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

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

Insurance Expansion Won’t Hurt Access to Primary Care, Study Finds

Fears that significant increases in the numbers of Americans with health insurance as a result of Affordable Care Act policies would overwhelm the health care system and lead to access to care problems are unfounded, according to a new Commonwealth Fund report.
According to the new report “How Will the Affordable Care Act Affect the Use of Health Care Services?”, the country’s current supply of primary care providers is more than adequate to meet any demand for primary care services. The study found that

… primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally.

The study concludes that

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold.

While the study’s findings appear encouraging, its methodology involved examining the supply of physicians and the expected increase in the demand for care only on a state-by-state basis and did not attempt to differentiate supply and demand in individual areas within states. Consequently, it did not specifically evaluate the prospects for access to care in medically underserved parts of Pennsylvania, including communities served by the state’s private safety-net hospitals. Such places have long had difficulty attracting primary care physicians (and specialists) because large numbers of their residents are uninsured or insured by Medicaid, which pays physicians poorly for their services, thereby discouraging doctors from establishing practices in such communities.
For a closer look at the study’s methodology and findings, see the research brief here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2015-03-02T06:00:34+00:00March 2nd, 2015|Uncategorized|Comments Off

States Seek to Reduce ER Use Among Medicaid Patients

Even though the rate at which non-Medicaid recipients inappropriately use hospital emergency rooms exceeds the rate of inappropriate use among Medicaid patients, a number of states are launching efforts to reduce ER overuse among their Medicaid recipients.
Medicaid patients currently use – as distinguished from inappropriately use – hospital ERs at twice the rate of privately insured patients, typically for a number of reasons: they are less healthy than insured patients; they have a more difficult time finding primary care physicians who will treat them; and they have jobs that prevent them from going to doctors during ordinary office hours.
To address overuse, states are trying a number of approaches. Nearly half of the states are imposing or increasing Medicaid co-pays for ER visits. Some are identifying Medicaid patients among their frequent ER users and making primary care appointments for them before they leave the ER. Some Medicaid managed care plans are doing the same, analyzing ER data among their users and making an extra effort to connect them to primary care physicians.
Some of these approaches are showing promise. When Washington state ER personnel started setting up appointments with primary care patients for Medicaid-insured ER visits, ER use among Medicaid patients fell 9.9 percent in the first year. When a Medicaid managed care plan in St. Louis tried a similar approach, ER use among its members declined 9.5 percent.
To learn more about what states and insurers are doing to reduce ER use among Medicaid patients, see this Stateline report.

PA Safety Net Admin2015-02-27T06:00:17+00:00February 27th, 2015|Pennsylvania Medicaid policy|Comments Off

Administration Blocks No-Hospitals Insurance Plans

Health insurance plans that do not include hospital benefits fail to meet employers’ obligations under the Affordable Care Act and will leave companies that provide such insurance vulnerable to fines of $3000 a year for every worker covered by such a plan, the Centers for Medicare & Medicaid Services (CMS) announced last week.
But in recognition that some employers had arranged such coverage well in advance, the federal government is permitting companies that committed to such plans by November 4 to use them for the next year, after which they must be replaced. In addition, employees who seek to compensate for that shortcoming in their coverage by purchasing supplemental insurance will be eligible for tax credits based on their income.
Such plans have been favored by many companies that employ large numbers of low-wage workers.
In a regulation issued last week, CMS wrote about health insurance without hospital benefits that

A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose of the MV [minimum value] requirement to ensure that an employer-sponsored plan, while not required to cover all EHB [essential health benefits], nonetheless must offer coverage with minimum value at least roughly comparable to that of a bronze plan offered on an Exchange.

For a closer look at the new regulation, why it was issued, and what it means for employers and their workers, see this Kaiser Health News article. Find the regulation announcing the policy here.

PA Safety Net Admin2015-02-26T06:00:21+00:00February 26th, 2015|Affordable Care Act|Comments Off

472,000 Pennsylvanians Sign Up for Insurance

Nearly 472,000 Pennsylvanians enrolled in health insurance during the Affordable Care Act’s open enrollment period, which ended on February 15.
Some were new enrollees and some were automatically renewed; a breakdown is not yet available.
For a closer look at Pennsylvanians obtaining health insurance during the open enrollment period and the national picture, see this Central Penn Business Journal article.

PA Safety Net Admin2015-02-23T06:00:16+00:00February 23rd, 2015|Affordable Care Act|Comments Off

“Super-Utilizers” Costing PA Millions, Report Shows

“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system millions of dollars a year.
According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to the hospital at least five times in a year – while just three percent of hospital patients in FY 2014, accounted for 17 percent of the state’s Medicaid expenditures for inpatient care ($216 million) and 14 percent of Medicare inpatient expenditures ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 were for super-utilizers.
PHC4 identified the three leading reasons for these admissions as heart failure, septicemia, and mental health disorders.
Learn more about super-utilizers and their impact on hospital admissions and health care spending in the PHC4 report, which can be found here.

PA Safety Net Admin2015-02-20T11:06:56+00:00February 20th, 2015|Uncategorized|Comments Off

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