The Pennsylvania Health Law Project has published its June 2016 newsletter.
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.
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 leadersLearn 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.
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.
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.
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.
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.
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.
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.
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 rateTo learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.
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.
The Pennsylvania Health Law Project has published the May 2016 edition of Health Law News, its monthly newsletter.
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.
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.