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

Medicaid Directors Seek Help With Hepatitis C Drugs

The combination of new cures for hepatitis C, the high cost of those cures, and the large population of low-income people suffering from the disease has the nation’s Medicaid directors asking for help from Congress.
“Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment,” the National Association of Medicaid Directors declared in a recent news release.
To help them address the high cost of providing a new generation of drugs to the estimated one million Medicaid recipients with hepatitis C, Medicaid directors have asked Congress to introduce policies that reduce the prices of those drugs or give states bigger rebates for purchasing them, noting that states have neither “…the financial capacity to cover the full cost of these treatments” nor “…the clear statutory authority to effectively and efficiently administer the program.”
Pennsylvania is in the midst of examining its policies regarding authorizing the use of expensive drugs to treat Medicaid patients with hepatitis C and is expected to make those drugs more widely available in the near future.
Learn more about the challenges state Medicaid programs face when serving beneficiaries with hepatitis C and the help they seek from Congress in this news release from the National Association of Medicaid Directors.

PA Safety Net Admin2016-07-12T06:00:12+00:00July 12th, 2016|Pennsylvania Medicaid policy, Uncategorized|Comments Off

CMS Proposes 2017 Medicare Outpatient Payment Policies

The Centers for Medicare & Medicaid Services has revealed how it proposes paying hospitals for Medicare-covered outpatient services in 2017.
Bookshelf with law books Among other matters, the 764-page proposed regulation addresses:

proposed rate increases for outpatient and ambulatory surgery center services;
new site-neutral outpatient payment policies;
changes in the value-based purchasing program;
changes in hospital outpatient quality reporting requirements;
electronic health record policies; and
changes in ambulatory surgical center quality reporting requirements.

Interested parties have until September 6 to submit written comments to CMS. The final rule will be published later this year and take effect on January 1, 2017. To learn more about what CMS has proposed for Medicare outpatient payments go here to see a CMS fact sheet and here to see the proposed regulation itself.

PA Safety Net Admin2016-07-08T06:00:26+00:00July 8th, 2016|Medicare|Comments Off

New Approach to Super-Utilizers: Free Housing

A Chicago hospital is experimenting with a new way of serving its most frequent uninsured ER visitors: arranging for free housing.
The University of Illinois Hospital has found that many of its most frequent ER patients, while suffering from numerous and chronic medical problems, turn to its ER for overnight accommodations during harsh weather. Under a pilot program, the hospital is spending $1000 a month to put its homeless super-utilizers into free housing.
With overnight hospital stays for uninsured patients costing $3000, the program offers the potential for significant savings for the hospital. In addition to free housing, participating patients are assigned a case manager to help coordinate their health care needs.
Such patients can be found outside of places like Chicago that have occasionally harsh weather, and so-called super-utilizers frequent hospitals because of medical problems, not just harsh weather. In fact, about half of overall Medicaid spending is for just five percent of the program’s 55 million participants. Pennsylvania’s safety-net hospitals serve significant numbers of such patients.
Learn more about how the University of Illinois Hospital is attempting to meet the needs of its uninsured super-utilizers in this report from National Public Radio.

PA Safety Net Admin2016-07-06T06:00:42+00:00July 6th, 2016|Pennsylvania safety-net hospitals|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its June 2016 newsletter.
phlp Included in this edition are stories about the delay in implementation of the state’s Community HealthChoices program of managed long-term services and supports for the dually eligible; challenges for those seeking home and community-based services from state waiver programs; and more.
Find the newsletter here.

PA Safety Net Admin2016-06-30T06:00:21+00:00June 30th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

CMS Proposes Changes in Terms of Medicare, Medicaid Provider Participation

The Centers for Medicare & Medicaid Services has proposed changes in the terms under which hospitals may participate in Medicare and Medicaid.
Among those changes, hospitals must:

establish an infection prevention and control program with qualified leaders
establish an antibiotic stewardship program with qualified leaders
establish policies prohibiting discrimination based on race, color, religion, national origin, general, sexual orientation, age, and disability
incorporate readmission and hospital-acquired conditions information into their Quality Assessment and Performance Improvement program
improve their medical record-keeping and provide for patient access to those records

Learn more what CMS has proposed and why it has proposed it in this CMS news release and this CMS fact sheet. CMS is accepting comments about the proposed changes until August 15. Find a link to the proposed rule itself here.

PA Safety Net Admin2016-06-28T06:00:07+00:00June 28th, 2016|Medicare|Comments Off

MACPAC Submits Annual Report to Congress

The non-partisan agency that advises Congress on Medicaid and Children’s Health Insurance Program issues has submitted its annual report to Congress.
In that report, the Medicaid and CHIP Payment and Access Commission offers an overview of historical federal spending on Medicaid, noting that Medicaid spending per beneficiary is growing slower than health care spending covered by Medicare and private insurance.
The MACPAC report also examines different approaches to Medicaid financing, including block grants, capped allotments, per capita limits, and more, reviewing the impact changes in Medicaid financing could have on care, state financing, providers, and state decision-making authority.
macpac In addition, MACPAC looks at the more than 100 different tools used at the state level to assess the functional capabilities of individuals who may be eligible for Medicaid-funded long-term services and supports.
For a closer look at what MACPAC had to say about these and other Medicaid- and CHIP-related issues, go here for a news release accompanying its annual report and a link to that report.

PA Safety Net Admin2016-06-24T06:00:11+00:00June 24th, 2016|Uncategorized|Comments Off

Medicare Notification of Observation Care Requirement Set

Beginning on August 6, hospitals will be required to notify patients if they are under observation care and have not formally been admitted to the hospital.
The new policy, required by last year’s Notice of Observation Treatment and Implication for Care Eligibility Act, requires hospitals to provide a written notice to patients “in plain language” explaining that they have not been admitted to the hospital and how that might affect what they owe the hospital for the care they receive and their eligibility for follow-up services. Hospitals will be required to provide this information no more than 36 hours after the observation care has begun.
Hospital building More than two million Medicare patients were hospitalized under observation status in 2014.
Learn more about the new policy, what it means, and some of the challenges it may pose in this Kaiser Health News article.

PA Safety Net Admin2016-06-23T06:00:08+00:00June 23rd, 2016|Medicare|Comments Off

SNAP Asks Legislature for Help With State Budget

The Safety-Net Association of Pennsylvania has asked Pennsylvania’s General Assembly to restore all funding for Medicaid ob/nicu, burn center, and critical access hospital payments and not to increase current hospital assessments in Pennsylvania’s FY 2017 budget.
In SNAP’s view, maintaining vital Medicaid funding is critical to ensuring that hospitals in general, and safety-net hospitals in particular, can deliver quality health care services to the state’s growing Medicaid population while also investing in innovative ways to improve the quality and efficiency of health care for all Pennsylvanians.
See SNAP’s FY 2017 budget advocacy document here.

PA Safety Net Admin2016-06-22T06:00:53+00:00June 22nd, 2016|Uncategorized|Comments Off

Medicaid Expansion Producing Benefits for Safety-Net Providers

Seeing fewer uninsured patients, safety-net hospitals in states that have expanded their Medicaid programs as provided for under the Affordable Care Act are finding themselves able to use money previously caring for the uninsured for things like more and better primary and behavioral health services, more staff, new or improved health centers and clinics, and better equipment.
This conclusion is drawn in a new study from the Georgetown University Health Policy Institute based on interviews with leaders of eleven hospital systems and federally qualified health centers (FQHCs) in seven states: four that expanded their Medicaid programs and three that did not.
While Pennsylvania was not one of the states included in the study, it is one of more than 30 states that has expanded its Medicaid program.
To learn more about what the study revealed, go here to read Beyond the Reduction in Uncompensated Care: Medicaid Expansion is Having a Positive Impact on Safety Hospitals and Clinics.

PA Safety Net Admin2016-06-21T06:00:03+00:00June 21st, 2016|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

SNAP Comments on Proposed Medicaid Observation Care Payment

The Safety-Net Association of Pennsylvania has written to the state’s Department of Human Services about DHS’s proposal to establish a payment policy for hospital observation services covered by the state’s Medicaid fee-for-service program.
While SNAP has long supported the concept of a Medicaid fee-for-service rate for observation services and welcomes DHS’s decision to create such a rate and associated policies, it expressed a number of concerns about DHS’s proposal, including about:

the proposed observation rate
the classification of observation care as an outpatient service
the manner in which the state proposes financing observation care
program integrity issues

To learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.

PA Safety Net Admin2016-06-20T06:00:37+00:00June 20th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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