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

Amid Rising Improper Medicaid Payments, CMS Offers Help

With improper Medicaid payments nearly twice as high as they were just a few years ago, the Centers for Medicare & Medicaid Services is reaching out to state Medicaid programs with suggestions for how to reduce those improper payments.
The problem?
According to CMS,

States are facing greater challenges keeping pace with stricter enrollment requirements, tracking providers who have been excluded from other States’ or Federal health care programs, and generally adapting to changing regulations for qualifications of certain provider types.

In a new e-alert, CMS identifies factors that contribute to improper payments – things like ineligible and excluded providers, provider identity theft, medical services not provided, phantom or invalid provider addresses and ID numbers, and more. For each factor it identifies in the new e-alert CMS suggests solutions and directs interested parties to resources that can help them with those solutions.
To learn more about the extent of improper Medicaid payments and their recent increase, what has contributed to that rise, and possible solutions go here to see the CMS e-alert “Medicaid Improper Payments.”

PA Safety Net Admin2016-09-06T06:00:22+00:00September 6th, 2016|Uncategorized|Comments Off

NIH Launches Research on Health Disparities in Disadvantaged Communities

The National Institutes of Health is launching a new Transdisciplinary Collaboratives Centers for Health Disparities Research on Chronic Disease Prevention program that seeks to respond to

…the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, under-served rural populations, people of less privileged socio-economic status, along with groups subject to discrimination who have poorer health outcomes often attributed to being socially disadvantaged. Two centers will focus their research efforts on development, implementation, and dissemination of community-based, multilevel interventions to combat chronic diseases such as heart disease, cancer and diabetes.

Anticipated funding over the first five years of the program is approximately $20 million.
In announcing the program, the NIH noted that

Heart disease, stroke, cancer, diabetes, and arthritis are among the most common, costly and preventable of all health problems. Many of these conditions disproportionately affect health disparity populations and in advanced stages can lead to significant limitations in activities of daily living.

These are the very health challenges that Pennsylvania’s safety-net hospitals tackle regularly – and far more often than the typical community hospital.
To learn more about what the program seeks to accomplish and the health challenges it anticipates addressing, see this NIH news release.

PA Safety Net Admin2016-09-02T06:00:16+00:00September 2nd, 2016|Uncategorized|Comments Off

Journal Looks at Health Disparities

The journal Health Affairs looks at health disparities and social determinants of health in its Augusts 2016 issue.
The article “Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health” looks at interventions that focus on social determinants of health, addresses how such interventions can reduce health disparities and improve population health, and considers the challenges to implementing such approaches. Find it here.
The article “Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research” also looks at health care disparities and how to address them, focusing on cardiovascular disease and cancer. Find it here.
Communities served by Pennsylvania’s safety-net hospitals usually suffer from the very health disparities policy-makers are currently working to address.

PA Safety Net Admin2016-09-01T06:00:22+00:00September 1st, 2016|Pennsylvania safety-net hospitals|Comments Off

PA Launches Prescription Drug Monitoring Program

Pennsylvania’s Department of Health has launched its much-anticipated prescription drug monitoring program.
Previously operated by the state’s office of the attorney general but assigned to the state’s Health Department through 2014 legislation, the program requires those authorized to prescribe controlled substance prescription drugs to collect and submit information to the PDMP each time they do so within 72 hours. That information is then stored in a database that is available to health care professionals to help them identify patients who may have problems with controlled substances or may even be going from provider to provider to gain additional prescriptions.
department of health The state Health Department has created a web site for the program that includes FAQs about how the PDMP works for those who prescribe and dispense controlled substances. Visit that web site here.

PA Safety Net Admin2016-08-31T06:00:46+00:00August 31st, 2016|Uncategorized|Comments Off

PA Ratchets Up Battle Against Opioid Abuse

The Commonwealth of Pennsylvania will create 25 new Opioid Use Disorder Centers of Excellence, joining 20 similar centers established last year.
According to a news release from the office of Pennsylania Governor Tom Wolf,

The additional COEs announced today will serve at least 5,600 additional individuals. The COEs are a central, efficient hub around which treatment revolves. These centers will have navigators to assist people with opioid-related substance use disorders through the medical system, and ensure they receive behavioral and physical health care, as well as any evidence-based medication-assisted treatment needed.

wolf The centers are funded in part by state behavioral health funds, in part by state Medicaid funds, and in part by federal Medicaid matching funds.
Learn more about the Centers of Excellence approach to combating opioid abuse and find a list of the new centers in this Wolf administration news release.

PA Safety Net Admin2016-08-30T13:08:35+00:00August 30th, 2016|Uncategorized|Comments Off

Who’s Still Uninsured?

Hispanics.
Young people between the ages of 19 and 34.
Men.
Low-income people, especially those living in states that have not expanded their Medicaid programs.
People in the South – again, especially those living in states that have not expanded their Medicaid programs.
Those who work for small companies.
The uninsured rate in the U.S., 20 percent before the Affordable Care Act took effect, is now 13 percent.
Learn more about how the Affordable Care Act has changed the rate at which different groups of Americans are insured in this Commonwealth Fund survey.

PA Safety Net Admin2016-08-29T06:00:54+00:00August 29th, 2016|Affordable Care Act|Comments Off

CMS Proposes Medicaid DSH Rule

The Centers for Medicare & Medicaid Services has proposed a new rule that would clarify the basis for eligible hospitals’ Medicaid disproportionate share hospital payments (Medicaid DSH).
Individual hospitals’ Medicaid DSH payments are based on their uncompensated care costs and the rule clarifies that only uncompensated costs for Medicaid patients for whom hospitals receive no other payments, such as from Medicare, state or local governments, or third-party payers, would count toward their hospital-specific Medicaid DSH limit.
See the rule here. Interested parties have until September 15, 2016 to submit formal comments to CMS about its proposal.
Representatives of Pennsylvania safety-net hospitals who would like to know more about how this proposal might affect their hospital can use the “contact us” link on this screen to seek further information.

PA Safety Net Admin2016-08-25T06:00:21+00:00August 25th, 2016|Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

Price Transparency Report Released by PA Department of Health

The Pennsylvania Department of Health has published a report it commissioned on the state of health care price transparency in the commonwealth.
Health Benefits Claim Form The report, prepared by the organization Catalyst for Payment Reform, seeks to

… evaluate the level and robustness of health care price transparency in the Commonwealth of Pennsylvania today and the opportunities to enhance it going forward. The report reviews and assesses the legal and regulatory landscape related to price transparency; identifies and compares the best practices of other states that are leading the country in enhancing price transparency; summarizes results from a CPR-conducted evaluation of consumer-facing transparency tools offered by health insurance plans; identifies gaps in price and quality transparency in the state; and lastly, provides actionable recommendations for furthering price transparency to the Commonwealth based on our research, as well as CPR’s expertise in this area.

Find the report here, in the “innovation” section of the web site of Pennsylvania’s Department of Health.

PA Safety Net Admin2016-08-24T06:00:23+00:00August 24th, 2016|Uncategorized|Comments Off

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations.
If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities. If this trend holds true in Pennsylvania, it could be harmful to many of the communities served by the state’s safety-net hospitals.
To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

PA Safety Net Admin2016-08-23T10:41:08+00:00August 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

PA Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.
The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment.
HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.
The Pennsylvania Department of Human Services has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.

PA Safety Net Admin2016-08-18T06:00:42+00:00August 18th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

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