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

The Battle Over 340B

Hospitals and other health care providers say it is an essential tool in ensuring access to care, and to prescription drugs, for their low-income patients.
Pharmaceutical companies say it has expanded beyond its original purpose and is being used by hospitals to pad their profits.
Members of Congress are divided: some are supportive and some are skeptical.
The section 340B program that requires drug companies to provide discounts to selected hospitals and other providers that serve large numbers of low-income patients has been the subject of controversy in recent years. During that time, the administration has generally sided with hospitals and maintained the program.
That support was tempered recently when the Centers for Medicare & Medicaid Services proposed a 28 percent cut in Medicare payments to hospitals for drugs provided to low-income patients through the 340B program. Hospital industry groups responded by suing the federal government and will have their day in court later this month.
Pennsylvania safety-net hospitals participate in the 340B program and consider it essential to their ability to serve their communities.
What are the issues? Why do hospitals and other providers consider 340B so essential to their well-being while pharmaceutical companies and now, CMS, view the program with increasing skepticism?
Kaiser Health News has taken a look at these and other 340B questions. Read its story here.

PA Safety Net Admin2017-11-30T06:00:12+00:00November 30th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

New PA Website With Resources for Seniors and the Disabled

Pennsylvania has launched a new website called Pennsylvania Link to Community Care to help seniors and people with disabilities find resources to help them address the challenges they face in their lives.
The site, a collaboration between the state’s Human Services and Aging departments, lists services in 12 categories: advocacy, behavioral health, employment, finance, health care, housing, in-home services, legal, meals, protection from abuse, support groups, and transportation. It also provides information to and links about programs, organizations, and services.
To learn more, see this state news release about the new site or go here to see the Pennsylvania Link to Community Care site itself.

PA Safety Net Admin2017-11-28T06:00:26+00:00November 28th, 2017|Uncategorized|Comments Off

Diabetes Admissions Up in PA

Hospital admissions for diabetes rose 13 percent in Pennsylvania between 2000 and 2016. While admissions among older Pennsylvanians declined, the rate for younger people under the age of 45 increased 38 percent over that period of time.
Diabetes admissions in Pennsylvania resulted in $205 million in payments to hospitals in 2016, but according to the Pennsylvania Health Care Cost Containment Council, about 86 percent of 2016 adult admissions could have been prevented with more timely and appropriate care and disease management.
Learn more about the prevalence of diabetes admissions in Pennsylvania in the new PHC4 research brief
“Pennsylvania Hospital Admissions for Diabetes,” which can be found here.

PA Safety Net Admin2017-11-23T06:00:14+00:00November 23rd, 2017|Uncategorized|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News.
Included in the November edition are articles about:

a proposal to impose a work requirement on Pennsylvania Medicaid recipients
the CHIP program
leadership changes in health care-related state agencies
the rollout of the Community HealthChoices program of managed long-term services and supports
HealthChoices managed care contracts
changes in several state waiver programs

Find these stories here in the latest edition of Health Law News.

PA Safety Net Admin2017-11-20T06:00:01+00:00November 20th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program.
Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments. If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients.
The 340B program is an essential source of resources for private Pennsylvania safety-net hospitals and many stand to lose hundreds of thousands of dollars, or even millions of dollars a year, if the payment cut is not reversed.
Go here to see Rep. McKinley’s news release on the bill and here to see the bill itself, which is H.R. 4392, “To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.”

PA Safety Net Admin2017-11-17T06:00:20+00:00November 17th, 2017|Pennsylvania safety-net hospitals|Comments Off

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

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