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

Decision to Restore PA Tobacco Money Upheld

The state’s Commonwealth Court has upheld a lower court decision restoring more than $125 million in tobacco funding that an arbitration panel sought to deny the state.
Under the terms of the Tobacco Master Settlement, states receive annual payments from tobacco companies to compensate them for the costs they incur caring for people sickened by cigarettes and smoking. In 2013, an arbitration panel ruled that the state had failed to fulfill all of the settlement agreement’s terms and reduced Pennsylvania’s proceeds from the agreement. A 2014 appeal of that decision restored much of that funding and the Commonwealth Court upheld that decision.
The tobacco funding is used to support smoking cessation programs, cancer research, and health care services. It is an important source of funding for care for low-income Pennsylvanians for the state’s safety-net hospitals.
Learn more about this issue and the Commonwealth Court’s ruling in this Philadelphia Business Journal article.

PA Safety Net Admin2015-04-17T06:00:12+00:00April 17th, 2015|Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

MedPAC Calls for End of “Two-Midnight Rule”

The independent agency that advises Congress on Medicare payment issues has recommended that Medicare eliminate its controversial two-midnight rule.
At its recent meeting in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC) also recommended that Medicare focus RAC (Recovery Audit Contractor) audits on hospitals with the highest numbers of short inpatient stays, shorten the look-back period for audits, modify the three-day rule for skilled nursing facility coverage, and require hospitals to inform patients when their stay has been classified as observation status rather than inpatient status.
Learn more about MedPAC’s recommendation in this Fierce Healthcare news report and go here to see the MedPAC presentation of the recommendations the agency’s board approved.

PA Safety Net Admin2015-04-16T06:00:40+00:00April 16th, 2015|Medicare|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published its March 2015 newsletter.
Included in this edition are articles about the state’s changes in how it is expanding its Medicaid program; a look at Governor Wolf’s proposed FY 2016 Medicaid budget; and closer examinations of a proposed expansion of services for older adults and people with disabilities and the budget of the state’s Office of Mental Health and Substance Abuse Services.
Find the Pennsylvania Health Law Project’s latest newsletter here.

PA Safety Net Admin2015-04-15T06:00:19+00:00April 15th, 2015|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania state budget issues, Proposed FY 2016 Pennsylvania state budget|Comments Off

Looking at Payment and Delivery System Reform

Last fall the Robert Wood Johnson Foundation brought together grant recipients and national experts to talk about health care payment and delivery system reform design and implementation issues.
Now, the foundation has released a brief paper that addresses what the experts consider to be the three greatest challenges in the pursuit of such reform:

Aligning alternative payments with clinician compensation
Considering social determinants of health in payment reform models
Repurposing hospital resources

The paper also takes a look at whether health care payments should be subject to risk adjustment to reflect the social and economic barriers to better health and care that some patients face. This is an important issue for Pennsylvania’s safety-net hospitals because of the significant numbers of low-income patients they serve.
These issues and more are addressed in greater detail in the new paper “Three Emerging Challenges for Sustained Payment and Delivery System Reform,” which can be found here.

PA Safety Net Admin2015-04-14T06:00:13+00:00April 14th, 2015|Uncategorized|Comments Off

Medicare-Medicaid Coordination Office Reports to Congress

The federal agency created by the Affordable Care Act to facilitate better coordination of federal benefits for those eligible for both Medicare and Medicaid has issued its annual report on its activities to Congress along with a number of recommendations for future policy changes.
In addition to reporting on its work over the past year, the Medicare-Medicaid Coordination Office recommended that Congress consider legislation to:

Create a pilot to expand the PACE program (Programs of All-Inclusive Care for the Elderly) to people between the ages of 21 and 55.
Ensure retroactive Medicare Part D coverage for newly eligible low-income beneficiaries.
Establish an integrated appeals process for dually eligible (Medicare and Medicaid) enrollees.
Allow for federal/state coordinated review of duals special need plan marketing materials.

The report also identified three areas the agency intends to explore further in the coming year:

Coverage standards for overlapping Medicare and Medicaid benefits.
Cost-sharing rules for qualified Medicare beneficiaries.
Quality measures and Medicare-Medicaid enrollees.

Because they serve so many low-income, dually eligible patients, Pennsylvania’s safety-net hospitals often have a considerable stake in this office’s efforts.
Find the Medicare-Medicaid Coordination Office’s complete report to Congress here.

PA Safety Net Admin2015-04-10T06:00:12+00:00April 10th, 2015|Uncategorized|Comments Off

MACPAC Looks at Value-Based Purchasing in Medicaid

At a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), the agency’s staff made a presentation on how different states are pursuing value-based purchasing in their Medicaid programs.
The presentation focused on current efforts in three states: Connecticut, Maryland, and Oklahoma, describing the policy approach those states have taken, the models they employ, the implementation challenges they have faced, and how they evaluate the effectiveness of their efforts.
Because they care for so many Medicaid patients, Pennsylvania’s safety-net hospitals have a special interest in new approaches to paying for Medicaid services.
Find the MACPAC presentation here.

PA Safety Net Admin2015-04-09T06:00:12+00:00April 9th, 2015|Pennsylvania safety-net hospitals|Comments Off

MACPAC Looks at DSRIP

The legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and state governments on Medicaid and Children’s Health Insurance Program (CHIP) issues recently took a look at a relatively new type of supplemental Medicaid funding.
The Medicaid and CHIP Payment and Access Commission (MACPAC) is examining Delivery System Reform Incentive Payment Programs (DSRIP), which it describes as

a new type of supplemental payment that provide incentive payments for hospitals and other providers to undertake delivery system transformation efforts. Currently operating in California, Texas, Massachusetts, Kansas, New Jersey, and New York, DSRIP projects are led by hospitals, but often involve collaborations with non-hospital providers. They generally fall into two categories—infrastructure development and care innovation and redesign. Payments are tied to corresponding improvements in health outcomes for Medicaid enrollees and the uninsured.

MACPAC’s staff delivered a presentation on DSRIP to commission members. See that presentation here.

PA Safety Net Admin2015-04-08T06:00:53+00:00April 8th, 2015|Uncategorized|Comments Off

How States View Medicaid Reform

What are states looking for from “Medicaid reform”?
How do they evaluate the prospects of reform proposals – and how do they evaluate reforms that have been implemented?
Across the country, states are pursuing Medicaid reform through section 1115 waivers, Delivery System Reform Incentive Payment Programs (DSRIP), the State Innovation Models (SIM) Initiative, and other means. As they do, they must decide what innovations to pursue and then make decisions about whether those they have chosen have achieved their objectives and produced genuine payment and delivery system reform, improved outcomes, and laid a foundation for further improvement.
Many of these decisions are made by state Medicaid directors, and now, the National Association of Medicaid Directors has published a paper offering its perspective on Medicaid reform: what it is, what it looks like, and how they will approach it. See its paper Perspectives on Innovation here.

PA Safety Net Admin2015-04-03T06:00:35+00:00April 3rd, 2015|Pennsylvania Medicaid policy|Comments Off

GAO Reports on CHIP Extension

As a House-approved bill that would extend authorization for the Children’s Health Insurance Program (CHIP) for two years awaits Senate consideration, the U.S. Government Accountability Office (GAO) has issued a mandated evaluation of the program.
Among the GAO’s findings, it concluded that children enrolled in the program

… (1) had substantially better access to care, service use, and preventive care when compared with uninsured children; and (2) experienced comparable access and service use when compared with privately insured children.

It also found that nearly all children between the age of one and two enrolled in CHIP or Medicaid made at least one visit to a primary care physician in 2013; that the program’s costs for families were almost always less than states’ benchmark plans established under the Affordable Care Act; and that its benefits were generally comparable to those offered by benchmark plans.
For a closer look at the GAO report Children’s Health Insurance Program: Effects on Coverage and Access, and Considerations for Extending Fund, find links to a summary and the full report here, on the GAO web site.

PA Safety Net Admin2015-04-02T06:00:52+00:00April 2nd, 2015|Uncategorized|Comments Off

State Uses DSRIP Innovation Funding to Improve Care for Urban Poor

New York Medicaid program is taking advantage of federal innovation money to explore new approaches to serving low-income urban Medicaid patients.
With the help of Delivery System Reform Incentive Payments (DSRIP), special Medicaid funding from the federal government, caregivers serving Medicaid patients are organizing into accountable care organizations (ACOs) in New York City.
Under the experiment, doctors and hospitals join together to serve populations of Medicaid patients. While the doctors are currently paid on a fee-for-service basis, the program’s goal is to move them toward outcomes-based reimbursement, with bonuses paid to providers who achieve specific goals for improving the health of their patients.
The state plans to spend $1 billion over the next five years on this aspect of its innovation program.
Learn more about how New York seeks to use DSRIP funding to improve the delivery of care to its Medicaid population in this New York Times report.

PA Safety Net Admin2015-04-01T12:00:51+00:00April 1st, 2015|Uncategorized|Comments Off

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