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

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

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

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