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

State Shares Preliminary Thoughts on HealthChoices Procurement

In anticipation of releasing a request for proposals later this year seeking health insurers interested in participating in Pennsylvania’s HealthChoices program for Medicaid beneficiaries, the state’s Department of Human Services (DHS) issued a request for information (RFI) in late May seeking input from stakeholders and interested parties on what the state might do through its next generation of HealthChoices contracts to improve the program and its delivery of care.
Now that the deadline for submitting comments has passed, DHS has released a new document that shares the comments offered most frequently by those who responded to the RFI along with brief descriptions of some of the changes the department is considering when it solicits bids for HealthChoices managed care plans later this year.
Find the original May RFI here, SNAP’s response to that RFI here, and the recent DHS follow-up document here.

PA Safety Net Admin2015-07-02T06:00:19+00:00July 2nd, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

Report on Public Health and Health Care

The Institute of Medicine (IOM) has published a report summarizing its February workshop that explored the relationship between public health and health care.
According to the IOM, the workshop

… was designed to discuss and describe the elements of successful collaboration between health care and public health organizations and professionals; reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table. The workshop presentations reflected on collaboration in four contexts: payment reform, the Million Hearts initiative, hospital – public health collaboration, and asthma control.

Because of the nature of the communities they serve and the work they do, Pennsylvania safety-net hospitals are often important parts of public health efforts throughout the commonwealth.
Find the IOM report Collaboration between Health Care and Public Health: Workshop Summary here.

PA Safety Net Admin2015-07-01T06:00:05+00:00July 1st, 2015|Uncategorized|Comments Off

PA Won’t Develop Exchange After All

Immediately after the Supreme Court verdict in the case of King v. Burwell was handed down, the Wolf administration announced that it will no longer seek to create a Pennsylvania health insurance exchange.
In a news release, Governor Wolf explained that

I took steps to protect Pennsylvania’s consumers by putting in place a contingency in the event the Supreme Court ruled people are not eligible for subsidies, but I am pleased to say that we will no longer need to rely on this plan.

See the news release here.

PA Safety Net Admin2015-06-30T06:00:14+00:00June 30th, 2015|Affordable Care Act|Comments Off

SNAP Calls for HealthChoices Improvements

The Safety-Net Association of Pennsylvania has urged Pennsylvania’s Department of Human Services to pursue transformative innovation in the state’s HealthChoices Medicaid managed care program.
In particular, SNAP has called on DHS to create regional health collaboratives consisting of both insurers and providers to work together to deliver better, more coordinated care to Pennsylvania’s Medicaid population.
SNAP also recommended that the state finance innovation by implementing a Delivery System Reform Incentive Payments program, better known as DSRIP, to fund innovation in the state’s Medicaid program.
SNAP’s suggestions came in response to a request for information issued by the state seeking recommendations for how to improve the HealthChoices program in anticipation of the state’s plan to rebid HealthChoices managed care contracts later this year.
See the state’s request for information here and find SNAP’s comment letter here.

PA Safety Net Admin2015-06-29T06:00:03+00:00June 29th, 2015|HealthChoices PA, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

CMS Issues Guidance on Medicaid Managed Care Rate-Setting

The federal government has provided new guidance to states concerning how to ensure that the rates they pay Medicaid managed care organizations are adequate.
While federal law has long required that such rates be “actuarially sound,” the Centers for Medicare & Medicaid Services (CMS), which issued the draft guidance, has released new guidance to advise states about the information it seeks to ensure that proposed rates are truly actuarially sound.
The guidance notes that CMS will follow three principles when evaluating proposed rates to be paid to Medicaid managed care organizations.

The capitation rates are reasonable and comply with all applicable laws (statutes and regulations) for Medicaid managed care;
the rate development process complies with all applicable laws (statutes and regulations) for the Medicaid program, including but not limited to eligibility, benefits, financing, any applicable waiver or demonstration requirements, and program integrity; and
the documentation is sufficient to demonstrate that the rate development process meets generally accepted actuarial practices and principles.

See the CMS document “Draft 2016 Medicaid Managed Care Rate Development Guide” here. The National Association of Medicaid Directors has conveyed its concerns about some aspects of the proposed guidance to CMS; find its letter here.

PA Safety Net Admin2015-06-24T06:00:47+00:00June 24th, 2015|Uncategorized|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the June edition of Health Law News, its monthly newsletter.
Included in this edition are articles about access to drug and alcohol treatment services for Pennsylvania Medicaid beneficiaries; the lack of habilitative services made available to people with disabilities or significant health problems by health insurance plans offered by insurers serving Pennsylvanians through the federal health insurance exchange; and the state’s recent proposal for managed long-term services and supports (MLTSS).
Find the latest edition of Health Law News here.

PA Safety Net Admin2015-06-23T06:00:44+00:00June 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP).
In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers.
Find a summary of the MACPAC report and a link to the complete report here.

PA Safety Net Admin2015-06-19T06:00:18+00:00June 19th, 2015|Uncategorized|Comments Off

Feds Approve Plan for PA to Establish Insurance Exchange

The U.S. Department of Health and Human Services (HHS) has approved a request by Pennsylvania Governor Tom Wolf for permission for his state to develop a state-based marketplace through which to offer health insurance to Pennsylvanians as provided for in the Affordable Care Act.
Currently, Pennsylvanians seeking health insurance use the federal exchange. The constitutionality of the use of that exchange is currently being weighed by the Supreme Court and the Wolf administration’s desire to create a state exchange is widely considered an attempt to avoid a crisis should the court rule against the federal government in the case of King v. Burwell. A ruling in that case is expected in the very near future.
Go here to see the letter from HHS Secretary Sylvia Burwell to Pennsylvania Governor Tom Wolf authorizing the state to move ahead with development of its state-based exchange.

PA Safety Net Admin2015-06-18T06:00:53+00:00June 18th, 2015|Affordable Care Act, Health care reform|Comments Off

Variations on Medicaid Expansion

While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways.
Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more.
In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 Waivers to Implement Medicaid Expansion Under the ACA, the Urban Institute takes a close look at the six states that have taken this alternative path; among the states reviewed is Pennsylvania and its now-discarded “Healthy Pennsylvania” Medicaid expansion plan. In addition, the Commonwealth Fund has published “The Promise and Pitfalls of Alternative State Approaches to Medicaid Reform,” a commentary on the efforts of the states that have followed this alternative path.

PA Safety Net Admin2015-06-17T06:00:02+00:00June 17th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Patient Satisfaction Survey Results Misleading?

A new report from a non-partisan bioethics institute suggests that the patient satisfaction surveys that Medicare uses as part of its value-based purchasing program may not be providing the kind of information on which Medicare payments should be based.
According to the Hastings Center report “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?” the surveys appear to blend patient satisfaction with their experience while hospitalized with the quality of care they received during that hospitalization and that “Good ratings depend more on manipulable patient perceptions than on good medicine.”
Currently, patient satisfaction is a major component of Medicare’s value-based purchasing program and hospitals can be rewarded or penalized based on their patients’ satisfaction as measured in surveys. The report notes that “The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost.”
Find the complete study here, on the web site of the Hastings Institute.

PA Safety Net Admin2015-06-12T06:00:16+00:00June 12th, 2015|Medicare|Comments Off

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