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

100,000 Apply for Medical Assistance

As 2014 ended, Pennsylvania had received 100,000 applications for Medicaid coverage under the state’s Healthy Pennsylvania Medicaid expansion program.
State officials estimate that approximately 600,000 adult Pennsylvanians are newly eligible for Medicaid under the program. The 100,000 figure represents applications, not individuals; some applications are for families of varying size. It is not yet known how many of the applicants are currently uninsured.
The state began accepting applications on December 1 for coverage to begin on January 1. There is no deadline for applying.
Learn more about the applications the state is receiving in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2015-01-06T06:00:19+00:00January 6th, 2015|Health care reform, Healthy PA|Comments Off

Medicaid Pay Bump Gone in PA; Will it Affect Access?

The temporary increase in Medicaid provider fees for primary care services ended yesterday, leaving observers to wonder whether it will affect access to care for the nation’s growing Medicaid population.
The increase, mandated by the Affordable Care Act, raised Medicaid primary care rates to the same level as Medicare payments in the hope that more primary care providers would begin serving Medicaid patients in anticipation of significant growth in the Medicaid population. Now that the two-year increase has ended, it is unclear whether providers who began serving Medicaid patients because of the increase will remain Medicaid providers and those who accepted more Medicaid patients will continue doing so.
Because of the relatively short duration of the increase, little research has been completed to determine whether the raise made a difference in access, but some states believe it did: a number will use their own money to continue the raises, which during the two-year experiment were paid entirely by the federal government.
Pennsylvania is not among the states that will continue paying the enhanced Medicaid fees for primary care services.
Kaiser Health News has taken a look at this issue and the potential implications of the end of the Medicaid pay raise; see its report here.

PA Safety Net Admin2015-01-02T06:00:57+00:00January 2nd, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Access to Medicaid Services

A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients.
Find that commentary here.

PA Safety Net Admin2014-12-31T06:00:33+00:00December 31st, 2014|Uncategorized|Comments Off

PA Addresses Healthy PA Transition Issues

The Pennsylvania Department of Human Services (DHS – formerly the Department of Public Welfare) has issued a memo to Medical Assistance stakeholders addressing two issues involving implementation of the state’s Healthy Pennsylvania Medicaid expansion that have been brought to its attention.
The first issue is that individuals who enrolled in Medicaid in December were not assigned to a behavioral health managed care organization.
The second addresses screening of individuals who currently qualify for Medicaid under the General Assistance category who have behavioral health needs and who likely qualify for the “Healthy Plus” Medicaid benefits plan beginning in 2015.
See the state’s message to stakeholders outlining what these issues are about and how it plans to address them in this memo from the state’s Office of Mental Health and Substance Abuse Services.

PA Safety Net Admin2014-12-30T06:00:43+00:00December 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Officially Ends Enhanced Medicaid Payments

The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31.
While some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1.
See the Medical Assistance Bulletin notice here.

PA Safety Net Admin2014-12-29T06:00:31+00:00December 29th, 2014|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Medical Assistance Eligibility Manual Released

The Pennsylvania Health Law Project has updated its Medical Assistance eligibility manual.
Written in plain English for a general readership, the manual describes the various ways individuals may qualify for Medical Assistance (Medicaid) in Pennsylvania and how they can go about applying for benefits.
Find the updated manual here.

PA Safety Net Admin2014-12-26T06:00:08+00:00December 26th, 2014|Pennsylvania Medicaid policy|Comments Off

PA Wins Innovation Planning Grant

Pennsylvania is among 21 states that will receive State Innovation Models Initiative Model Design Awards from the federal Center for Medicare and Medicaid Innovation.
The award of $3 million will be used to

…engage a diverse group of stakeholders, including public and commercial payers, providers and consumers, to develop a State Health Care Innovation Plan.

The purpose of the state innovation models program is to support

…states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation. The Innovation Center is interested in testing innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while maintaining or improving quality of care for program beneficiaries.

The grant funds were awarded on a competitive basis, with funding decisions based on an initial round of state innovation model planning. Michael Chirieleison, president of the Safety-Net Association of Pennsylvania (SNAP), served on the committee that developed the commonwealth’s state innovation model proposal.
Learn more about the federal State Innovation Models Initiative here.

PA Safety Net Admin2014-12-24T06:00:48+00:00December 24th, 2014|Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year.
At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington.
During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016. They will vote on their recommendation at their next meeting.
A presentation to MedPAC members by their staff also offered a number of observations about Medicare services:

Demand for hospital services is stable.
With hospital occupancy down to 60 percent, it appears hospitals have excess capacity.
The quality of care hospitals provide is improving according to several metrics.
Hospital cost growth is down.
Hospitals’ Medicare margins are steady, although they remain negative, especially for outpatient services.
MedPAC should consider recommending policies to reduce or eliminate differences between payments to hospitals and doctors’ offices for selected outpatient services.

For a closer look at the Medicare inpatient and outpatient issues MedPAC examined at its December meeting, see the presentation on this subject here, on MedPAC’s web site.

PA Safety Net Admin2014-12-23T06:00:27+00:00December 23rd, 2014|Uncategorized|Comments Off

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments: a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

PA Safety Net Admin2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia.
Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index: elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English. Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions for the three conditions studied, with employment status more than three times as powerful an indicator as lack of high school education.
High unemployment is typically a major problem in the communities served by Pennsylvania safety-net hospitals.
Learn more about the study in this Fierce Healthcare report and see the study itself here.

PA Safety Net Admin2014-12-19T06:00:57+00:00December 19th, 2014|Uncategorized|Comments Off

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