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

No-Hospitalization Group Plans To Be Banned

Companies will no longer be able to provide their employees with group health insurance plans that do not cover inpatient hospitalization.
This news came in a recent notice published by the Internal Revenue Service.
Recently, many large employers with lower-wage workers were purchasing low-cost health insurance that does not cover hospitalization. The IRS, however, has ruled that such plans do not meet the Affordable Care Act’s minimum value threshold. Companies were only able to purchase such plans because they are not required meet the reform law’s essential health benefits package requirement, which applies only to plans offered to individuals on health insurance exchanges.
The no-hospitalization policies were likely to leave many lower-income workers without the coverage they needed – and with large medical bills. They also were likely to leave hospitals with unexpected uncompensated care. This could have proven especially challenging for Pennsylvania safety-net hospitals because they serve larger numbers of lower-income workers than the typical hospital.
The administration is permitting employers that committed to such plans by November 4 to use them for one year and is offering affected workers access to premium subsidies that some of those workers did not otherwise have if they choose to purchase insurance on an exchange instead.
The IRS will issue regulations formalizing this policy next year.
To learn more about this issue and its implications for large businesses, low-wage workers, and hospitals, see this Kaiser Health News report. Go here to see the IRS notice.

PA Safety Net Admin2014-11-11T06:00:31+00:00November 11th, 2014|Affordable Care Act|Comments Off

PA Contacts Medicaid Recipients About Benefits

The Pennsylvania Department of Public Welfare is in the process of sending letters to all current adult Medicaid recipients in the state advising them of changes in their Medicaid benefits to take effect on January 1 as a result of the state’s Healthy Pennsylvania Medicaid expansion.
The Pennsylvania Health Law Project has published an explanation of the situation, including sample copies of the letters the state is sending, information about the different benefit packages available to Medicaid recipients, and advice on how recipients who believe they have more serious medical problems can apply for a benefits package better suited to their needs.
Find the Pennsylvania Health Law Project notice here.

PA Safety Net Admin2014-11-10T09:05:50+00:00November 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Suit Against Medicare Rate Cut Continues

Hospital groups are suing the Centers for Medicare & Medicaid Services (CMS) over the 0.2 percent rate cut in Medicare inpatient payments during the 2014 fiscal year.
According to the hospital groups, CMS failed to provide a rationale for the rate cut and denied interested parties access to the data and analysis underlying its rate cut decision.
At the heart of the cut was CMS’s expectation that implementation of Medicare’s controversial “two-midnight rule” would result in an increase in admissions. The rule was never fully implemented.
CMS has asked the court to dismiss the suit.
Learn more about the suit and find links to the hospitals’ and CMS’s legal briefs in this Fierce Healthcare article.

PA Safety Net Admin2014-11-07T06:00:29+00:00November 7th, 2014|Uncategorized|Comments Off

PA Makes Healthy PA Implementation Official

The Pennsylvania Department of Public Welfare (DPW) has published an official notice in the state’s Medical Assistance Bulletin announcing the implementation of the Healthy Pennsylvania Medicaid expansion program on January 1, 2015.
The notice provides background information about the plan, how it will work, and how it will differ from the state’s current Medicaid program. It also presents the final word on how the state will define “medically frail” for determining which benefits package participants will receive, outlines how the program’s health screening of applicants will work, and explains enrollees’ cost-sharing responsibilities.
The Bulletin notes that the state will issue a separate announcement to providers with more information about the scope of benefits to be provided, how the program will employ private insurers to serve the state’s Medicaid population, and when training will be offered to familiarize providers on how to work with the new program.
Find the Bulletin here.

PA Safety Net Admin2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

MACPAC Not Yet Sold on Continuing Medicaid Primary Care Pay Increase

The independent federal agency that advises Congress on Medicaid and the Children’s Health Insurance Program is not ready to endorse continuing the Affordable Care Act’s two-year increase in Medicaid primary care fees as a means of encouraging more doctors to serve Medicaid patients.
At its October 30-31 public meeting in Washington, D.C., the staff of the Medicaid and Children’s Health Insurance Program Payment and Access Commission (MACPAC) reported that it has begun looking into the effectiveness of the temporary pay increase in persuading more doctors to care for Medicaid recipients. Among its preliminary findings are that

The payment increase had at best, a modest effect on provider participation according to states and MCOs
Most states reported that the provision had no effect on the use of primary care services

Consequently, MACPAC did not offer any recommendations on this issue at the public meeting and intends to continue studying the impact of enhanced Medicaid primary care fees on physician willingness to serve Medicaid patients.
For the two years ending on December 31, 2014, the federal government has paid for 100 percent of the fee increases. Some states have already decided to continue making the enhanced payments at their own expense, some will make enhanced payments but not necessarily at the level authorized by the Affordable Care Act, and some intend to restore the payments to their previous levels.
Pennsylvania plans to return its Medicaid primary care fee-for-service rates to their 2012 level.
The MACPAC presentation on Medicaid primary care physician payments can be found here.

PA Safety Net Admin2014-11-04T06:00:10+00:00November 4th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

To Increase or Not to Increase? That is the Question

To induce more primary care providers to serve Medicaid patients at a time when Medicaid enrollment was about to increase significantly nation-wide, the Affordable Care Act raised Medicaid primary care reimbursement to the same level as Medicare rates for 2013 and 2014, with the federal government to pick up the tab for 100 percent of the increase in state spending for these services.
With that two-year increase coming to an end, states now must decide whether to continue the increase and pay for it themselves or let their Medicaid primary care rates return to their old levels.
According to a survey taken by the Kaiser Family Foundation, 15 states will continue the increases either in part or in full; 24 do not plan to continue the increases; and 12 still have not decided.
Some states that are continuing the increases in some form also are changing the types of primary care providers that will receive the enhanced Medicaid payments.
Pennsylvania is among the 24 states not planning to continue the rate increase.
For a closer look at the issue, including a map that illustrates each state’s intentions, see the Kaiser Family Foundation report “The ACA Primary Care Increase: State Plans for SFY 2015” here, on the foundation’s web site.

PA Safety Net Admin2014-11-03T06:00:34+00:00November 3rd, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

PA Closing in on Classification Criteria for New Medicaid Recipients

Among the features of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program is the consolidation of 14 current adult benefits packages into just two packages: the “Healthy” package for new recipients considered low-risk patients and the “Healthy Plus” package for those who are considered high-risk patients, or medically frail.
But ever since the Corbett administration unveiled its Medicaid expansion plan last fall, the question of how new recipients would be evaluated to determine which benefit package they will receive has remained unanswered.
Now, the Pennsylvania Department of Public Welfare (DPW) appears to be getting closer to providing a clear answer.
Recently, DPW’s Medical Assistance Advisory Committee (MAAC) circulated three working documents that present the state’s latest thinking on the classification process.
The first document presents an overview of the latest version of state’s screening tool, including what the tool is, how it defines “medically frail,” and how it will be used. It also notes that use of the tool is not mandatory.
This next document offers additional information about how the state envisions defining “medically frail.”
And this third document is a draft of the screening tool itself, the health care needs questionnaire.
Pennsylvania’s Medicaid expansion is scheduled to take effect on January 1, 2015, but people who think they may be eligible may begin enrolling on December 1 through the state’s enrollment web site or at any state county assistance office.

PA Safety Net Admin2014-10-31T06:00:57+00:00October 31st, 2014|Healthy PA|Comments Off

Some PA Women Could Lose State Medical Benefits

The expiration of a state health program could leave about 90,000 low-income Pennsylvania women without the free family planning and women’s health benefits they currently receive.
A program called SelectPlan for Women offers limited health benefits to low-income women between the ages of 18 and 44 who are otherwise ineligible for Medicaid. While there has been no formal announcement of the program’s termination, women’s health advocates have informally been told that such a termination is possible at the end of the year.
If the program expires, some of the women it currently covers will be eligible for Medicaid under the state’s Medicaid expansion to take effect on January 1 while others should be eligible for at least some subsidization of insurance premiums on the federal health insurance exchange.
The SelectPlan for Women, however, has no limits on visits, no co-pays, and no premiums.
Learn more about SelectPlan for Women, what it does, and why it may soon disappear in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-10-30T06:00:59+00:00October 30th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

State Releases Information on Primary Care Loan Repayment Program

Part of Governor Corbett’s Healthy Pennsylvania health care reform plan, introduced in the fall of 2013, was a program to help primary care providers pay off their education loans in exchange for a commitment to provide care in facilities that serve predominantly underserved communities and low-income patients.
Now, the state has released further information about the program, including what kinds of providers are eligible for assistance, how they may apply to participate, and how the facilities in which they work can be certified for eligibility. Also available are application materials.
The deadline for primary care providers to apply is December 4.
Find a fact sheet about the program here and more information about the application process here.

PA Safety Net Admin2014-10-29T06:00:19+00:00October 29th, 2014|Healthy PA|Comments Off

The Candidates Talk Health Care

One of the issues in almost any major election is health care, and this year’s gubernatorial race in Pennsylvania is no exception.
With this in mind, the Central Penn Business Journal has published excerpts of Pennsylvania Physician magazine interviews with the candidates in next month’s election, Republican Governor Tom Corbett and his Democratic challenger, Tom Wolf. In the article, the candidates share their views on some of this year’s more important health care issues, including Medicaid expansion, emergency care, the challenge of attracting more doctors to Pennsylvania, and more.
Find the article here.

PA Safety Net Admin2014-10-28T06:00:19+00:00October 28th, 2014|Uncategorized|Comments Off

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