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Congressional Task Force Considers Medicaid Reforms

A House Energy and Commerce Committee group is looking at potential Medicaid reforms for 2017.
The task force, consisting entirely of Republican members, was created late last year to “… strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
energy and commerceAt a recent event at George Mason University, task force chairman Brett Guthrie (R-KY), cited continued high Medicaid spending as a reason to consider reform and noted that the degree to which the task force could tackle Medicaid in 2017 would depend on which party occupies the White House and controls Congress. He suggested that the task force would look for ways to prevent people from needing to choose between getting jobs and keeping health insurance. Among the potential legislative vehicles for reform, Guthrie said, are reauthorization of the Children’s Health Insurance Program and Medicare extenders.
Because they serve so many Medicaid and low-income patients, the task force’s deliberations will be of particular interest to Pennsylvania’s safety-net hospitals.
Learn more about the House Energy and Commerce Committee’s Medicaid Task Force here and about Rep. Guthrie’s remarks at the George Mason University forum here.

2016-05-13T06:00:47+00:00May 13th, 2016|Uncategorized|Comments Off on Congressional Task Force Considers Medicaid Reforms
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Affordability a Challenge for Many Newly Insured

Many Americans who have obtained private health insurance through the Affordable Care Act continue to have problems affording health care.
According to a Kaiser Family Foundation report based on focus groups six states, low-income individuals with new private insurance report continued problems with:

  • kaisermedical debt
  • affording care that is not covered by their insurance plans
  • handling out-of-pocket expenses, including deductibles
  • unexpected bills for treatment they thought was covered

Such patients pose a challenge for many Pennsylvania safety-net hospitals because of their inability to afford their co-pays and deductibles, leaving these hospitals with unexpected uncompensated care and bad debt. Because they care for more low-income patients than the average hospital, this is a bigger problem for the state’s safety-net hospitals.
For a closer look at how the study and focus groups were conducted and what they found, go here for the Kaiser Family Foundation report Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities.

2016-05-11T06:00:32+00:00May 11th, 2016|Affordable Care Act, Uncategorized|Comments Off on Affordability a Challenge for Many Newly Insured
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New Tools for Addressing Old Medicaid Problems

The new federal Medicaid managed care regulation gives state Medicaid programs new tools with which to address longstanding Medicaid challenges.
In an article titled “The Medicaid Managed Care Rule: The Major Challenges States Face,” the Commonwealth Fund describes the tools the rule does and does not offer for addressing five major Medicaid challenges:

  • commonwealth fundreaching medically underserved communities
  • unstable eligibility and enrollment
  • organizing coverage an care and developing effective payment incentives
  • aligning managed care with health, education, nutrition, and social services
  • information technology

Find the article here, on the Commonwealth Fund’s web site.

2016-05-10T06:00:30+00:00May 10th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on New Tools for Addressing Old Medicaid Problems
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Background Information on Payment Methodologies and Benefit Design

The Urban Institute has issued two new papers with background information on health care payment methodologies and the design of health care benefits packages.
The first paper, Payment Methods: How They Work, describes nine payment methodologies:

  • fee schedules
  • primary care capitation
  • per diem payments to hospitals for inpatient visits
  • DRG-based payments to hospitals for inpatient visits
  • global budgeting for hospitals
  • bundled payments
  • global capitation for organizations
  • shared savings
  • pay for performance

The second paper, Benefit Designs: How They Work, explains seven different types of benefit designs:

  • value-based design
  • high-deductible health plans
  • tiered networks
  • narrow networks
  • reference pricing
  • centers of excellence
  • benefit design for alternative sites of care

urban institute 2A third paper, Matching Payment Methods with Benefit Designs to Support Delivery Reforms, describes how to match benefit designs with payment methods.
Go here to find Payment Methods: How They Work.
Go here to find Benefit Designs: How They Work.
And go here to find Matching Payment Methods with Benefit Designs to Support Delivery Reforms.

2016-05-09T06:00:00+00:00May 9th, 2016|Health care reform|Comments Off on Background Information on Payment Methodologies and Benefit Design
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Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April 2016 edition of Health Law News, its monthly newsletter.
phlpIncluded in this edition are articles about a new, faster process the state has introduced for people to enroll in Medicaid; the awarding of contracts to managed care organizations to participate in the state’s HealthChoices program; an update on the Community HealthChoices program that will help nursing home-eligible seniors remain independent in the community; new funding for the state’s “Money Follows the Person” demonstration program; and more.
Find the latest edition of Health Law News here.

2016-05-06T06:00:03+00:00May 6th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off on Pennsylvania Health Law Project Releases Monthly Newsletter
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PA Awards HealthChoices Managed Care Contracts

Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program.
healthchoicesEight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions.
All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members.
Learn more about who won the contracts and how the winners will be expected to perform differently than HealthChoices managed care organizations have in the past in this state news release.

2016-05-05T06:00:56+00:00May 5th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off on PA Awards HealthChoices Managed Care Contracts
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PA Medicaid: One Year, 625,000 New Beneficiaries

Last week marked the one-year anniversary of Pennsylvania’s Affordable Care Act-authorized expansion of its Medicaid program.
In that year, nearly 625,000 Pennsylvanians enrolled in the program.
Among them,

  • 46 percent are under the age of 35
  • 109,000 are parents
  • 300,000 are employed

pa healthchoices regions
If past Medicaid utilization patterns hold true, most of these new Medicaid beneficiaries will receive most of their health care benefits from the state’s private safety-net hospitals.
Learn more about Pennsylvania’s Medicaid expansion, who has taken advantage of it, and how the program has changed in the past three years in this state news release.
 

2016-05-04T06:00:05+00:00May 4th, 2016|Affordable Care Act, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on PA Medicaid: One Year, 625,000 New Beneficiaries
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Data-Sharing Could Help Address “High-Fliers”

A new study suggests that hospitals might better serve frequent emergency room patients if they share data with one another.
jama internal medicineAccording to a new report in the journal JAMA Internal Medicine, nearly 70 percent of “high-fliers” – patients known to make repeated visits to hospital ERs – visited more than one hospital ER in a study of patients who had more than five ER visits in Maryland in 2014. As a result, individual hospitals may not have a complete picture of such patients’ medical issues and the frequency with which they are turning to hospitals for care – a problem that could detract from individual hospitals’ attempts to find better ways to serve such patients.
A possible solution, the study suggests, is better information-sharing among hospitals.
Pennsylvania’s safety-net hospitals serve more such patients than the typical hospital because their communities have more low-income and uninsured residents with limited access to medical care.
To learn more about the study and its implications for efforts to reduce overuse of hospital ERs, go here to find the JAMA Internal Medicine study “The Adequacy of Individual Hospital Data to Identify High Utilizers and Assess Community Health.”

2016-05-03T06:00:01+00:00May 3rd, 2016|Uncategorized|Comments Off on Data-Sharing Could Help Address “High-Fliers”
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  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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