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

DHS Issues RFI for Vendors to Help Monitor Payments

Pennsylvania’s Department of Human Services (DHS), which administers the state’s Medicaid program, is seeking information from vendors that offer data mining and predictive analytics that might help the state monitor Medicaid and other payments.
DHS seeks to use such services to “…detect patterns of waste, fraud, and abuse in its programs on a prospective or retrospective basis.”
Among the challenges such vendors might address in their responses, as stated in the RFI, are:

Identifying claim review strategies that efficiently and proactively prevent or address potential errors (e.g., prepayment edit specifications or parameters).
Providing mechanisms to investigate patterns that may indicate abuse of services by clients.
Producing innovative views of utilization or billing patterns that illuminate potential errors.
Maximizing recoveries by identifying high volume or high cost services that are widely over utilized.
Identifying areas of potential errors (e.g., services which may be non-covered or not correctly coded) that poses the greatest risk or vulnerability.
Establishing baseline data to enable DHS to dynamically recognize unusual trends, changes in utilization over time, or schemes to inappropriately maximize reimbursement. Adapting systems, rules, and algorithms on an ad hoc basis in order to be responsive to emerging trends, patterns, and issues as they are identified.
Clearly distinguishing which applications are standardized as part of the product package and which applications will need to be purchased as a system enhancement.
Establishing baseline data and recommendations to improve the client experience related to access to services and the quality of the services received.

The call for vendors is a request for information (RFI) and not a request for proposals (RFP) but it appears likely that the state will issue an RFP after it has had an opportunity to review the information submitted to it.
RFI submissions are due on November 9. See the RFI document here.

PA Safety Net Admin2015-09-17T06:00:51+00:00September 17th, 2015|Meetings and notices|Comments Off

MedPAC Looks at Various Issues at September Public Meeting

The independent federal agency that advises Congress on Medicare payment issues held its monthly public meeting in Washington, D.C.
During the two days of meetings, the Medicare Payment Advisory Commission (MedPAC) discussed its work on six specific issues:

developing a unified payment system for post-acute care
a preliminary analysis of Medicare Advantage encounter data for Part B services
factors affecting variation in Medicare Advantage plan star ratings
Medicare drug spending
emergency department services provided at stand-alone facilities
payments from drug and device manufacturers to physicians and teaching hospitals

Each discussion was accompanied by an issue brief and a presentation; find those documents here.

PA Safety Net Admin2015-09-16T06:00:54+00:00September 16th, 2015|Medicare|Comments Off

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries.
The plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for

…Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

This is the very population served in disproportionate numbers by many of Pennsylvania’s private safety-net hospitals.
The program will focus on six priorities:

expanding the collection, reporting, and analysis of standardized data
evaluating disparity impacts and integrating equity solutions across Medicare programs
developing and dissemination promising approaches to reducing health disparities
increasing the ability of the health care workforce to meet the needs of vulnerable populations
improving communication and language access for individuals with limited English proficiency and persons with disabilities
increasing physical accessibility of health care facilities

To learn more about The CMS Equity Plan for Improving Quality in Medicare, see this CMS news release.

PA Safety Net Admin2015-09-15T06:00:58+00:00September 15th, 2015|Medicare, Pennsylvania safety-net hospitals|Comments Off

PA Insurance Commissioner to Hold Hearing on Balance Billing

Pennsylvania Insurance Commissioner Teresa Miller will hold a public hearing next month to begin exploring the practice of balance billing.
According to a department news release, the hearing will

…be an opportunity to begin exploring options to make sure consumers are informed about their care and do not face these unexpected bills without recourse, as well as to identify some possible consumer-friendly solutions to the issue. Miller believes this hearing will be a substantive first step in tackling the issue of balance billing, and giving consumers more peace of mind and predictability in coverage.

The hearing will be held on October 1 in Harrisburg.
For more information about balance billing and the issues the Insurance Department hopes to begin addressing at this hearing, see this news release.

PA Safety Net Admin2015-09-14T06:00:37+00:00September 14th, 2015|Uncategorized|Comments Off

PA Included in New Medicare Value-Based Insurance Program Demonstration

Pennsylvania is one of seven states that will participate in a new value-based purchasing demonstration program for Medicare Advantage plans.
According to a fact sheet published by the Centers for Medicare & Medicaid Services (CMS),

Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with chronic diseases. As part of the “better care, smarter spending, healthier people” approach to improving health care delivery, CMS will test VBID in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements does encourage enrollees to use health care services in a way that reduces costs.

According to CMS,

The MA-VBID model supports high-value clinical services, improved health outcomes, and health care cost savings or cost neutrality through the use of structured patient cost sharing and other health plan design elements that encourage enrollees to use high-value clinical services. The MA-VBID model will provide flexibility for Medicare Advantage plans accepted into the model to develop clinically-nuanced benefit designs for enrollee populations that fall within certain clinical categories.

The clinical conditions on which the program will focus are diabetes, chronic obstructive pulmonary disease, congestive heart failure, patients who have suffered strokes, hypertension, coronary artery disease, and mood disorders.
The program, to be launched in January of 2017, will run for five years in seven states: in addition to Pennsylvania, Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, and Tennessee will be invited to participate.
To learn more about Medicare’s new Value-Based Insurance Design programs, see this CMS news release and fact sheet.

PA Safety Net Admin2015-09-11T06:00:03+00:00September 11th, 2015|Medicare|Comments Off

Newspaper Profiles DHS Secretary

The Pittsburgh Post-Gazette has published a profile of Pennsylvania Department of Human Services Secretary Ted Dallas. His department and its Office of Medical Assistance Programs administers the state’s Medicaid program.
Find that profile here.

PA Safety Net Admin2015-09-10T06:00:52+00:00September 10th, 2015|Uncategorized|Comments Off

PA Shortens Wait Time for Medicaid Applications

Recent changes in how Pennsylvania processes Medicaid applications has greatly shortened the waiting period for gaining access to care for qualified applicants.
The waiting period during which applications were considered, approximately 70 days just a few months ago, is now much shorter, with only two percent of applicants waiting more than 30 days for a decision compared to 13 percent in January.
Most applicants, according to the Pennsylvania Department of Human Services, have an answer within 22 days.
To learn more about how the state has reduced the time it takes to review Medicaid eligibility applications as well as more about the state’s Medicaid program, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2015-09-09T06:00:51+00:00September 9th, 2015|HealthChoices PA|Comments Off

Socio-Economic Status Affects Health, Study Shows

A new study by California state public health officials has concluded that demographic factors have a major influence on individuals’ health.
Among the factors specifically cited in the study are education, employment status, gender identity, race and ethnicity, income, and sexual orientation.
In Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, the California Department of Public Health’s Office of Health Equity identifies and describes the socio-economic factors that influence health status and proposes interventions for overcoming those challenges.
SNAP has long pointed to such challenges as one of the chief distinctions between Pennsylvania’s safety-net hospitals and other hospitals in the state.
See the California report here.

PA Safety Net Admin2015-09-08T06:00:44+00:00September 8th, 2015|Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

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

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