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

SNAP Seeks State Help With Unpaid Claims

The Safety-Net Association of Pennsylvania (SNAP) is seeking the state Department of Human Services’ assistance with millions in unpaid Medicaid fee-for-service claims.
According to SNAP, the state’s Place of Services Review and Utilization Review processes are not addressing fee-for-services claims in a timely manner, leaving safety-net hospitals with large, long-overdue receivables. Eight SNAP members alone currently await payments of more than $30 million, and in many cases, some of those unpaid claims are more than a year old.
SNAP is seeking a meeting with state officials to discuss the problem and possible solutions.
See SNAP’s letter to the Department of Human Services (“SNAP Seeks State Help With Unpaid Claims Problem”).

PA Safety Net Admin2014-12-16T06:00:45+00:00December 16th, 2014|Uncategorized|Comments Off

Access to Primary Care a Medicaid Problem, HHS OIG Says

Many of the primary care providers that participate in Medicaid managed care programs are inaccessible to those plans’ members, according to a new report by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG).
As states’ Medicaid rolls grow and they direct more of their Medicaid beneficiaries into managed care plans, those beneficiaries may be encountering difficulty converting their access to health insurance into access to health care.
According to the OIG report Access to Care: Provider Availability in Medicaid Managed Care,

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

In response to these problems, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) work with states to

… (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

Pennsylvania’s safety-net hospitals will need to monitor this situation closely in the coming months as the state’s Medicaid expansion begins, bringing as many as 600,000 new beneficiaries into the program.
See the complete OIG report here.

PA Safety Net Admin2014-12-15T06:00:51+00:00December 15th, 2014|Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Residents of Disadvantaged Neighborhoods More Likely to Require Readmission

Medicare beneficiaries living in the most disadvantaged neighborhoods are more likely than others to require readmission to the hospital for problems associated with congestive heart failure, pneumonia, or myocardial infarction.
This is one of the findings in a new Annals of Internal Medicine study titled “Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study.”
The study, based on data from 2004 through 2009, compared Medicare readmission rates in different geographic areas using what is called a validated area deprivation index that measures relative socioeconomic disadvantage to identify the most disadvantaged areas. Researchers concluded that

The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI.

These findings document the special challenges Pennsylvania’s private safety-net hospitals face in serving some of the most disadvantaged communities in the state.
Find the study here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2014-12-12T06:00:34+00:00December 12th, 2014|Uncategorized|Comments Off

Hospitals Worry About Underpayments as Medicaid Expands in PA

The Healthy Pennsylvania Medicaid expansion will bring Medicaid payments that often fall below hospital costs, potentially causing problems for hospitals that serve especially large numbers of new Medicaid beneficiaries.
While hospitals acknowledge that in some cases they will, under the program, start receiving payments for care they otherwise might have provided without any reimbursement at all, they note that the payments they expect from Healthy PA private insurers will fail to cover the cost of the care they provide in many cases.
The problem is especially acute when it comes to payment for outpatient services, which may cover only about 30 percent of the cost of outpatient care.
Because they serve so many Medicaid patients, this situation is likely to pose an especially great challenge for Pennsylvania’s safety-net hospitals.
For a look at the challenges hospitals expect under the Healthy PA Medicaid expansion and the effect it may have on their bottom line, see this Pittsburgh Tribune-Review story.

PA Safety Net Admin2014-12-11T06:00:55+00:00December 11th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

Among the articles in the November newsletter are a piece on how some immigrants currently covered by the state’s General Assistance program may be able to retain their coverage under Healthy Pennsylvania and another on differences in how the state’s Medicaid expansion population will obtain behavioral health services from private option plans participating in that expansion.
Find the November newsletter here.

PA Safety Net Admin2014-12-10T06:00:45+00:00December 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Homelessness and Safety-Net Hospitals

Homeless people with serious medical problems are more likely than others to be readmitted to hospitals – and especially, to safety-net hospitals – during their convalescence from illnesses and injuries.
This is one of the conclusions in the recently published Journal of Community Health Nursing article “Assessing the Needs for a Medical Respite: Perceptions of Service Providers and Homeless Persons.”
According the study, homeless people lack safe places to convalesce. Shelters do not suffice, the study found, because they are not open around the clock and lack staff qualified to support recovery. The homeless also report that their drugs are often stolen in shelters and they are vulnerable to infections while staying in them.
As a result, many of these patients end up being readmitted to the safety-net hospitals that originally treated them – often, for extended periods of time. Among others, this poses a real challenge for Pennsylvania safety-net hospitals because they serve so many more homeless patients than the typical hospital.
In more than 70 cities across the country, respite care facilities have been established to serve the homeless recovering from serious injuries and illnesses.
Learn more about the challenges facing homeless patients and the role safety-net hospitals play in addressing those challenges in this Dallas Morning News story and find the Journal of Community Health Nursing article here.

PA Safety Net Admin2014-12-09T06:00:10+00:00December 9th, 2014|Uncategorized|Comments Off

Feds Release Medicaid DSH “Uninsured” Definition

The Centers for Medicare & Medicaid Services (CMS) has published a new regulation that defines “uninsured” for the purpose of calculating the limit for how much individual hospitals may receive in Medicaid disproportionate share hospital payments (Medicaid DSH).
Under federal law, Medicaid DSH payments to hospitals cannot exceed the uncompensated costs of the services those hospitals provide to Medicaid recipients and the uninsured. In calculating hospital-specific limits, according to the new regulation,

… the calculation of uncompensated care for purposes of the hospital-specific DSH limit will include the cost of each service furnished to an individual by that hospital for which the individual had no health insurance or other source of third party coverage.

This regulation is important to Pennsylvania safety-net hospitals because they receive Medicaid DSH payments and serve more uninsured patients than the typical hospital.
Find the complete regulation here, in the Federal Register.

PA Safety Net Admin2014-12-08T06:00:42+00:00December 8th, 2014|Uncategorized|Comments Off

Healthy PA Enrollment Begins

Uninsured Pennsylvanians with an income less than 138 percent of the federal poverty level have begun enrolling in health insurance plans under the state’s Healthy Pennsylvania Medicaid expansion.
The official date on which enrollment began is December 1 in anticipation of the program’s official implementation on January 1. During this period, an estimated 600,000 eligible Pennsylvanians may choose private insurers through which they can receive health care coverage, with their premiums to be paid with federal Medicaid funds.
While the program is expected to begin as scheduled on January 1, it is not clear how long it will last in its current form. Governor-elect Tom Wolf has expressed opposition to the approach taken by the Corbett administration through Healthy Pennsylvania and envisions a more traditional expansion of the state’s Medicaid program. Whether Mr. Wolf will pursue such an approach, and when he might do so, remains unknown.
For a closer look at the Healthy Pennsylvania launch and the immediate future of Medicaid expansion in Pennsylvania, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-12-03T06:00:06+00:00December 3rd, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Richman to Advise Wolf on Medicaid

Pennsylvania Governor-elect Tom Wolf has appointed former Department of Public Welfare Secretary Estelle Richman to advise him on Medicaid matters during his transition period.
Richman served as secretary of the Department of Public Welfare – now the Department of Human Services – from 2003 to 2009, during the administration of former governor Ed Rendell.
Richman is expected to focus on the expansion of the state’s Medicaid program, authorized under the federal Affordable Care Act and to begin on January 1 as part of Governor Corbett’s Healthy Pennsylvania program. Instead of expanding the state’s traditional Medicaid program, Healthy Pennsylvania will involve those newly eligible for Medicaid choosing from a pool of private insurers selected by the state, with their insurance premiums to be paid with federal Medicaid funds.
Learn more about Ms. Richman and her expected role in the Wolf transition in this Harrisburg Patriot-News article.

PA Safety Net Admin2014-12-01T06:00:24+00:00December 1st, 2014|Pennsylvania Medicaid policy|Comments Off

Administration Delays Major 340B Program Regulation

The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program.
The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients. While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned.
A spokesman for the federal Health Resources and Services administration told Bloomberg BNA that the release has been delayed until next year and that the agency

…plans to issue a proposed guidance for notice and comment that will address key policy issues raised by various stakeholders committed to the integrity of the 340B program. HRSA is also planning to issue proposed regulations where the statute provides explicit rulemaking authority, pertaining to civil monetary penalties for manufacturers, calculation of the 340B ceiling price, and administrative dispute resolution.

Because they serve so many low-income patients and typically participate in the 340B program, Pennsylvania’s private safety-net hospitals have a great deal of interest in any attempt by the federal government to alter the scope or regulation of the program.

To learn more about the delay in the anticipated 340B regulation, see this Bloomberg BNA article.

PA Safety Net Admin2014-11-24T06:00:26+00:00November 24th, 2014|Uncategorized|Comments Off

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