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

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required that such rates be “actuarially sound,” the Centers for Medicare & Medicaid Services (CMS), which issued the draft guidance, has released new guidance to advise states about the information it seeks to ensure that proposed rates are truly actuarially sound.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

Medicaid Expansion Not Significantly Improving Hospital Financial Health

While the Affordable Care Act’s Medicaid expansion has helped millions of Americans gain health insurance, it has not translated (so far) into improved financial health for the hospitals providing those Medicaid services.
This is the conclusion drawn recently by Moody’s Investor Services, the credit-rating company.
According to Moody’s, hospital financial performance has improved across the board since implementation of the Affordable Care Act but has not improved more in states that expanded their Medicaid programs than it has in states that chose not to expand Medicaid eligibility. As a result, hospital operating margins in states that have expanded their Medicaid programs have not improved more than those in states that did not expand.
What hospitals in expansion states have experienced in many cases is reduced uncompensated care as more of the patients who come through their doors have Medicaid coverage. The financial benefits this brings, though, are often offset, in part or in whole, because Medicaid underpays providers so much in many states.
This suggests that Pennsylvania’s Affordable Care Act-inspired Medicaid expansion, which took effect on January 1, may not give the state’s private safety-net hospitals the financial boost many observers often assume.
Learn more about how Medicaid expansion is and is not affecting hospital financial performance in this Moody’s news release and this Wall Street Journal article.

PA Safety Net Admin2015-06-10T06:00:05+00:00June 10th, 2015|Uncategorized|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the May edition of Health Law News, its monthly newsletter.
Included in this edition are articles about the Wolf administration’s newly released Medicaid managed long-term supports and services proposal; the increase in Medicaid enrollment since the state’s Medicaid expansion began on January 1; the Medical Assistance Transportation Program; and the state’s application to the federal government to establish Pennsylvania’s own health insurance marketplace.
Go here to see the latest edition of PA Health Law News.

PA Safety Net Admin2015-06-09T06:00:56+00:00June 9th, 2015|Uncategorized|Comments Off

30-Day Readmission Standard Flawed, Study Suggests

A new study raises the possibility that Medicare’s policy of penalizing hospitals that readmit patients within 30 days of their discharge may be flawed.
According to a new report in the Annals of Internal Medicine, risk factors for readmission often change within those 30 days.
In addition, patients with chronic medical problems are more likely to need readmission. Even the time of day of discharge appears to affect patients’ likelihood of readmission, with those discharged between 8 a.m. and 1:00 p.m. less likely to be readmitted.
The study also found that social determinants and insurance status also increase the likelihood of readmission within 30 days of discharge.
Together, these and other findings appear to raise questions about the fairness of Medicare’s hospital readmissions reduction program.
These findings also mirror a growing body of research that suggests that the program is inherently unfair to safety-net hospitals that serve large numbers of low-income patients who have had limited and sporadic access to medical care during their lives.
To learn more, see this Fierce Healthcare report. Find the study “Differences Between Early and Late Readmissions Among Patients: A Cohort Study” here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2015-06-08T06:00:26+00:00June 8th, 2015|Medicare|Comments Off

PA Seeks to Establish Health Insurance Marketplace

In anticipation of a possible Supreme Court decision that could jeopardize the health insurance of an estimated 382,000 Pennsylvanians, the Wolf administration has applied to the federal government to establish a state-based health insurance marketplace.
The Supreme Court is currently weighing a challenge to the use by some states of the federal health insurance marketplace and the contention of litigants that the Affordable Care Act specifies that insurance subsidies would only be available through state-based exchanges. If the court rules against the federal government, the insurance of residents of states that did not establish their own exchanges and who instead obtained their insurance and federal subsidies through the federal exchange will be in jeopardy.
The move by the Wolf administration is a contingency plan and does not commit the state to developing its own exchange.
For further information about the state’s application to establish a health insurance exchange, see this Wolf administration news release.

PA Safety Net Admin2015-06-05T06:00:42+00:00June 5th, 2015|Affordable Care Act, Health care reform|Comments Off

SNAPShots

SNAPShots

About PA Safety Net Admin

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

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