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

Late Budget for PA?

Pennsylvania’s constitution calls for the state to adopt a budget for the next fiscal year by June 30, the end of its fiscal year, but it is looking more and more as if the legislature and governor will miss that deadline this year.
Although budgets typically come easily when the same party controls the governor’s mansion and both chambers of the General Assembly, the state’s revenue shortfall, a structural deficit that will carry over into next year, and the introduction of additional issues into the budget process appear to be slowing progress toward adopting a spending plan for the state’s 2015 fiscal year.
To reinforce the notion that June 30 may come and go without a budget adopted, state Senate majority leader Dominic Pileggi recently told members of his Republican caucus to put their fourth of July celebration plans on hold because their work for the legislative season may not be done.
At stake for Pennsylvania’s safety-net hospitals is funding for the state’s Medicaid program. The budget includes numerous items that may prove tempting for officials to prune in search of money to close the current revenue shortfall. Most tempting may be millions in Tobacco Uncompensated Care Fund revenue frozen by the Corbett administration last year in response to an arbitrator’s decision to reduce the state’s proceeds from the national tobacco settlement.
Tobacco Uncompensated Care funds help underwrite some of the $1 billion in charity care Pennsylvania’s hospitals provide annually – more than 40 percent of it provided by the 25 percent of acute-care hospitals in the state that are safety-net hospitals. The Safety-Net Association of Pennsylvania (SNAP) is conveying its concern about the possibility of reducing this funding to legislators.
Learn more about the potential delay in adopting a state budget in this PA Politics report and this York Dispatch article.

PA Safety Net Admin2014-06-18T06:00:38+00:00June 18th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

MedPAC: Keep Paying More For Medicare Primary Care Services

The federal government should continue paying extra for primary care services provided to Medicare patients, Congress has been told by its chief advisor on Medicare payment policy.
According to the Medicare Payment Advisory Commission (MedPAC), the independent federal agency that advises Congress on Medicare payment matters, Medicare has long undervalued primary care services in comparison to specialty medical care, and in 2010 the Affordable Care Act introduced a ten percent bonus for primary care services provided to seniors through 2015.
With the expiration of that bonus coming in a little more than a year, MedPAC has told Congress it should seek to continue the practice but perhaps by making the additional payment on a per beneficiary basis rather than a per visit basis, to make such an approach part of the broader effort to discourage the volume provision of services and to encourage outcomes-oriented care.
In its June 2014 report to Congress, MedPAC also outlines how such a payment might work.
Pennsylvania’s safety-net hospitals all care for significant numbers of Medicare patients, including many low-income seniors.
Learn more about MedPAC’s overall recommendations, including this one involving Medicare primary care payments, in this MedPAC fact sheet. Find the entire MedPAC June 2014 report to Congress here.

PA Safety Net Admin2014-06-17T06:00:28+00:00June 17th, 2014|Affordable Care Act|Comments Off

Thousands in PA Await Word on Medicaid Eligibility

More than 60,000 Pennsylvanians are waiting to hear from the state about their application for Medicaid benefits.
The 60,000 are among more than 1.7 million people nation-wide who have applied for Medicaid are still waiting for a decision on their eligibility – some for as long as eight months.
More than half of those still waiting are in California while some live in states that, like Pennsylvania, have not expanded their Medicaid programs.
The delays have been attributed to problems transferring data received on the federal health insurance exchange to state governments, state programs overwhelmed with volume, technical problems in the states, and other reasons.
Many of those who still await word on their application for Medicaid benefits undoubtedly live in communities served by the state’s private safety-net hospitals.
Learn more about this problem, what is being done about it, and how it affects access to care in this Kaiser Health News article.

PA Safety Net Admin2014-06-10T06:00:52+00:00June 10th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Uncompensated Care Down in Medicaid Expansion States

Hospitals in states that chose to take advantage of the Affordable Care Act’s Medicaid expansion option are providing less charity care than hospitals in states that have not expanded their Medicaid programs.
So reports the Colorado Hospital Association after its survey of 465 hospitals in 30 states.
According to the survey, hospitals’ proportion of Medicaid patients increased in states that expanded their Medicaid programs and did not increase in states that did not expand their Medicaid program and uncompensated care fell in states that expanded their Medicaid programs but did not in other states.
Addressing the extent of these changes, the survey found that

The changes seen here are not only distinct, but also substantial. The Medicaid proportion of total charges increased over three percentage points to 18.8 percent in 2014 from 15.3 percent in 2013, representing a 29 percent growth in the volume of Medicaid charges. When compared to the first quarter of 2013, there was a 30 percent drop in average charity care per hospital across expansion states, to $1.9 million from $2.8 million. Similarly, total self-pay charges declined 25 percent in expansion states, bringing its proportion of total charges down to 3.1 percent from 4.7 percent. In contrast, the proportion of Medicare volume shows little variation through first quarter 2014.

Pennsylvania has not yet expanded its Medicaid program but is currently negotiating the terms of doing so with the federal government.
Find the complete Colorado Hospital Association report here.

PA Safety Net Admin2014-06-06T06:00:25+00:00June 6th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Members of Congress Urge Delay in Medicare DSH Cuts

Fifty-eight members of the House of Representatives have written to House leadership asking them to delay the continued implementation of Affordable Care Act-mandated Medicare disproportionate share (Medicare DSH) cuts.
The letter, to House Speaker John Boehner and minority leader Nancy Pelosi, notes that

…hospitals that qualify for Medicare DSH are, by definition, the very providers caring for the greatest numbers of low-income and low-income elderly patients. In recent years, hospitals have incurred $270 billion in Medicare cuts, including reductions in their annual cost-of-living adjustments, penalties through Medicare’s value-based purchasing and readmissions reduction programs, reduced Medicare bad debt reimbursement, and continued cuts from sequestration. Medicare DSH cuts at this time could jeopardize the health care safety net that our constituents and yours need and deserve.

Medicare DSH payments are vital to most of Pennsylvania’s private safety-net hospitals.
Read the entire congressional letter here.

PA Safety Net Admin2014-06-05T06:00:07+00:00June 5th, 2014|Affordable Care Act|Comments Off

Feds Question PA’s MCO Gross Receipts Tax

The federal government is questioning Pennsylvania’s use of proceeds from its tax on Medicaid managed care organizations to draw down federal Medicaid matching funds.
Federal law permits some use of revenue from health care-related taxes to help finance the state’s share of Medicaid spending, but such taxes must be “broad-based” and a 2009 change in the law narrowed the definition of what constitutes a broad-based tax.
According to an audit performed by the U.S. Department of Health and Human Services’ Office of the Inspector General, Pennsylvania’s current tax on HealthChoices managed care organizations (MCOs)

…is impermissible because it is not broad based (the Gross Receipts Tax does not apply to all MCOs) and because it holds the Medicaid MCOs harmless as taxpayers…

According to the inspector general’s report, the state collected $1.76 billion in gross receipts tax revenue from its Medicaid MCOs between FY 2009 and 2011 and drew down federal Medicaid funds to match that revenue.
State officials disagree with the inspector general’s findings and have submitted their opposing arguments to the federal government.
The loss of gross receipts tax revenue would leave an enormous hole in the state’s financing of its share of Medicaid spending and could pose a considerable challenge for the state’s private safety-net hospitals because they serve so many Medicaid patients.
Find the inspector general’s report, including its findings and recommendations and the state’s response to them, here on the web site of the Office of the Inspector General.

PA Safety Net Admin2014-06-03T06:00:47+00:00June 3rd, 2014|Pennsylvania Medicaid policy|Comments Off

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.
The initiative consists of two parts: first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.
Learn more about this new undertaking in this Kaiser Health News report.

PA Safety Net Admin2014-05-29T06:00:25+00:00May 29th, 2014|Pennsylvania Medicaid policy|Comments Off

Hospitals Reconsidering Charity Care Policies?

In the wake of Affordable Care Act policies that enhance access to health insurance, hospitals around the country are beginning to take a second look at their charity care policies.
Some are charging co-pays to uninsured patients; others are moving the line at which they provide free or subsidized care.
Such practices are not occurring in great numbers and do not yet constitute a trend, but they do reflect a growing concern among hospitals that some of their uninsured patients have options they are choosing not to exercise.
The New York Times has taken a look at a few hospitals that have reconsidered their long-time charity care policies. Read its report here.

PA Safety Net Admin2014-05-27T10:23:53+00:00May 27th, 2014|Affordable Care Act|Comments Off

PHC4 Issues Report on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued its annual report on the financial performance of the state’s acute-care hospitals.
Among the highlights:

The state-wide average operating margin of hospitals fell from 5.73 percent in FY 2012 to 4.69 percent in FY 2013.
Uncompensated care rose 5.41 percent, to more than $1 billion, and up from an average of 2.72 percent of hospital net patient revenue in FY 2012 to 2.81 percent in FY 2013.
35 percent of hospitals reported negative operating margins.
22 percent reported negative operating margins over the latest three-year period.

Find the complete PHC4 report here.

PA Safety Net Admin2014-05-22T09:20:26+00:00May 22nd, 2014|Uncategorized|Comments Off

No Observation Rate Yet for PA Medicaid

The Pennsylvania Department of Public Welfare has published a notice in the Pennsylvania Bulletin continuing its current payment methodology under the state’s Medicaid program but noting that it still has not developed an observation rate for the program.
Last year the state indicated that it wanted to establish such an observation rate, but it has not yet done so. The new notice states that

The Department also announced its intent to establish an observation rate for hospital cases for which an inpatient admission is not medically necessary, but medical observation of a patient is required. The Department received multiple public comments concerning an intended observation rate. At this time, the Department plans to develop a payment policy and rates for observation services and will provide an opportunity for public comment in a future notice of intent.

At the time the state expressed an interest in developing an observation rate, the Safety-Net Association of Pennsylvania wrote to the Department of Public Welfare expressing support for the concept. Read SNAP’s letter here.
Find the entire Pennsylvania Bulletin notice here.

PA Safety Net Admin2014-05-19T06:00:51+00:00May 19th, 2014|Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off

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