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

Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program.
The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343.
Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate.
Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals that serve especially large numbers of low-income patients. The new proposal seeks to address that unfairness.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about this proposal, see this news release announcing the bill. Find the bill itself here.

PA Safety Net Admin2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off

New Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its February newsletter.
This edition features articles on Medicaid expansion in Pennsylvania; problems posed by Healthy Pennsylvania for individuals who receive drug and alcohol or mental health services and how the state is addressing those problems; and the new, special enrollment period for those who are uninsured to sign up through the federal marketplace and avoid the fine for failing to secure health insurance.
The newsletter also lists upcoming state legislative budget hearings that will address health care issues and raises the possibility of the state establishing an Affordable Care Act-authorized “Community First Choice” program, which gives a state access to additional federal matching funds to pay for attendant services for Medicaid beneficiaries with severe intellectual or physical disabilities.
Find the latest edition of Health Law PA News here.

PA Safety Net Admin2015-03-13T06:00:18+00:00March 13th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Restores Substance Abuse Services to Medicaid Patients

Pennsylvania’s Department of Human Services (DSH) has restored access to drug and alcohol treatment services to Medicaid recipients who were placed in new Medicaid private coverage option plans that do not cover such care.
At fault was a glitch in the implementation of the Healthy Pennsylvania Medicaid expansion in which some Medicaid recipients were placed in “low risk” insurance plans that do not cover drug and alcohol treatment. DHS staff combed the rolls of Medicaid recipients who joined those plans in search of recipients who needed those services and shifted them into plans that provide such coverage.
About 8500 Medicaid beneficiaries affected by the problem have been moved into plans that enable them to resume resume treatment.
Some providers chose to continue treating their Medicaid patients who lost their coverage and have suffered financial problems as a result. The state intends to address those situations on a case-by-case basis, according to acting DHS secretary Ted Dallas.
Some of those recipients may eventually be on the move again as the Wolf administration continues phasing out the Healthy Pennsylvania program in favor of expanding the state’s pre-Healthy Pennsylvania Medicaid program.
For a close look at this problem, how it affects patients and providers, and how the state corrected it, see this Philadelphia Inquirer article.

PA Safety Net Admin2015-03-12T06:00:39+00:00March 12th, 2015|Pennsylvania Medicaid policy|Comments Off

MedPAC Looks at Short-Stay Issues

The agency that advises Congress on Medicare payment issues is preparing to suggest changes in how Medicare approaches paying for short hospital stays.
At last week’s meeting of the Medicare Payment Advisory Commission (MedPAC), commissioners received a staff presentation on issues surrounding Medicare payments for short hospital stays and discussed possible recommendations for changes in how Medicare pays for those short hospital stays.
Among the possibilities discussed at the recent MedPAC meeting are revising how Medicare’s recovery audit contractors program (RAC audits) looks at short hospital stays; revising the three-day-stay requirement for Medicare to cover post-discharge skilled nursing care; penalizing hospitals found to have unusually large numbers of short stays; and shortening the time-frame during which individual cases are subject to RAC audits.
See the presentation made to MedPAC members here. Also, see this CQ HealthBeat report presented by the Commonwealth Fund on the MedPAC meeting at which this issue was discussed.

PA Safety Net Admin2015-03-11T06:00:18+00:00March 11th, 2015|Uncategorized|Comments Off

PA Updates Medicaid Expansion Timetable

The Pennsylvania Department of Human Services (DHS) has released a timetable for its planned transition from the Corbett administration’s Healthy Pennsylvania Medicaid expansion to its expansion of the state’s previous Medicaid program.
According to a DHS news release,

Phase 1

This phase will begin in April 2015 and be completed by June 1, 2015.
Individuals who were enrolled in the General Assistance and Select Plan program in December 2014 will begin to be transferred from the private coverage option (PCO) to the new streamlined Adult benefit package.
New applicants will no longer be enrolled in the PCO and will be enrolled in the new Adult benefit package with coverage provided by the HealthChoices managed care organizations.

Phase 2

This phase will begin in July 2015 and be completed by September 30, 2015.
All remaining PCO enrollees will transition from PCO plans into the HealthChoices by September 1, 2015.

For a closer look at the plan for Medicaid expansion, see this DHS news release.

PA Safety Net Admin2015-03-10T06:00:35+00:00March 10th, 2015|Pennsylvania Medicaid policy|Comments Off

MACPAC Looks at Medicaid, CHIP Issues

The Medicaid and CHIP Payment and Access Commission (MACPAC), the independent, non-partisan federal agency that advises Congress on the Medicaid and CHIP programs, met in Washington, D.C. recently to examine a number of issues under its purview.
During two days of meetings, MACPAC heard staff presentations on the status of Medicaid expansion, sites of care for the delivery of Medicaid services, Medicaid eligibility and enrollment issues, Medicaid behavioral health populations, and more.
See these and other presentations here, on MACPAC ‘s web site.

PA Safety Net Admin2015-03-09T06:00:49+00:00March 9th, 2015|Uncategorized|Comments Off

PA Outlines Medicaid Transition Timetable

Pennsylvania should complete by the end of September its transition from former Governor Tom Corbett’s Healthy Pennsylvania Medicaid expansion program to new Governor Tom Wolf’s more traditional approach to Medicaid expansion.
According to Ted Dallas, acting secretary of the Department of Human Services, the transition involves combining the addition of newly eligible Pennsylvanians onto the state’s Medicaid rolls, moving all eligible participants into a single benefit plan instead of the two-tiered plan employed under Healthy Pennsylvania, and updating the state’s information systems to accommodate these changes.
Adding the newly eligible Pennsylvanians to the state’s Medicaid rolls and moving them into a single benefit plan should be completed by the end of April. Updating the state’s information systems will take longer and should be completed by the end of September.
For more on the planned transition, see this Philadelphia Inquirer article.

PA Safety Net Admin2015-03-06T06:00:54+00:00March 6th, 2015|Pennsylvania Medicaid policy|Comments Off

PA Revises Guidelines for Medicaid Presumptive Eligibility

The Pennsylvania Department of Human Services has revised its guidelines for hospitals qualified to make presumptive eligibility determinations for potentially Medicaid-eligible patients who seek services but are uninsured.
The revisions are described in Medical Assistance Bulletin 01-15-08, “Revised Presumptive eligibility as Determined by Hospitals,” which was issued on February 24 but is retroactive to January 1.
In support of that new guidance the state also has issued an addendum for providers outlining their responsibilities and a worksheet for hospitals to use in determining eligibility.

PA Safety Net Admin2015-03-05T06:00:02+00:00March 5th, 2015|Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

PA Governor Proposes New Budget With Medicaid Implications

Yesterday Pennsylvania Governor Tom Wolf presented his proposed FY 2016 budget to the state’s General Assembly.
Included in that budget are proposed spending levels for Medicaid, including supplemental payments and other programs that affect the state’s private safety-net hospitals.
The Safety-Net Association of Pennsylvania has prepared a detailed memo outlining the budget’s broader themes and then details its potential implications for safety-net hospitals. Hospital officials interested in requesting a copy of the memo can do so by hitting the “contact us” link on the upper right-hand corner of this screen.

PA Safety Net Admin2015-03-04T16:56:41+00:00March 4th, 2015|Proposed FY 2016 Pennsylvania state budget|Comments Off

Update on PA’s Health IT Efforts

Last week leaders of Pennsylvania’s Health IT Initiative presented an update on their program’s efforts at a meeting of the Medical Assistance Advisory Committee.
The presentation focused on the distribution of funds made available through the American Reinvestment and Recovery Act of 2009. The purpose of this funding is to promote the adoption, implementation, and meaningful use of electronic health records (EHRs) by health care providers.
The presentation reviewed the goals of the program; the payments made through the state’s Medicaid program to hospitals and qualified physicians so far; upcoming deadlines for pursuing additional financial support; problems encountered by the program and lessons learned; and progress to date toward building the state’s health information exchange.
See the presentation here.

PA Safety Net Admin2015-03-03T06:00:59+00:00March 3rd, 2015|Pennsylvania Medicaid policy|Comments Off

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