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

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

Examining Medicare’s Skilled Nursing Facility Three-Day Inpatient Stay Requirement

The Congressional Research Service has prepared a new report that takes a look at the requirement that Medicare patients spend three days as hospital inpatients before Medicare will pay for post-discharge skilled nursing care.
The report reviews the current requirements for Medicare coverage of skilled nursing care, describes the role of hospital outpatient observation care in clouding the question of whether individual patients have spent three days in the hospital, and examines proposals for changing the three-day requirement. It also addresses the need for greater transparency in hospital decisions to classify patients as under observation status rather as inpatients, the need to educate patients about the impact of such classification decisions, and the potential impact of changing the current policy.
Go here to see the CRS report Medicare’s Skilled Nursing Facility (SNF) Three-Day Inpatient Stay Requirement.

PA Safety Net Admin2016-06-17T06:00:14+00:00June 17th, 2016|Medicare|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the May 2016 edition of Health Law News, its monthly newsletter.
phlp Included in this edition are articles about a new federal managed care regulation and federal policy governing balance billing of dual-eligible (Medicare- and Medicaid-covered) individuals. The newsletter also takes a look at Pennsylvania one year after the state expanded its Medicaid program and offers an update on Community HealthChoices, the new program of managed long-term services and supports the state intends to implement.
Find the latest edition of Health Law News here.

PA Safety Net Admin2016-06-16T06:00:37+00:00June 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

New MLTSS Program Delayed Six Months

The launch of Community HealthChoices, Pennsylvania’s new approach to the delivery of managed long-term services and supports for seniors eligible for both Medicare and Medicaid, will be delayed six months.
The program was scheduled to begin in southwestern Pennsylvania on January 1, 2017 but state officials recently announced that they have pushed back the start date to July 1, 2017.
In a message to interested parties, state officials wrote that

The decision to extend our start date builds on this approach and allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved. We will continue to work with all stakeholders, such as the Area Agencies on Aging and Centers for Independent Living, on a robust CHC education and outreach effort to ensure that we reach as many consumers and caregivers as possible.

The time-frame for implementation in other parts of the state remains unchanged.
To learn more about what Community HealthChoices is and why its launch has been delayed, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2016-06-15T06:00:05+00:00June 15th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Hepatitis C Treatment Challenges PA’s Medicaid Program

The cost of treating Medicaid patients who suffer from hepatitis C is posing a challenge to Pennsylvania’s Medicaid program.
As new, more expensive, but more effective hepatitis C drugs reach the market, the state’s costs for treating Medicaid patients with the disease have doubled since 2013.
Meanwhile, the state continues to consider at what point in the progression of their hepatitis C Medicaid patients should be offered the most expensive drugs.
Prescription Medication Spilling From an Open Medicine Bottle Current guidelines are evolving both in the state and nationally, with medical authorities and federal regulators weighing in with their views. Recently, an advisory committee to the Pennsylvania Department of Human Services offered its own recommendations for criteria for prescribing the most expensive drugs.
Learn more about the issue, the cost of treatment, and current Pennsylvania Medicaid policy on when hepatitis C patients must be offered the most expensive drugs and how that policy might be changing in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2016-06-14T11:23:40+00:00June 14th, 2016|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Uncategorized|Comments Off

Fewer People Skipping Care for Financial Reasons

Fewer Americans are choosing not to pursue medical care for financial reasons, according to new information from the Centers for Disease Control and Prevention.
According to the CDC’s National Health Interview Survey, 4.5 percent of the people surveyed reported not getting medical attention they needed for financial reasons in 2015, down from 6.9 percent in 2009 and 2010.
This suggests that the Affordable Care Act’s changes in providing access to health insurance are making a different in the ability of people to get the care they believe they need.
Prior to the reform law’s passage, the proportion of people reporting that they chose not to seek care for financial reasons had been rising steadily since 1998.
This is good news for Pennsylvania safety-net hospitals, which often must deal with the medical and financial implications of serving especially large numbers of patients who, for financial reasons, have had limited and sporadic contact with the health care system over the years.
To learn more about the survey’s findings see this CQ HealthBeat report presented by the Commonwealth Fund and go here to see the CDC report Early Release of Selected Estimates Based on Data From the 2015 National Health Interview Survey.

PA Safety Net Admin2016-06-06T06:00:03+00:00June 6th, 2016|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

2015 Financial Performance Mixed for PA Hospitals

Most Pennsylvania acute-care hospitals fared well financially in 2015.
But not all of them.
According to a new report issued by the Pennsylvania Health Care Cost Containment Council, total acute-care hospital margins fell 0.01 percentage points in 2015 but operating margins rose 1.21 percentage points.
49 of the state’s 170 acute-care hospitals lost money on operations and 46 lost money overall.
phc4 Other highlights:

uncompensated care fell 8.6 percent
inpatient days declined for the eighth straight year
outpatient visits rose 2.5 percent
53.7 percent of net patient revenue came from inpatient care

Go here for a news release summarizing PHC4’s finding and go here to see the complete report Financial Analysis 2015: An Annual Report on the Financial Health of Pennsylvania Hospitals, which includes state-wide analyses and performance data on individual hospitals.

PA Safety Net Admin2016-06-03T06:00:51+00:00June 3rd, 2016|Uncategorized|Comments Off

Homeless Health Care Costs Driven More by Hospital Stays Than ER Visits

Extended hospital stays and not frequent visits to hospital emergency rooms constitute the greatest cost in caring for homeless Medicaid patients, a new analysis has found.
A review of 1100 homeless people served by the Boston Health Care for the Homeless Program found that while repeated visits to the ER do constitute a problem for caregivers, the cost of those visits is dwarfed by costs associated with the same patients spending long periods of time in the hospital.
According to the review, 30 percent of the group’s Medicaid costs were for hospital stays while only four percent were for ER services. The homeless frequently spend more time in the hospital because they are in such poor overall health.
In recent years, providers have focused much of their attention on frequent ER visitors – so-called “frequent flyers” or “super-utilizers” – but the experience of the Boston program suggests that conditions that lead to long periods of hospitalization among the homeless may need more attention as well.
Because of where they are located, Pennsylvania safety-net hospitals serve far more homeless patients than the typical hospital.
For a closer look at the Boston program and what its leaders learned, see this Boston Herald article.

PA Safety Net Admin2016-06-01T06:00:44+00:00June 1st, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments.
Under the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments.
According to a Ways and Means summary of the bill,

Section 201 provides for an exception to section 603 of the Bipartisan Budget Act of 2015 (BBA’15) for those hospital outpatient departments (HOPDs) that were defined as “mid-build” prior to November 2, 2015. “Mid-build” is defined as a provider that had a binding written agreement with an outside, unrelated, party for the actual construction of the HOPD. To qualify as “mid-build,” each HOPD will be required to submit a certification from the provider’s Chief Executive Officer/Chief Operating Officer that the HOPD meets the definition of mid- build prior to July 1, 2016. Further, each mid-build HOPD will be required to submit an attestation that it meets the requirements of being provider-based (42 Code of Federal Regulations 413.65) by July 1, 2016. In addition, the section also requires the Secretary to audit the accuracy of these attestations. HOPDs that meet all of above requirements will receive the full HOPD payment rate beginning January 1, 2018 instead of the lower physician fee schedule or ambulatory surgical center payments required under the BBA’ 15. Finally, those off-campus HOPDs that submitted a voluntary attestation prior to December 2, 2015 will receive the full HOPD payment rate beginning January 1, 2017.

To learn more about this and other provisions of H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016, go here to see the Ways and Means Committee’s summary of the bill and go here to see the bill itself.

PA Safety Net Admin2016-05-26T06:00:30+00:00May 26th, 2016|Medicare|Comments Off

Help on the Way for Those With Hepatitis C?

Pennsylvanians insured by Medicaid who have Hepatitis C have often found themselves blocked from access to new treatments that can cure the disease.
But that may be changing.
Prescription Medication Spilling From an Open Medicine Bottle While states’ finances have been groaning under the cost of new budget-busting treatments, a growing trend is to increase access to the costly treatments rather than keep it very limited.
Last week the Pharmacy and Therapeutics Committee of the state’s Medicaid program voted to ease the state’s current limits on access to treatment that costs between $31,000 and $58,000 a patient. Currently, about 30,000 Pennsylvania Medicaid beneficiaries suffer from Hepatitis C and another 10,000 are thought to be infected but not yet suffering.
The committee’s vote is advisory; the final decision rests with Department of Human Services Secretary Ted Dallas.
Learn more about the state of Hepatitis C treatment in Pennsylvania’s Medicaid program and the changes that may be coming in this Philadelphia Inquirer article.

PA Safety Net Admin2016-05-25T06:00:28+00:00May 25th, 2016|Pennsylvania Medicaid policy|Comments Off

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