Pennsylvania’s Medicaid program is moving toward greater use of value-based purchasing in its Medicaid behavioral health programs.
Last week, the state’s Office of Mental Health and Substance Abuse Services held a webinar to offer information about the state’s plan for employing value-based purchasing in Medicaid and how it will do so for behavioral health services in particular. Go here to see the presentation delivered at that webinar.
While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well: replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants.
In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid. Among the issues the brief addresses are:
Any move to Medicaid per capita limits or block grants could have serious implications for Pennsylvania safety-net hospitals and the communities they serve because these hospitals serve so many dually eligible Medicare/Medicaid patients.
Learn more about a possible change in how the federal government pays for its share of the Medicaid program that will surely find its way into future health policy discussions and debates in the Kaiser Family Foundation issue brief “What Could a Medicaid Per Capita Cap Mean for Low-Income People on Medicare?”
In 2011 the Centers for Medicare & Medicaid Services launched a “Medicare-Medicaid Financial Alignment Initiative” that seeks “…to provide Medicare-Medicaid enrollees with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.”
How is that initiative working so far? CMS recently released three reports that evaluate different aspects of the program. Those reports are:
Pennsylvania’s private safety-net hospitals serve especially large numbers of dually eligible Medicare and Medicaid beneficiaries, so such programs are always of special interest to them.
In addition to viewing the reports, go here to learn more about the Medicare-Medicaid Financial Alignment Initiative.
Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act.
So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues.
In its March 2017 report to Congress, MACPAC writes that
In both expansion and non-expansion states, deemed DSH hospitals, which are statutorily required to receive DSH payments because they serve a high share of Medicaid-enrolled and low-income patients, continue to report negative operating margins before DSH payments.
This finding reflects the experience of Pennsylvania safety-net hospitals, most of which consider Medicaid DSH to be absolutely critical to their financial health and continued ability to serve their communities.
Learn more about this evaluation, and other facets of the Medicaid DSH program, in this March 2017 report from MACPAC to Congress. Find a summary of the report here.
Members of the non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program matters met in Washington recently to discuss a number of issues.
On the agenda of the Medicaid and CHIP Payment and Access Commission were the following issues:
Because Pennsylvania safety-net hospitals serve so many Medicaid and CHIP participants, MACPAC’s deliberations are especially important and relevant to them.
Go here for a link to overviews of these issues and the presentations offered at the MACPAC meeting.
The manner in which Pennsylvania operates its county assistance offices would change under a new proposal from the Department of Human Services that was included in Governor Wolf’s proposed FY 2018 budget.
Under the plan, the state would consolidate county assistance office back-office operations in five new regional processing centers. While every county will have what DHS is calling a county assistance office “presence,” the new approach would lead to the lay-off of 70 of the county assistance office program’s nearly 7000 employees.
The process of determining Medicaid eligibility in Pennsylvania either begins or works its way through the state’s county assistance offices.
Learn more about the proposal to change some aspects of county assistance office operations in this DHS notice.
The Pennsylvania Department of Human Services has announced new steps designed to combat opioid abuse within the state’s Medicaid population.
Among those steps are ensuring that only providers registered with the state’s Medicaid program can prescribe opioids and fill opioid prescriptions for Medicaid patients; monitoring the opioid-prescribing practices of participating Medicaid providers and taking actions when those practices are inappropriate; introducing new opioid prescribing guidelines; improving access to naloxone to fight opioid overdoses; expanding drug treatment programs; and more.
To learn more, see this news release from the office of Pennsylvania Governor Tom Wolf.
The Pennsylvania Health Law Project has issued a statement detailing its perspective on the recently proposed American Health Care Act, which would both repeal and replace the Affordable Care Act of 2010.
See that statement here.
The non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on a variety of Medicaid and State Children’s Health Insurance Program issues met last week in Washington, D.C.
Among the issues on the agenda of the Medicaid and CHIP Payment and Access Commission were:
Because Pennsylvania safety-net hospitals serve so many low-income Medicaid and CHIP beneficiaries, MACPAC’s deliberations are often very important to them.
Go here, to the MACPAC web site, for links to documents on all of these subjects.
Pennsylvania’s plan to implement new contracts with HealthChoices physical health managed care plans on June 1 has been put on hold.
The reason: for the second time, companies that lost a public bidding process protested the state’s choices. The first time, the state threw out all the bids and started over again. This time the state says it needs more time to deal with the protests, negotiate new contracts, and get the new contractors up and running.
In addition to the delay, the new contracts will be phased in at different times in different parts of the state, with the first regional launch now scheduled for January of 2018 and the last a year later.
Learn more about why the new contracts have been delayed and how they will be implemented from this Philadelphia Inquirer article and this notice from the Pennsylvania Department of Human Services.