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

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs.
In a paper entitled “Medicaid Managed Care Modernization: Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome.
The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans.
The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many Medicaid patients and managed care has become the primary means through which the state’s Medicaid program serves those patients.
Learn more about Medicaid directors’ recommendations for improving and regulating state Medicaid managed care programs in this National Association of Medicaid Directors correspondence with the Center for Medicaid and CHIP Services.

PA Safety Net Admin2014-10-27T06:00:19+00:00October 27th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

New Video Explains PA Medicaid Expansion

The Pennsylvania Department of Public Welfare has posted a new presentation video on its Healthy Pennsylvania Medicaid expansion program. The video outlines how the program works, who is eligible to participate, what the benefits are, and more. It offers useful information for hospital employees and other Pennsylvania health care providers who will soon see an influx of as many as 600,000 new Medicaid recipients in the state.
Find the video here, on the state’s Healthy PA web site.

PA Safety Net Admin2014-10-24T06:00:48+00:00October 24th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Corbett Signs Observation Status Notification Bill

Pennsylvania Governor Tom Corbett has signed into law a bill that requires hospitals to inform patients when their stay in a hospital has been classified as observation status and not an inpatient admission.
The new law calls for hospitals to provide such notification when patients are under a hospital’s care for more than 23 consecutive hours; when they are in a bed and receiving meals outside of the emergency room; and when they have not formally been admitted.
Observation status poses considerable financial challenges to patients, leaving them vulnerable for charges for tests, medicine, and post-discharge nursing and rehabilitation care that would be covered by their insurance if they were inpatients but are not covered to the same degree if their stay has been classified as observation status (because insurers pay lower outpatient rates only for observation services). Most people have been unaware of this distinction and have neither been told of their observation status nor apprised of the difference between that status and inpatient hospitalization. This has especially been a problem for Medicare beneficiaries.
The bill was sponsored by Pennsylvania state representative Stan Saylor (R-York County). See Rep. Saylor’s memo to his House colleagues outlining the rationale for his bill here and find the bill itself here.

PA Safety Net Admin2014-10-23T06:00:13+00:00October 23rd, 2014|Uncategorized|Comments Off

Congressman Calls for Helping Safety-Net Hospitals by Improving Medicare Readmissions Program

Congressman James Renacci (R-OH) is again asking his House colleagues to support his proposal to adjust Medicare’s hospital readmissions reduction program – a program he maintains is especially harmful to safety-net hospitals.
Noting that in its current form the program penalizes hospitals that care for larger numbers of poorer, sicker patients and that this “jeopardizes the viability of hospitals that service this vulnerable population,” the congressman urges his colleagues to support his bill, H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program Act.
This bill calls for adjusting the program’s approach “to account for certain disparities in patient population…”
See Representative Renacci’s letter to House colleagues here.

PA Safety Net Admin2014-10-22T11:44:02+00:00October 22nd, 2014|Uncategorized|Comments Off

Increased Utilization by New Medicaid Patients Levels Off, Study Finds

Spikes in hospital emergency room and inpatient admissions attributed to patients who have recently obtained Medicaid coverage eventually taper off, according to a new study.
According to the study Increased Service Use Following Medicaid Expansion is Mostly Temporary: Evidence From California’s Low Income Health Program, dramatic increases in ER use and hospitalizations among those newly insured by Medicaid eventually level off and should not especially tax either hospital capacity or state Medicaid budgets.
The study, performed by the UCLA Center for Health Policy Research, found that after pent-up demand for care among those who previously had limited access to services was satisfied, utilization dropped by more than two-thirds and then remained relatively constant. Outpatient utilization remains generally stable, the study found.
These findings may be a glimpse into Pennsylvania’s future and what its hospitals will face when the state eventually expands its Medicaid program.
For further information about the study and its implications for hospitals and state Medicaid budgets, see this Kaiser Health News report. To see the UCLA study itself, go here.

PA Safety Net Admin2014-10-16T11:53:50+00:00October 16th, 2014|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Insurers Struggle to Find Providers to Participate in Healthy PA Medicaid Expansion

The insurers selected to participate in Pennsylvania’s Healthy PA Medicaid expansion program are having a hard time persuading hospitals and doctors to join their provider networks.
Citing low Medicaid reimbursement rates, providers have been reluctant to work with the chosen insurers.
The state selected nine insurers to offer Medicaid coverage to approximately 600,000 new recipients beginning on January 1, but now, one of those insurers has withdrawn from the program and another is considering reducing the geographic region it intends to serve.
Originally, the Corbett administration said it hoped to have at least three insurance options in each of the nine regions created for the Medicaid expansion program. Now, it appears that two carriers per region is a more realistic expectation.
Read more about the challenges insurers are encountering in lining up participating providers, and how that problem could affect the overall Medicaid expansion effort, in this Pittsburgh Tribune-Review article.

PA Safety Net Admin2014-10-10T06:00:53+00:00October 10th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Teaching Hospitals Pitch More Residencies

With the country facing a physician shortage and the number of medical residencies capped by the 1997 Balanced Budget Act (because Medicare and Medicaid provide the primary funding for the residencies), teaching hospitals need an additional 4000 residency slots a year.
This was the message conveyed recently to a gathering of congressional aides co-sponsored by the Association of American Medical Colleges.
This issue is of interest to Pennsylvania’s safety-net hospitals, some of which are teaching hospitals.
Such an increase would cost $10 billion over the next ten years.
Learn more about the case for more residency slots in this Kaiser Health News article.

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

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its September newsletter. Included in this edition is a story on federal approval of Pennsylvania’s Medicaid expansion proposal, an FAQ on how the approved plan will work, and a chart detailing key differences between what the state proposed and what the federal government ultimately approved.
Find the newsletter here.

PA Safety Net Admin2014-10-07T06:00:17+00:00October 7th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Medicare Announces Readmissions Penalties

Medicare will impose financial penalties in FY 2015 on the majority of U.S. hospitals for excessive patient readmissions.
In all, 2610 hospitals face penalties that range from one one-hundredth of one percent to three percent of all Medicare payments. Last year, the maximum penalty was two percent.
The majority of hospitals in 29 states will be penalized and 39 hospitals face the maximum penalty of three percent. Overall, the penalties will amount to $428 million. Many hospitals will be penalized even though they reduced their readmissions in the past year.
Medicare’s hospital readmissions reduction program was mandated by the Affordable Care Act in the belief that penalizing hospitals for what were considered avoidable readmissions would spur them to take steps to prevent such readmissions. Readmissions cost Medicare $26 billion a year, of which $17 billion is considered unavoidable.
Concerns have been raised that the readmissions penalties are unfair to safety-net hospitals because they serve more low-income patients with more complex medical problems and who, after discharge, face financial and logistical challenges during their recovery that make them more likely to require readmission. Some studies have verified this view and some groups – including the Medicare Payment Advisory Commission (MedPAC) – have called on Congress to revise the program with this consideration in mind.
For a closer look at FY 2015’s readmissions penalties, including links to a file that lists individual hospital penalties nation-wide, see this Kaiser Health News report.

PA Safety Net Admin2014-10-06T06:00:33+00:00October 6th, 2014|Affordable Care Act|Comments Off

Enrolling in PA’s Medicaid Expansion Program

On December 1, Pennsylvanians who believes they may be eligible for Medicaid under the state’s expanded eligibility criteria – part of the Healthy Pennsylvania program – can begin submitting applications for coverage, which will begin on January 1.
People can apply in four ways:

the state’s online application process – at https://www.compass.state.pa.us/
the healthcare.gov site
a dedicated call center set up by the Affordable Care Act – 866-550-4355
a paper application at any county assistance office

PA Safety Net Admin2014-10-02T06:00:05+00:00October 2nd, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

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