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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.
Doctor listening to patientFor 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.
 

2015-03-24T06:00:58+00:00March 24th, 2015|Medicare|Comments Off on House May Address Doc Fix Bill This Week

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.

2015-03-23T06:00:57+00:00March 23rd, 2015|Pennsylvania Medicaid policy|Comments Off on PA Releases Document Outlining Transition to “Traditional Medicaid Expansion”

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.
 

2015-03-19T06:00:57+00:00March 19th, 2015|Pennsylvania safety-net hospitals, Proposed FY 2016 Pennsylvania state budget|Comments Off on States Turning More to Providers to Fund Medicaid

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.

2015-03-18T06:00:35+00:00March 18th, 2015|Uncategorized|Comments Off on Safety-Net Hospitals Struggle With Medicare’s Value-Based Purchasing

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.
Group of healthcare workersThe 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.

2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off on Congress Mulls Another Medicare Doc Fix

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.
HospitalSince 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.

2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off on Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

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.
 

2015-03-13T06:00:18+00:00March 13th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off on New Pennsylvania Health Law Project Newsletter

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.

2015-03-12T06:00:39+00:00March 12th, 2015|Pennsylvania Medicaid policy|Comments Off on PA Restores Substance Abuse Services to Medicaid Patients

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.

2015-03-11T06:00:18+00:00March 11th, 2015|Uncategorized|Comments Off on MedPAC Looks at Short-Stay Issues

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.

2015-03-10T06:00:35+00:00March 10th, 2015|Pennsylvania Medicaid policy|Comments Off on PA Updates Medicaid Expansion Timetable
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