health and Human Services, and other related materials.
 

2017-02-10T06:00:00+00:00February 10th, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2018 budget|Comments Off on Governor Proposes FY 2018 Budget

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2017 newsletter.
Included in this edition are stories about:

  • impending changes in the lineup of managed care providers that serve Medicaid participants in the state’s HealthChoices program for physical health services;
  • the status of the state’s implementation of its Community HealthChoices program of managed long-term services and supports for low-income, elderly Pennsylvanians who seek to continue living independently in the community;
  • the potential impact of a repeal of the Affordable Care Act on Pennsylvanians; and
  • Pennsylvania’s receipt of a Certified Community Behavioral Health Clinic demonstration grant from the federal government to improve services and care coordination for individuals on Medicaid or CHIP.

Go here for the latest edition of PA Health Law News.

2017-02-08T17:39:17+00:00February 8th, 2017|Affordable Care Act, HealthChoices PA, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project Newsletter

ACA Replacement?

While both the Trump administration and Congress insist that they will repeal and replace the Affordable Care Act, neither has yet provided information about what that replacement might look like.
priceBut one place worth looking for a possible glimpse into the future is the Affordable Care Act replacement plan proposed by Rep. Tom Price (R-GA), President Trump’s nominee to serve as Secretary of the Department of Health and Human Services.
In 2015, Rep. Price proposed the Empowering Patients First Act as a vehicle for replacing the Affordable Care Act. While the bill was not adopted by Congress at the time, Dr. Price should soon be in a position to exert meaningful influence over the manner in which the Trump administration and Congress go about replacing the Affordable Care Act.
The Kaiser Family Foundation has prepared a summary of Dr. Price’s 2015 proposal. Go here to see that summary and to find a link to the legislation itself.

2017-01-24T06:00:29+00:00January 24th, 2017|Affordable Care Act|Comments Off on ACA Replacement?

MedPAC: Small Pay Raise for Hospital Inpatient, Outpatient Services

The independent agency that advises Congress on Medicare payment matters has recommended modest increases in Medicare payments for hospital inpatient and outpatient services in FY 2018.
The Medicare Payment Advisory Commission voted in support of a market basket increase of approximately 1.85 percent for Medicare outpatient and inpatient services in FY 2018.
new medpacMedPAC also voted to recommend a 0.5 percent increase in payments to physicians but no increase for ambulatory surgery centers.
MedPAC will formally submit its recommendations to Congress in March.
Learn more about these and other MedPAC recommendations for changes in Medicare provider reimbursement in this article on the Provider web site.

2017-01-20T06:00:54+00:00January 20th, 2017|Medicare|Comments Off on MedPAC: Small Pay Raise for Hospital Inpatient, Outpatient Services

Implications of ACA Repeal for Medicaid

How might repeal of the Affordable Care Act affect Medicaid?
Medicaid beneficiaries?
States and providers?
commonwealth fundBecause they care for so many Medicaid patients, including many who enrolled in Medicaid as a result of the Affordable Care Act, the answers to these questions are of special importance to Pennsylvania safety-net hospitals.
These issues and more are considered in the new Commonwealth Fund report “Medicaid’s Future: What Might ACA Repeal Mean?” Find it here.

2017-01-19T06:00:04+00:00January 19th, 2017|Affordable Care Act|Comments Off on Implications of ACA Repeal for Medicaid

ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance

Accountable care organizations that serve large numbers of minority patients score lower on Medicare quality measures than other ACOs, a new study has found.
According to the study, ACOs serving larger numbers of minority patients perform worse than other ACOs on 25 of 44 Medicare performance measures – and that performance does not improve over time.
Happy medical team of doctors togetherThe study also pointed out that the minority patients served by ACOs are generally poorer and sicker than other ACO participants.
These are the very patients typically served in especially large numbers by Pennsylvania’s safety-net hospitals.
Learn more about these and other findings in the report “ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance,” which can be found here.

2017-01-17T06:00:42+00:00January 17th, 2017|Medicare|Comments Off on ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance

Academies Completes Work on Social Risk Factors in Health Care

Completing its assignment from the U.S. Department of Health and Human Services, the Health and Medicine Division of the National Academies of Science, Engineering, and Medicine has published its fifth and final report on social risk factors that affect health outcomes for Medicare beneficiaries and how to account for those risk factors in Medicare payments.
PrintAmong other things, the report notes that

Although VBP [value-based purchasing] programs have catalyzed health care providers and plans to address social risk factors in health care delivery through their focus on improving health care outcomes and controlling costs, the role of social risk factors in producing health care outcomes is generally not reflected in payment under current VBP design. This misalignment has led to concerns that trends toward VBP could harm socially at-risk populations: Providers disproportionately serving socially at-risk populations are more likely to score poorly on performance/quality rankings, more likely to be penalized financially, and less likely to receive bonus payments under VBP. VBP may be taking resources from the organizations that need them the most.

The risk factors the Academies considered were socioeconomic position; race, ethnicity, and cultural context; gender; social relationships; and residential and community context.
The Academies’ fifth and final report brings together its first four efforts.

  • The first report, Accounting for Social Risk Factors in Medicare Payment Programs: Identifying Social Risk Factors, presented a conceptual framework and the results of a literature search linking social risk factors to health-related measures.
  • The second report, System Practices for the Care of Socially At-Risk Populations, explored six patient-centered systems practices that show potential for improving care for socially at-risk communities.
  • The third report, Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods, offered guidance on social risk factors might be incorporated into future Medicare payment systems.
  • The fourth report, Accounting for Social Risk Factors in Medicare Payment: Data, offered data strategies and solutions for collecting data to measure social risk factors that might be addressed in future Medicare payment systems.

The fifth and final report, Accounting for Social Risk Factors in Medicare Payment, offers additional thoughts and recommendations for next steps.
The subject of socio-economic risk adjustment is of interest to Pennsylvania safety-net hospitals because so many of the patients they serve present with such risk factors.
Find the new report here.

2017-01-13T06:00:16+00:00January 13th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off on Academies Completes Work on Social Risk Factors in Health Care

Medicaid Directors Comment on Proposed Medicaid Pass-Through Regulation

national association of medicaid directorsLast November the Centers for Medicare & Medicaid Services proposed a new regulation governing the use of pass-through payments in state Medicaid managed care programs.
The National Association of Medicaid Directors submitted formal comments to CMS about that proposed regulation. See its comments here.
 

2017-01-11T06:00:13+00:00January 11th, 2017|Pennsylvania Medicaid policy|Comments Off on Medicaid Directors Comment on Proposed Medicaid Pass-Through Regulation

Weighing the Impact of ACA Repeal

How might repeal of the Affordable Care Act affect the financial health of different kinds of hospitals?
iStock_000001497717XSmallThe New York Times recently took a look at how the 2010 reform law’s repeal would affect two Pennsylvania health systems: the Temple University Health System, led by a heavily Medicaid-dependent safety-net hospital located in one of the poorest communities in the country; and Main Line Health, a non-profit organization with several hospitals all located in affluent communities.
See what the Times found here.

2017-01-10T06:00:03+00:00January 10th, 2017|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off on Weighing the Impact of ACA Repeal

Medicaid Directors Set 2017 Legislative Priorities

The National Association of Medicaid Directors has published its legislative priorities for 2017. Those 13 priorities, and the manner in which the group hopes to achieve them, are:

  1. namdImplement requirements for advance review of federal regulations and guidance by state Medicaid staff. Require in federal statute a distinct role for state Medicaid leaders to review the conceptual soundness and operational feasibility of federal regulations and guidance prior to finalization, which directly or indirectly impact the Medicaid program.
  2. Advance value-based reimbursement methodologies for all types of Medicaid providers.   Update the tools states may use to allow for aligned value-based purchasing approaches for all Medicaid safety-net providers, including modest down-side risk where consistent with broader statewide reforms.
  3. Provide long-term certainty for effective state Medicaid program innovations. Establish a reasonable path for states to make permanent the foundational aspects of their Section 1115 demonstrations programs. 
  4. Make consistent the federal financing options for Medicaid eligibility expansions and ensure state flexibility on coverage strategies. Provide states more options under the Medicaid state plan to address coverage gaps for low-income populations. An example is to allow a phased approach to coverage for new populations up to 100 percent of the federal poverty level. The existing phase down in federal financing should be consistent for all states, regardless of their starting point.
  5. Provide flexible options for states to streamline waiver authorities and braid funding for Medicaid, overlapping health-related services programs and the social determinants of health. Establish federal demonstration pilots that allow states to integrate funding from other federal health care funding streams, particularly those for behavioral health services, with the explicit purpose of enhancing states’ ability address the total cost of care for Medicaid enrollees. 
  6. Resolve statutory conflicts presented by federal mental health and addiction disorder parity requirements, the federal payment exclusion for Medicaid Institutions for Mental Diseases (IMD) exclusion and federal privacy laws for individuals with a substance use disorder. Repeal or make meaningful modifications to the parameters of the Medicaid IMD payment exclusion or authorize defined waiver authority to do so. Revise existing privacy rules to enable access to protected health information (PHI) of individuals with a substance use disorders diagnosis. 
  7. Delink Medicaid from Medicare financing. Congress should develop a mechanism for keeping the impact of Medicare policies on states predictable, reasonable, and sustainable. 
  8. Address the service dichotomy that continues to impede coordinated, high value care for individuals dually eligible for Medicare and Medicaid. Enhance support for the MMCO’s work with states around the dual eligible population, including by authorizing permanent authority for demonstration models which align and coordinate services for the population dually eligible for Medicare and Medicaid. Permanently reauthorize the SNP program, requiring agreements between all types of SNP plans and states, and providing clear expectations for CMS and states to collaborate to maximize the administrative and care coordination opportunities. 
  9. Allow all states to cover complex populations in managed care. Repeal the prohibition on requiring enrollment in Medicaid managed care for the Medicare and Medicaid dual eligible population and children with special health care needs. States have significant experience designing, launching and administering managed care programs for special populations. 
  10. Harmonize federal payment rules across Medicaid delivery system models. Resolve the inconsistency in federal Medicaid policy so that payment rules apply equitably, regardless of the state’s delivery system model. 
  11. Expand the tools states can use to design and manage Medicaid’s optional prescription drug benefit, including flexibility to exclude some FDA-approved drugs from coverage. Expand the factors states may consider in setting their prescription drug benefit, including cost. Also, advance a multi-pronged strategy to address the affordability of prescription drugs, including providing: transparency for drug pricing for public programs; providing authority for new purchasing and reimbursement strategies for Medicaid’s prescription drug benefit, including flexibility to exclude some FDA-approved drugs from coverage; and limiting the states’ exposure to high-cost prescription drugs. 
  12. Equalize treatment of the territories of the United States. Apply the same formulary to the territories as for the broader group of states and remove the Medicaid cap. 
  13. Facilitate innovation in long-term care, particularly home and community-based services. Allow states to target services to specific populations who will most benefit and for whom the services would be cost-effective.

Learn more about NAMD’s goals for 2017 in its publication NAMD’s Legislative Priorities for 2017.

2017-01-06T06:00:57+00:00January 6th, 2017|Uncategorized|Comments Off on Medicaid Directors Set 2017 Legislative Priorities
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