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.
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.
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:
With only 60 days until approximately 600,000 newly eligible Pennsylvanians can begin enrolling in the state’s Medicaid program on December 1, the state still has not clarified some aspects of its Healthy Pennsylvania Medicaid expansion program.
The newly eligible, for example, will be classified into high-risk or low-risk health plans – but the criteria for making those classification decisions remain unknown.
Also unknown is exactly what benefits the newly eligible will be entitled to receive.
In addition, the state is thought to be in negotiations with federal officials about reducing the benefits that the 2.2 million Pennsylvanians already eligible for Medicaid may receive.
For a closer look at these and other issues that remain to be addressed before Pennsylvania expands its Medicaid program on January 1, see this Philadelphia Inquirer article.
A new report suggests that education is more important to an individual’s overall health than access to health care.
According to the Virginia Commonwealth University’s Center on Society and Health,
More education means better health – in part because more education brings better jobs, improved access to health insurance, and higher earnings that can help pay for medical expenses and a healthier lifestyle. Conversely, people with less education tend to have more challenges accessing health services – lower rates of health insurance coverage and less money to afford copayments and prescription drugs; they are also more likely to live in low-income neighborhoods with limited access to primary care providers.
Improved access to health care may improve overall health but it will not necessarily compensate for the entire difference in health status between those with more and those with less education. In fact, the disparity even exists, the report notes, in countries like Great Britain where the entire population has access to the same national health care system.
Learn more about the possible effects of education on health status here, in the Virginia Commonwealth University Center on Society and Health policy brief “Health Care: Necessary But Not Sufficient.”
The Pennsylvania Department of Public Welfare is no more.
The state executive branch agency whose Office of Medical Assistance Programs has overseen Pennsylvania’s Medicaid program since its inception has officially been renamed the Department of Human Services.
The legislation requiring the name change takes effect in November and the department will phase-in its new name over time.
Read the press release from the governor’s office announcing the name change here.
The non-partisan federal agency charged with advising Congress, the Department of Health and Human Services, and the states on matters involving Medicaid and the Children’s Health Insurance Program (CHIP) met last week in Washington, D.C.
The Medicaid and CHIP Payment and Access Commission (MACPAC) addressed a number of CHIP-related issues during its September 18-19 meetings, including the future of the program, its funding, state experiences with CHIP changes, and consumer protections.
MACPAC also looked at a variety of Medicaid issues, including state Medicaid expansions through premium assistance, enrollment so far in 2014, the Centers for Medicare & Medicaid Services’ Medicaid program integrity plan, early experiences of new enrollees, and future reductions in Medicaid disproportionate share payments (Medicaid DSH).
CHIP and Medicaid are especially important for Pennsylvania’s safety-net hospitals because they serve so many low-income patients. Those hospitals also are very concerned about future reductions in Medicaid DSH payments.
For a summary of the commission’s deliberations, see this CQ HealthBeat article presented by the Commonwealth Fund.
To see the presentations made during the two-day session go here, to MACPAC’s web site.
Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.
The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays.
The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals. Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute. The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care. Hospitals that wish to take advantage of the CMS offer must drop their claims for all such cases; they cannot selectively choose to drop some appeals and continue to pursue others.
Now, CMS has outlined how the process of filing for settlement of the cases will work, including the information hospitals must provide and the format in which they must provide it, the forms they must use, and descriptions of the processes it will employ to address discrepancies and reconcile claims.
CMS also has posted an FAQ, a recording of a teleconference on the subject, and the email address for questions.
Learn more about CMS’s offer and this process and find the materials cited above and additional documents available for download in this announcement on the CMS web site.
Nearly 80,000 low-income Pennsylvanians insured through the state’s General Assistance program will need to switch to private option Medicaid plans once the Healthy Pennsylvania Medicaid expansion takes effect next year.
These individuals – generally, adults whose income is less than 44 percent of the federal poverty level but who have no children and meet other limited criteria – can begin enrolling in private option insurance plans on December 1 and will need to be enrolled by January 1, 2015, when the General Assistance program ends. Because of their extremely low income, these participants will not be required to pay insurance premiums.
Learn more about the end of General Assistance and the state’s plans for continuing to serve this population in this article on the web site of public radio station WITF.