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

Feds Issue Proposed Guidance for 340B Program

The federal Health Resources and Services Administration (HRSA) has issued proposed guidelines governing its section 340B Drug Pricing Program.
The 340B program, which requires pharmaceutical companies to provide discounted drugs for qualified providers to dispense to low-income patients, has become controversial in recent years amid a significant increase in the number of eligible providers and allegations by the pharmaceutical companies that the drugs are not being used for their intended purpose.
The proposed guidance released by HRSA seeks to clarify a number of the concerns that have been raised about the program. Among other considerations, these guidelines address entities that may participate in the program; patient eligibility requirements; and audits, records, and compliance.
For a closer look at the proposed guidelines, see this article in Becker’s Hospital Review. Find the 90-page guidance document itself here, in the Federal Register. Interested parties have until October 27 to submit written comments to HRSA about the proposed guidance.

PA Safety Net Admin2015-09-03T06:00:15+00:00September 3rd, 2015|Uncategorized|Comments Off

DHS Reorganizes

The Pennsylvania Department of Human Services (DHS), which administers the state’s Medicaid program, has reorganized both the department as a whole and its Office of Medical Assistance Programs.
New tables of organizations for both entities have been published in the Pennsylvania Bulletin. Find them here.

PA Safety Net Admin2015-09-01T06:00:43+00:00September 1st, 2015|Pennsylvania Bulletin|Comments Off

Changes Coming For Medicare Hospital-Acquired Condition Reduction Program

In response to the concerns of hospitals, Medicare is planning changes in its hospital-acquired condition reduction program.
The program, a product of the Affordable Care Act, penalizes hospitals that perform poorest on measures designed to identify medical problems their patients incur while hospitalized. Hospital performance is judged based on criteria developed by the Centers for Medicare & Medicaid Services (CMS).
In the face of criticisms about the program’s design, overlapping measures, and more, CMS now plans to share more information with hospitals about how it scores their performance and also will update some of the measures upon which those scores are based.
A recent article in the journal Health Affairs describes the hospital-acquired condition reduction program, the challenges it has faced, and CMS’s plans for it moving forward. Find that article here.

PA Safety Net Admin2015-08-12T06:00:11+00:00August 12th, 2015|Medicare|Comments Off

Is Medicare “Pay for Performance” Doing the Job?

Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care.
But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.

PA Safety Net Admin2015-08-10T06:00:27+00:00August 10th, 2015|Medicare|Comments Off

PA Seeks to Modernize, Improve Medicaid Program Integrity

The Pennsylvania Department of Human Services (DHS) has announced new steps to enhance its program integrity efforts and reduce improper and fraudulent payments, including Medicaid payments.
The proposed new approach will rely heavily on automation, analytics, and technology. Major changes include:

Consolidation of the Office of Program Integrity and Bureau of Program Integrity
Issuing a request for information for program integrity data analysis of provider payments
Implementation of a customer portal for third-party liability
Implementation of “identity proofing” of program recipients
Automating provider enrollment
Eliminating manual updating of milestone changes

In the state’s 2015 fiscal year it prevented nearly $600 million in improper payments, 74 percent of which were potential provider payments.
For a closer look at the state’s plans, see this DHS news release.

PA Safety Net Admin2015-08-07T06:00:01+00:00August 7th, 2015|Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the July edition of Health Law News, its monthly newsletter.
Included in this edition are articles about the continued expansion of Pennsylvania’s Medicaid program; the next steps in Pennsylvania’s managed long-term services and supports (MLTSS) initiative; the state’s selection of its benchmark essential health benefits insurance plan for 2017; and about how the state will phase out its current AIDS waiver while continuing to serve those covered by the waiver.
Find the latest edition of Health Law News here.

PA Safety Net Admin2015-08-05T06:00:29+00:00August 5th, 2015|Affordable Care Act, long-term care, Pennsylvania Medicaid policy|Comments Off

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD).
According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing

… an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or have fidelity to evidence-based models consistent with industry standards. In addition, we seek to support states that are interested in developing new payment mechanisms and performance quality initiatives…

The aim of this initiative is to enable states that are pursuing significant delivery system transformation efforts in the area of SUD to better identify individuals with an SUD in the Medicaid population, increase access to care for these individuals, increase provider capacity, to deliver effective treatments for SUD, and use quality metrics to evaluate the success of these interventions.

The notice outlines the specific goals of the initiative, the reforms CMS seeks, examples of the kinds of changes it envisions, the results it expects to see, and the process for pursuing section 1115 waivers to launch such initiatives.
For a more detailed look at what CMS is attempting to achieve and how it envisions states working to achieve it, see the letter “New Service Delivery Opportunities for Individuals with a Substance Use Disorder” sent by CMS to the nation’s Medicaid directors.

PA Safety Net Admin2015-07-30T06:00:07+00:00July 30th, 2015|Uncategorized|Comments Off

The Challenges Medicaid Faces

As it celebrates is fiftieth birthday, Medicaid now covers 70 million Americans at a cost of $500 billion a year. As the program continues to grow amid the expansion facilitated by the Affordable Care Act, Kaiser Health News has identified the five biggest challenges the program faces today:

controlling costs
getting all states to expand income eligibility
providing better oversight of managed care
ensuring access to doctors and dentists
meeting the growing demand for long-term care

For a closer look at these challenges and what they entail, see this Kaiser Health News article.

PA Safety Net Admin2015-07-29T06:00:55+00:00July 29th, 2015|Affordable Care Act|Comments Off

439,000 Added to PA Medicaid Rolls

150,000 Pennsylvanians have enrolled in Medicaid since the Wolf administration officially launched its HealthChoices expansion on April 27.
Added to the 289,000 who enrolled during the Corbett administration’s Healthy Pennsylvania program, that means about 439,000 Pennsylvanians have obtained Medicaid coverage since the state expanded its Medicaid program as authorized by the 2010 federal health care reform law.
To learn more about the latest Medicaid enrollments, their financial impact on the state, and how the HealthChoices expansion works, see this Wolf administration news release.

PA Safety Net Admin2015-07-27T06:00:19+00:00July 27th, 2015|Affordable Care Act, HealthChoices PA, Healthy PA|Comments Off

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.
In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.
Access to behavioral health care can be an especially major challenge in the low-income communities typically served by Pennsylvania’s safety-net hospitals.
Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

PA Safety Net Admin2015-07-24T06:00:04+00:00July 24th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

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