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Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
phlpThe December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more.
Find the newsletter here.

2015-12-28T06:00:32+00:00December 28th, 2015|Pennsylvania Medicaid policy|Comments Off on Latest Edition of Health Law News

CHIP On the Move

Pennsylvania Governor Tom Wolf has signed a bill that shifts responsibility for Pennsylvania’s Children’s Health Insurance Program (CHIP) from the state’s Insurance Department to its Department of Human Services (DHS).
PA_CHIP_logoThe move is designed to streamline the administration of the program and improve the delivery of services for the more than 150,000 children currently enrolled in CHIP.
DHS already administers the state’s Medicaid program, which serves more than 2.5 million Pennsylvanians.
Go here to see a state news release announcing the change.

2015-12-23T11:38:14+00:00December 23rd, 2015|Pennsylvania Medicaid policy|Comments Off on CHIP On the Move

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued a report that offers a wide range of statistics describing the performance and quality of care provided by the state’s acute-care hospitals.
phc4The report presents regional and hospital-by-hospital mortality and readmission rates for a wide variety of medical conditions, doing so on a regional basis.
It also tallies the volume of hospital patients according to medical conditions and describes who is paying for the different types of care hospitals are providing.
Go here to see the PHC4 report Hospital Performance Report: 2014 Data.
 

2015-12-18T06:00:37+00:00December 18th, 2015|Uncategorized|Comments Off on PHC4 Reports on Hospital Performance

MedPAC Meets, Discusses Payment Issues

Last week the commissioners serving on the Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C. to discuss the group’s future recommendations to Congress.
 
While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.
medpacAmong the issues MedPAC addressed during two days of public meetings were:

  • Medicare inpatient and outpatient payments
  • the Medicare Advantage program star rating system
  • payments to ambulatory surgery centers, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals
  • payments for physician services, home health services, hospice care, and outpatient dialysis

Find issue briefs on each subject, and copies of the presentations MedPAC staff made to commissioners, here on MedPAC’s web site.

2015-12-14T15:53:19+00:00December 14th, 2015|Medicare|Comments Off on MedPAC Meets, Discusses Payment Issues

Source Materials on Medicaid

The National Association of Medicaid Directors recently held its 2015 fall conference. The following are presentations made at the conference by state and federal Medicaid officials, consultants, foundation officials, associations, non-profit groups, and others.

2015-12-02T06:00:54+00:00December 2nd, 2015|Uncategorized|Comments Off on Source Materials on Medicaid

Little Outside Interest in HealthChoices

When Pennsylvania put its HealthChoices contracts up for bid, the sizeable market to be served – more than 2.5 million people – was expected to draw interest from major national managed care organizations that serve Medicaid patients.
It didn’t happen.
Instead, of the nine companies that submitted bids, only one came from a national company that did not already participate in HealthChoices: Centene, a St. Louis company that serves six million Medicaid patients in 21 states.
National Medicaid managed care organizations Anthem, Molina Healthcare, and WellCare did not bid.
Three much smaller organizations submitted bids to enter the Pennsylvania Medicaid market: Accendia, a subsidiary of Capital Blue Cross; Meridien Health Plan, a Detroit-based company serving 700,000 Medicaid recipients in six midwestern states; and Trusted Health Plan, a two-year-old plan currently serving Medicaid beneficiaries in Washington, D.C.
healthchoicesThe state is expected to award contracts in its five HealthChoices zones in January.
Read more about the bidding for HealthChoices contracts in this Philadelphia Inquirer article.

2015-12-01T06:00:16+00:00December 1st, 2015|HealthChoices PA|Comments Off on Little Outside Interest in HealthChoices

Push From Volume to Value Continues

As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care.
The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning.
cmsThe blog also describes the many programs launched by the Affordable Care Act-created Center for Medicare and Medicaid Innovation, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Comprehensive Care for Joint Replacement program, the Comprehensive Primary Care Initiative, the Independence at Home demonstration, the Bundled Payment for Care Improvement Initiative, and the State Innovation Models initiative.
Together, CMS hopes these and other programs will help achieve its stated goal of paying for 30 percent of Medicare services through alternative payment models and making 85 percent of payments based on quality or value by the end of 2016.
For a better sense of how CMS sees these efforts pushing toward its policy objectives, see the commentary “Continuing the shift from volume to results in American healthcare” here, on the CMS blog.

2015-11-30T06:00:46+00:00November 30th, 2015|Affordable Care Act, Health care reform, Medicare|Comments Off on Push From Volume to Value Continues

Feds OK Medicaid Money for Housing

The Obama administration has informed state Medicaid programs that they may use federal Medicaid money to help the chronically homeless obtain housing.
While a June bulletin to state Medicaid directors technically only clarified existing policy, it signaled states that the administration will be receptive to Medicaid waivers that propose using Medicaid funding to help the homeless obtain housing.
Increasingly, state Medicaid programs have been finding that helping the homeless with housing is a key to improving their physical and behavioral health and can offer later savings as the individuals who have received such assistance live more stable lives, especially as more homeless people qualify for Medicaid benefits in states that have expanded their Medicaid programs.
Doctor listening to patientThe Safety-Net Association of Pennsylvania (SNAP) has long identified homelessness and inadequate housing as challenges that urban safety-net hospitals face in the low-income communities they serve.
To learn more about why officials believe housing is an important part of addressing the health care needs of the homeless and how some programs attempt to provide such assistance, see this Stateline report.

2015-11-25T06:00:31+00:00November 25th, 2015|Safety-Net Association of Pennsylvania|Comments Off on Feds OK Medicaid Money for Housing

Financial Performance Mixed for PA Non-General Acute-Care Hospitals

Pennsylvania’s non-general acute-care hospitals are generally in good financial health, although their financial performance varied in FY 2014.
phc4According to a new report published by the Pennsylvania Health Care Cost Containment Council, in FY 2014

  • psychiatric hospital operating margins rose from 8.29 percent to 9.87 percent
  • long-term acute care hospital operating margins fell from 5.77 percent to 5.24 percent
  • rehab hospital operating margins decreased from 12.93 percent to 12.74 percent
  • specialty hospital operating margins more than doubled, from 5.25 percent to 11.38 percent

For a closer look at the financial performance of non-general acute-care hospitals, find links to the report Non-General Acute Care Hospitals – Volume Three here, on the web site of the Pennsylvania Health Care Cost Containment Council.

2015-11-24T06:00:17+00:00November 24th, 2015|Uncategorized|Comments Off on Financial Performance Mixed for PA Non-General Acute-Care Hospitals

Latest Edition of Health Law PA News

phlpThe Pennsylvania Health Law Project has released the latest edition of its newsletter. The November 2015 edition includes new Children’s Health Insurance Program (CHIP) benefits, Pennsylvania Medicaid’s new specialty pharmacy drug program, and Pennsylvania’s receipt of a federal planning grant for certified community behavioral health clinics.
Find the latest Health Law PA News here.

2015-11-23T06:00:47+00:00November 23rd, 2015|Pennsylvania Medicaid policy, Uncategorized|Comments Off on Latest Edition of Health Law PA News
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