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

GAO Questions Cost of Private Market Medicaid Expansion

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.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Feds Provide More Info on Short Stay Settlement Offer

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.

PA Safety Net Admin2014-09-12T06:00:11+00:00September 12th, 2014|Uncategorized|Comments Off

GA Population Will Be on the Move

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.

PA Safety Net Admin2014-09-11T06:00:37+00:00September 11th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Medicare Offers Hospitals a Deal

Faced with an 18-month backlog of hundreds of thousands of appeals on cases in which auditors say hospitals billed Medicare for inpatient services that should have been billed at outpatient rates, the Centers for Medicare & Medicaid Services (CMS) is offering hospitals a deal: drop your appeals and accept a payment of 68 percent of the amount in dispute.
Under the offer, acute-care and critical access hospitals have until October 31 to accept CMS’s terms, and once the paperwork is completed, they should receive their payments within 60 days. Hospitals must be willing to relinquish all of their short stay-related claims; they cannot seek payment for some but continue to appeal others.
The offer has both appeal and risk: on one hand, hospitals that have large sums of money – millions – tied up in appeals could receive a welcome infusion of cash; on the other hand, accepting the agreement means foregoing the possibility of additional money they might have received if their appeals succeeded.
The cases all involve Medicare-covered short hospitals stays in which hospitals billed Medicare for inpatient stays but Medicare’s auditors – contractors that perform audits for the agency under its Recovery Audit Program (RAC) – concluded that such care should have been billed at less-costly outpatient rates. Only appeals of this type of case are eligible for the settlement offer.
To learn more about the appeals backlog and Medicare’s plan for addressing it, read this notice on CMS’s web site.

PA Safety Net Admin2014-09-08T06:00:22+00:00September 8th, 2014|Uncategorized|Comments Off

Mackereth Explains PA Medicaid Expansion

In a letter to the editor of the York Daily Record, Pennsylvania Department of Welfare Secretary Beverly Mackereth has outlined the rationale for the Corbett administration’s “Healthy Pennsylvania” health care reform plan and its approach to expanding access to Medicaid services.
In the letter, Secretary Mackereth stresses the importance of a program tailored to Pennsylvania and describes the thinking behind the state’s approach to benefit packages, encouraging enrollees to engage in healthy behaviors, Medicaid premiums, and the use of private health insurance instead of the general expansion of Medicaid many other states are employing.
See Secretary Mackereth’s letter to the York Daily Record here.

PA Safety Net Admin2014-09-05T06:00:29+00:00September 5th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Hospitals, Charitable Groups to Pay Insurance Premiums?

Hospitals and charitable groups such as the United Way are exploring the possibility of paying the health insurance premiums of uninsured patients who come through hospital doors.
Such an approach would enhance access to care for the uninsured while helping hospitals get paid for care they will be providing regardless of whether the patients in question have health insurance.
Such a practice is not entirely new. A United Way organization in Wisconsin raised $2 million to help low-income residents purchase health insurance and hospital groups in New York and Florida are exploring a similar approach.
Health insurers oppose the idea, maintaining that hospitals selectively choosing whom to help will skew the pool of insured people toward those with greater health problems that incur greater costs to serve.
The federal government has not been clear about its perspective on the idea of anyone other than those seeking insurance paying their own premiums. While it requires insurers to accept premiums paid by selected federal programs, it issued an FAQ last year discouraging hospitals from taking the same approach. Regulations issued after that FAQ, however, did not fully clarify the federal position.
Learn more about the issue, how such payments work, and the perspectives of hospitals, insurers, charitable organizations, and the federal government, in this Kaiser Health News article.

PA Safety Net Admin2014-09-04T06:00:20+00:00September 4th, 2014|Affordable Care Act|Comments Off

Medicaid Benefit Cuts Coming?

While the federal government has approved the Corbett administration’s proposal to expand Medicaid eligibility in Pennsylvania and serve the newly eligible through private insurance plans, it did not rule on a key component of the administration’s Healthy Pennsylvania proposal: reducing benefits for some Medicaid recipients.
Instead, any changes in the state’s Medicaid benefits must still be negotiated with the federal government and remain subject to federal approval.
For a closer look at the state’s Medicaid expansion plan and its implications, see this report in the “State House Sound Bites” section of the web site of public radio station WITF.

PA Safety Net Admin2014-09-03T10:50:47+00:00September 3rd, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

Medicaid patients use hospital emergency rooms more frequently than privately insured and uninsured patients but are not overusing or abusing ER services.
So says the Medicaid and CHIP Payment and Access Commission (MACPAC) in a recent report that contradicts the widely held belief that Medicaid patients abuse hospital ER services.
According to “Revisiting Emergency Department Use in Medicaid,” “Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured.”
In addition, MACPAC found, “High ED use also can be a sign of poor access to primary, specialty, dental, and outpatient mental health care in other settings.” In 2012, for example, “…about one in four adult Medicaid enrollees who reported a recent visit to the ED went there because of difficulty accessing another provider, not because of a serious health problem.”
MACPAC also concluded that “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention…Non-urgent visits account for just 10 percent of all Medicaid-covered ED visits for non-elderly patients, a proportion comparable to that of privately insured patients.”
Pennsylvania’s safety-net hospitals serve far more Medicaid patients than the typical acute-care hospital and therefore face far greater challenges in meeting these patients’ needs.
Learn more about MACPAC’s findings in “Revisiting Emergency Department Use in Medicaid,” which can be found here.

PA Safety Net Admin2014-09-02T06:00:03+00:00September 2nd, 2014|Uncategorized|Comments Off

PA Medicaid Expansion Approved by Feds

Pennsylvania’s request for federal approval of its Medicaid expansion plan has been approved by the federal government.
The plan, part of the Corbett administration’s “Healthy Pennsylvania” health care reform proposal, calls for an expanded population of Pennsylvanians who are newly eligible for Medicaid to obtain subsidized coverage through the private health insurance market – managed care organizations approved by the state to serve the new Medicaid expansion population.
The letter of approval from Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner to Pennsylvania Department of Public Welfare Secretary Beverly Mackereth notes that

…the state aims to modify Pennsylvania’s Medicaid program and expand access to coverage to adults in Pennsylvania with incomes through 133 percent of the federal poverty level (FPL) beginning January 1, 2015.

The terms of the demonstration have been incorporated into the accompanying Special Terms and Conditions (STCs) and waiver authorities for the demonstration approval. The approved demonstration authorizes the state to charge premiums to newly eligible individuals up to 133 percent of FPL with access to health care coverage through managed care health plans. Specifically, beginning in January 2016 of the demonstration, the state may charge monthly premiums in an amount not to exceed 2 percent of household income for certain adults with incomes above 100 percent of the FPL.

Beneficiaries subject to a premium as authorized by the demonstration will not be charged copayments (with the exception of an $8 copayment for non- emergency use of the emergency room, which the state may authorize within the Medicaid state plan). Individuals failing to pay the monthly premiums for three consecutive months may be disenrolled from coverage, and may re-enroll without a waiting period. The Commonwealth is not imposing premiums on individuals with incomes at or below 100 percent of the FPL.

The Healthy Pennsylvania demonstration includes an incentive program that is intended to improve the use of preventive services and other healthy behaviors. Enrollees who complete specified healthy behaviors during the first year of enrollment in the demonstration shall have their premium obligations reduced in their second year. For each subsequent year, enrollees will have the opportunity to complete healthy behaviors to reduce their amount of financial obligations.

We have provided authority for the state to not offer non-emergency medical transportation (NEMT) during the first year of the demonstration. This authority will sunset on December 31,2015, and the state will provide NEMT to these beneficiaries beginning in year 2 of the demonstration. The changes in the Pennsylvania demonstration are consistent with those in other demonstrations.

The Commonwealth will deliver services to the newly eligible population through contracts with managed care organizations. Individuals covered will have the choice of an approved health plan in their region. Medicaid managed care rules continue to apply under the demonstration although as stipulated in the demonstration the Commonwealth may rely on state or federal commercial standards when those standards are at least as robust as the Medicaid standards.

Benefits provided to individuals eligible under the expansion will be consistent with federal statutory requirements effectuated through amendments to the Commonwealth’s state plan, rather than the approved demonstration. The expansion population, including those who are subject to this demonstration and those who are medically frail and covered outside of this demonstration, will receive the full complement of health services required under the law. Medically frail individuals will receive coverage from the state through a “high risk” benefit plan.

CMS and the state have been in active consultation on the state plan amendments needed to effectuate this change and have reached agreement on the overall benefits approach, pending final submission of documents by the state consistent with the agreement that has been reached.

In addition, outside this demonstration, the state aims to encourage employment through incentives for job training and work-related activities, including access to Healthy Pennsylvania Career Coaches, for Healthy Pennsylvania beneficiaries who choose to participate in the state’s Encouraging Employment program. Health coverage provided by the Medicaid program and this demonstration will not be affected by this state initiative.

The complete approval letter and a second document describing the special terms and conditions the federal government has attached to the waiver approval can be found here, on the Healthy Pennsylvania web site.

PA Safety Net Admin2014-08-29T06:00:52+00:00August 29th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Charity Care? Wait a Minute

Many hospitals are considering whether they should continue to provide charity care to people who were eligible for Affordable Care Act subsidies to purchase health insurance but chose instead to remain uninsured.
The issue for many is whether the availability of charity care is an inducement for some people not to purchase health insurance and whether such patients are unwilling or unable to pay for care.
Some hospitals have decided not to provide non-emergency charity care to those who chose not to purchase subsidized health insurance. Others are currently considering whether they need to revise their approach to charity care. Still others have decided that they will not change their charity care policies.
Charity care is an especially critical issue for the state’s safety-net hospitals because they serve so many more low-income and uninsured patients than the typical Pennsylvania hospital.
Learn more about this latest phase in the evolution of charity care and how hospitals are approaching it in this Kaiser Health News report.

PA Safety Net Admin2014-08-28T06:00:40+00:00August 28th, 2014|Affordable Care Act|Comments Off

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