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

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

Full Speed Ahead on Healthy PA Medicaid Expansion

When the federal government approved the Corbett administration’s Healthy Pennsylvania Medicaid proposal at a time when the governor trailed in the polls in his bid for re-election, observers wondered whether Mr. Corbett would continue to implement the program if he lost even if his opponent opposed that implementation.
The answer, apparently, is yes.
Department of Public Welfare Secretary Beverly Mackereth told the Pittsburgh Post-Gazette that the state continues to implement the Healthy Pennsylvania Medicaid expansion and will begin enrolling participants on December 1 in anticipation of the program’s official launch on January 1.
It is doing so despite being asked not to do so by representatives of Governor-elect Tom Wolf, who does not take office until January 20.
Learn more about the circumstances surrounding Medicaid expansion in Pennsylvania in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-11-21T06:00:26+00:00November 21st, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Feds Share Pennsylvania Health Insurance Rate Data

The Centers for Medicare & Medicaid Services (CMS) has published data showing changes in the premiums for individual and small group health insurance plans offered in Pennsylvania for 2015.
Including plans offered both within and outside the federal health insurance marketplace, the numbers show that individual plan premiums are up an average of 2.31 percent while small group plans have seen rates rise 3.19 percent.
Learn more about the data release in this Central Penn Business Journal article or go here for the entire CMS database, where you can search for data by state.

PA Safety Net Admin2014-11-20T06:00:51+00:00November 20th, 2014|Affordable Care Act|Comments Off

States Face Medicaid Challenges

Fifty American states have 50 different Medicaid programs. While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities.
The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years. Among the areas the survey explored are:

budgets
Affordable Care Act implementation
relationships with others in their state government, federal agencies, and regulators
program integrity
innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and challenges in the area of long-term services and supports

Find out how the country’s 50 Medicaid directors view the challenges they face in the coming year in State Medicaid Operations Survey: Third Annual Survey of Medicaid Directors, which you can find here.

PA Safety Net Admin2014-11-19T06:00:27+00:00November 19th, 2014|Uncategorized|Comments Off

PA Congressional Delegation Seeks Medicare “Doc Fix”

Seventeen of the 18 members of Pennsylvania’s U.S. House delegation have sent a joint, bipartisan letter to House Speaker John Boehner and minority leader Nancy Pelosi asking them make a priority of repealing – before the current session of Congress ends – the sustainable growth rate formula (SGR) used to determine how doctors are paid to serve Medicare patients.
See their letter here.

PA Safety Net Admin2014-11-18T06:00:21+00:00November 18th, 2014|Uncategorized|Comments Off

MedPAC Meets, Addresses Hospital Issues

The independent federal agency that advises Congress on Medicare payment issues met last week in Washington and addressed a number of issues of importance to hospitals.
Among the issues discussed by the Medicare Payment Advisory Commission (MedPAC) were:

beneficiary access to hospital care and how service volume affects hospital costs
hospital short stay policy issues
per beneficiary payment for primary care
the 340B drug pricing program
site-neutral payments for selected conditions treated in inpatient rehabilitation facilities and skilled nursing homes
payment policies to promote the use of services based on clinical evidence

Find links to the presentations offered by MedPAC staff on these issues here, on MedPAC’s web site.

PA Safety Net Admin2014-11-17T06:00:53+00:00November 17th, 2014|Uncategorized|Comments Off

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