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

Pennsylvania Health Law Project Newsletter

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

new starting dates for the beginning of new HealthChoices physical health contracts
an update on Community HealthChoices, the state’s planned program of managed long-term services and supports for those who qualify for nursing home care but wish to continue living independently in the community
the launch of the state’s ABLE Savings Program through which children and adults with significant disabilities can open special state-sponsored investment accounts
the introduction of a new assessment tool for people in need of substance disorder treatment

Find the latest edition of PA Health Law News here.

PA Safety Net Admin2017-04-06T06:00:52+00:00April 6th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

To Require Work or Not to Require Work

That is the question policy-makers are asking as they consider imposing work requirements on healthy Medicaid participants.
In recent years a number of states have attempted to establish such a requirement, only to have their requests to do so rejected by regulators in Washington, and a clause permitting states to establish such a requirement was included last month in the eventually sidetracked American Health Care Act. Even now, a Kentucky Medicaid waiver application under consideration by the Centers for Medicare & Medicaid Services includes a work requirement.
Does the lack of a work requirement encourage people in Medicaid expansion states to withdraw from the workforce?
Is a work requirement a way to raise the income of beneficiaries just enough to cost them their Medicaid eligibility?
Are there jobs available for beneficiaries if such a requirement were to be imposed?
And aren’t many able-bodied Medicaid beneficiaries already working?
This issue is of particular interest to Pennsylvania safety-net hospitals because they serve such large numbers of Medicaid patients.
The Urban Institute looks at these and other Medicaid work-related issues in the new paper “Rationale for Medicaid work requirements not supported by evidence.” Find that paper here.

PA Safety Net Admin2017-04-05T06:00:54+00:00April 5th, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

CMS Clarifies Medicaid DSH Rule

Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs. This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit.
According to CMS,

This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients.

The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments. This is consistent with the statutory requirements governing Medicaid DSH and applicable limits.

All Pennsylvania safety-net hospitals receive Medicaid DSH payments.
See the full rule here.

PA Safety Net Admin2017-04-04T06:00:05+00:00April 4th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Presentation on Value-Based Purchasing in PA Medicaid

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.

PA Safety Net Admin2017-04-03T11:38:31+00:00April 3rd, 2017|HealthChoices, Pennsylvania Medicaid policy|Comments Off

Temporarily Gone But Not Forgotten

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:

why such a switch would matter to low-income seniors at all
how it might change federal funding of Medicaid for low-income seniors
how states might react in ways that would affect low-income seniors
how it might affect the providers who serve low-income seniors
how such an approach might vary from state to state

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?”

PA Safety Net Admin2017-03-31T06:00:22+00:00March 31st, 2017|Federal Medicaid issues, Medicare, Pennsylvania safety-net hospitals|Comments Off

CMS Shares Evaluation of Medicare-Medicaid Financial Alignment Efforts

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.

PA Safety Net Admin2017-03-29T06:00:43+00:00March 29th, 2017|Federal Medicaid issues, Medicare, Uncategorized|Comments Off

MACPAC Looks at Medicaid DSH

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.

PA Safety Net Admin2017-03-24T06:00:43+00:00March 24th, 2017|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MACPAC Meets, Discusses Medicaid Issues

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:

state Medicaid flexibility
state Medicaid responses to fiscal pressures
a study requested by Congress on mandatory and optional benefits and populations
current Medicaid parallels to per capita financing options
illustrations of state-level effects of per capita cap design elements
high-cost hepatitis C drugs
the role of section 1915(b) waivers in Medicaid managed care

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.

PA Safety Net Admin2017-03-23T06:00:24+00:00March 23rd, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

PA Proposes Changes in County Assistance Office Operations

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.

PA Safety Net Admin2017-03-21T06:00:22+00:00March 21st, 2017|Pennsylvania Medicaid policy|Comments Off

PA Takes Steps to Fight Opioid Epidemic

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.

PA Safety Net Admin2017-03-15T06:00:56+00:00March 15th, 2017|Pennsylvania Medicaid policy|Comments Off

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