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

Providers Can’t Sue Over Low Medicaid Payments

Health care providers may not turn to the courts when they believe their state Medicaid program is not paying them enough for the services they deliver, the Supreme Court has decided.
Instead, they must seek help from the federal government, which makes the rules that govern Medicaid provider payments.
The Supreme Court decision overturns a lower court ruling in response to a suit by facilities in Idaho that provide residential services to the disabled claiming that the state was paying them less than it had agreed to pay. As a result, providers must now turn to the Centers for Medicare & Medicaid Services (CMS) if they believe they are not being paid fairly.
Learn more about the Supreme Court’s decision in this news story in The Hill.

PA Safety Net Admin2015-04-01T06:00:50+00:00April 1st, 2015|Uncategorized|Comments Off

340B Program Faces Challenges, Change

A federal program that helps selected health care providers obtain discounted drugs for low-income patients they are serving on an outpatient basis may soon face major changes.
The 340B prescription drug pricing program, created more than 20 years ago to help serve low-income individuals, has come under fire in recent years in both the House and the Senate over how qualified, participating providers – disproportionate share hospitals, Federally Qualified Health Centers and their look-alikes, children’s hospitals, critical access hospitals, rural referral centers, and others – use the savings they derive from the program. While there is a general expectation that providers will use those savings to provide additional services to low-income patients, they are required neither to do that nor to discloses how they do use their savings.
The House Energy and Commerce Committee held a hearing about the program last week and Congress has asked the Medicare Payment Advisory Commission (MedPAC) to look into the program as well.
In addition, the U.S. Government Accountability Office (GAO) recently published an update on the status of its 2011 recommendations for improving the program, which it found suffered from inadequate oversight by Health Resources and Services Administration (HRSA), lacked adequate criteria for determining patient and provider eligibility, and lacked controls for preventing drugs acquired through the program from being diverted to ineligible patients.
The administration has long been thought to be preparing new guidelines for the 340B program.
Most Pennsylvania safety-net hospitals qualify for the 340B program because of the many low-income patients they serve, so any changes in the program will be of special interest to them.
For a closer look at the issues surrounding the 340B program, see this Roll Call blog report. Find a summary of the GAO report Drug Discount Program: Status of GAO Recommendations to Improve 340B Drug Pricing Program Oversight and a link to the study itself here and a report on some of the testimony provided at the congressional hearing here.

PA Safety Net Admin2015-03-30T06:00:39+00:00March 30th, 2015|Pennsylvania safety-net hospitals|Comments Off

PA Medicaid Transition Timetable

The Pennsylvania Department of Human Services has published a “HealthChoices Key Events and Milestones” table outlining the key steps in the state’s transition from the Healthy PA Medicaid expansion to the Wolf administration’s Medicaid expansion through the state’s existing HealthChoices program.
Listed on the timetable are the major steps in that transition and target dates for the completion of each.
Find that timetable here.

PA Safety Net Admin2015-03-27T06:00:46+00:00March 27th, 2015|Uncategorized|Comments Off

Numbers Link Medicaid Expansion, Diabetes Diagnoses

One of the primary arguments made by the Safety-Net Association of Pennsylvania in favor of state Medicaid reimbursement policies that support the work of safety-net hospitals is that many of the low-income patients they serve have had sporadic contact with the health care system over the years and often present with medical problems that go well beyond the immediate reason that brings them to hospitals.
Now comes new information that supports that argument.
The medical testing company Quest Diagnostics has found that the number of Medicaid patients its testing has found to have diabetes has risen more than 24 percent during two recent six-month review periods in states that have expanded their Medicaid programs while the number of such patients found to have diabetes in states that did not expand their Medicaid programs saw only a 0.4 percent increase in diabetes diagnoses.
Pennsylvania did not expand access to Medicaid during the review periods covered by the Quest analysis but now that it has done so, the problem seems likely to arise in the state.
Because of where they are located, Pennsylvania’s safety-net hospitals serve higher proportions of low-income patients than the typical community hospital and are therefore more likely to be caring for these more challenging patients newly diagnosed with diabetes in the near future.
For more information about the Quest findings and their implications, see this New York Times article. In addition, the latest edition of the journal Diabetes Care presents a study on the subject. See that article here.

PA Safety Net Admin2015-03-26T06:00:08+00:00March 26th, 2015|Pennsylvania safety-net hospitals|Comments Off

OIG Reiterates Medicare, Medicaid Recommendations

Every year the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) examines the operations of various department offices, programs, and policies and offers recommendations for changes and improvements. Some of those recommendations are adopted and others are not.
The OIG annually publishes a document reiterating what it believes to be its most important and potentially useful recommendations that were not adopted, and that publication was just released.
Among the Medicare and Medicaid recommendations it has presented again are:

Establish accurate and reasonable Medicare payment rates for hospital inpatient services.
Establish accurate and reasonable Medicare payment rates for hospital transfers.
Reduce hospital outpatient department payment rates for ambulatory surgical center-approved procedures.
Prevent inappropriate payments to Medicare home health agencies.
Reduce inappropriate payments to skilled nursing facilities.
Prevent payments for ineligible Medicare beneficiaries.
Reconcile Medicare outlier payments in accordance with federal guidance and regulations.
Ensure that states calculate accurate costs for Medicaid services provided by local providers.
Ensure the collection of identified Medicare overpayments.
Improve oversight of management of Medicaid personal services.
Improve the Medicare appeals process at the administrative law judge level.
Enhance efforts to identify adverse events to ensure quality of care and safety.
Ensure that Medicare children receive all required preventive screening services.
Strengthen oversight of state access standards for Medicaid managed care.

In its Compendium of Unimplemented Recommendations/March 2015, the OIG presents the issues and its rationale for its recommendation and describes the status of implementation, including, in some cases, why CMS has chosen not to implement its recommendations.
Find the report here.

PA Safety Net Admin2015-03-25T06:00:00+00:00March 25th, 2015|Medicare|Comments Off

House May Address Doc Fix Bill This Week

Means-testing for Medicare beneficiaries.
Modest raises for doctors now and the promise of no cuts for a decade.
An extension of the Children’s Health Insurance Program (CHIP) for ten years.
These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1.
For years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the quality rather than the quantity of care they deliver.
What’s in this latest proposal? Kaiser Health News has published an FAQ that describes the issue, the proposed solutions, and the challenges those solutions face in the coming days. See that FAQ here.

PA Safety Net Admin2015-03-24T06:00:58+00:00March 24th, 2015|Medicare|Comments Off

PA Releases Document Outlining Transition to “Traditional Medicaid Expansion”

The Pennsylvania Department of Human Services (DHS) has posted a document outlining its plan for transitioning from the Healthy Pennsylvania Medicaid expansion to what it terms a “traditional Medicaid expansion.”
The document summarizes what the state is doing, why it is doing it, and how it plans to move from the previous approach to the new one. It also includes links to expansion-related documents and explanations, presents the cost of the transition and the new program, and explains to interested parties how they can comment on the state’s plans.
Find the notice document “Transition to Traditional Medicaid Expansion” here.

PA Safety Net Admin2015-03-23T06:00:57+00:00March 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

States Turning More to Providers to Fund Medicaid

States are relying more on provider taxes and other sources to raise their share of Medicaid funding, a new study by the U.S. Government Accountability Office (GAO) has found.
According to the GAO, state use of such funding rose 21 percent from 2008 to 2012. Most of the money came from health care provider taxes, provider donations, intergovernmental transfers, and Medicaid certified public expenditures.
While the study examined the issue nation-wide it focused on Medicaid financing in three states: California, Illinois, and New York.
Use of provider taxes is of special interest to Pennsylvania safety-net hospitals because it appears the state’s proposed FY 2016 budget may call for funding more of the state’s Medicaid program with proceeds from hospital provider taxes.
To learn more about how states are financing their share of their Medicaid programs and why this is of interest to policy-makers, see the recently re-released GAO report States’ Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection and a newly published companion to the report titled Questionnaire Data on States’ Methods for Financing Medicaid Payments from 2008 through 2012.

PA Safety Net Admin2015-03-19T06:00:57+00:00March 19th, 2015|Pennsylvania safety-net hospitals, Proposed FY 2016 Pennsylvania state budget|Comments Off

Safety-Net Hospitals Struggle With Medicare’s Value-Based Purchasing

Safety-net hospitals are more likely than others to fare poorly under Medicare’s value-based purchasing program.
Or so concludes a new study published in the journal Health Affairs.
Researchers examined the impact of the addition of patient mortality measures to the program in 2014, and according to the abstract of the new study,
We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program.
See the new study “Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based Purchasing” here, on the Health Affairs web site.

PA Safety Net Admin2015-03-18T06:00:35+00:00March 18th, 2015|Uncategorized|Comments Off

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face. See its report here.

PA Safety Net Admin2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off

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