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

The Path to PA’s Medicaid Waiver

The Corbett administration’s Healthy Pennsylvania proposal seeks to go where only two states have gone so far with their Affordable Care Act-enabled Medicaid expansion: the unconventional route.
While many of the states that have chosen to expand their Medicaid programs under the terms of the Affordable Care Act did so by embracing those terms, others are viewing Medicaid expansion as an opportunity to pursue wholesale changes in how they serve their low-income residents.
Arkansas and Iowa have already received federal waivers – exemptions from selected aspects of existing Medicaid law– to expand their Medicaid programs. Under these waivers, the states operate demonstration programs to test the effectiveness of their variations on ordinary Medicaid practices.
Pennsylvania seeks to follow in their path, and Virginia, New Hampshire, Indiana, and possibly a few other states are expected to do the same in 2014.
Learn more about the path to obtaining such a waiver and the challenges Pennsylvania may face along the way in this Stateline report.

PA Safety Net Admin2014-01-28T06:00:55+00:00January 28th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

CMS Offers Advice on Managing Expected Upsurge in ER Visits

With Medicaid enrollment rising because of eligibility changes introduced through the Affordable Care Act, hospital emergency rooms expect to see an increase in the number of emergency room visits as new Medicaid enrollees seek care for long-neglected health problems.
In anticipation of this rise in ER visits, the Centers for Medicare & Medicaid Services (CMS) has issued an informational bulletin with suggestions for hospitals on how to manage the expected increase in ER utilization.
Among CMS’s suggestions are for hospitals to broaden access to primary care services (because much of the increased utilization will be because the newly insured still do not know where to turn for care); focus on helping especially frequent ER visits find more appropriate sources of care; and target the needs of people with behavioral health problems.
This influx of new ER patients will pose a challenge for Pennsylvania’s safety-net hospitals because even though the state has not expanded its Medicaid eligibility criteria as provided for in the Affordable Care Act, other reform-related measures should result in some increase in the state’s Medicaid population.
To learn more about CMS’s recommendations for addressing this ER challenge, including some of the legal and reimbursement-related challenges this will pose, see the CMS informational bulletin “Reducing Nonurgent Use of Emergency Departments and Improving Appropriate Care in Appropriate Settings.”

PA Safety Net Admin2014-01-24T06:00:53+00:00January 24th, 2014|Affordable Care Act|Comments Off

CHIP Option Granted Temporary Stay in PA

Children currently receiving Children’s Health Insurance Program (CHIP) benefits in Pennsylvania will have the option of remaining in the program for one more year.
This comes as a result of negotiations between state officials and the U.S. Department of Health and Human Services.
Under the Affordable Care Act, children eligible for CHIP benefits who previously did not qualify for Medicaid now do qualify for Medicaid and the federal government expected states to fold these CHIP participants into their Medicaid programs. Pennsylvania officials, however, argued that CHIP participants often had a broader choice of providers than Medicaid recipients and that taking those children out of CHIP would damage the continuity of care they were receiving.
State and federal officials negotiated this issue for months until this week, when federal officials announced that Pennsylvania children in families whose income is between 100 percent and 133 percent of the federal poverty level can choose whether to remain in CHIP or move to the state’s Medicaid program. That choice ends at the close of 2014, when these participants will be enrolled in Medicaid.
CHIP insurers will mail information about this option to the 30,000 affected families.
To learn more about this issue and how it might affect care for low-income children, see this news release from the Pennsylvania Insurance Department.

PA Safety Net Admin2014-01-23T06:00:39+00:00January 23rd, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Safety-Net Hospitals Hurt More by Readmissions Reduction Program

Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study.
According to the study,

Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

Because they care for so many more low-income patients than the typical hospital, Pennsylvania’s safety-net hospitals are especially vulnerable to the Medicare hospital readmissions reduction program’s financial penalties.
The study, “The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations,” was published recently in Health Services Research and can be found here.

PA Safety Net Admin2014-01-22T06:00:20+00:00January 22nd, 2014|Affordable Care Act|Comments Off

Changes in Medicaid Fee Schedule

The Pennsylvania Department of Public Welfare has announced changes in its Medical Assistance fee schedule. Those changes, published in the January 18 edition of the Pennsylvania Bulletin, can be found here.

PA Safety Net Admin2014-01-21T06:00:39+00:00January 21st, 2014|Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

The Time May Have Arrived for a Permanent “Doc Fix”

Congress appears serious about addressing a long-running problem: the need for an annual “Medicare doc fix” to address the problem stemming from the use of the sustainable growth rate formula, or SGR, to determine Medicare payments for physician services.
For years, application of the SGR called for reductions in Medicare payments to doctors, forcing Congress to apply temporary patches to the problem – and to find ways to pay for those patches.
Now, however, Congress appears intent on doing away with the SGR and fixing the problem once and for all.
But what exactly is the problem, what will it cost to fix, and how might Congress fix it? And why address it now, after years of short-term solutions? These questions and others are answered in a new Kaiser Health News FAQ, which you can find here.

PA Safety Net Admin2014-01-20T06:00:06+00:00January 20th, 2014|Uncategorized|Comments Off

Healthy PA Hearings End

Public hearings on the Corbett administration’s “Healthy Pennsylvania” health care reform and Medicaid insurance expansion proposal ended last week with a hearing in Harrisburg.
Forty people testified at the final hearing, including SNAP president Michael Chirieleison; his oral testimony and SNAP’s more detailed written submission can be found here.
For a summary of the final hearing and a look at what might happen next according to Department of Public Welfare Secretary Beverly Mackereth, see this article on the web site of WITF, Harrisburg’s public television station.

PA Safety Net Admin2014-01-17T06:00:48+00:00January 17th, 2014|Healthy PA|Comments Off

Providers Receive Expanded Authority to Extend Presumptive Medicaid Eligibility

While hospitals and providers in 33 states have long enjoyed the ability to extend presumptive eligibility for Medicaid to children or pregnant women, that authority is now being extended in some states to any adults whose income appears likely to fall below 138 percent of the federal poverty level.
The extension of this authority comes via the Affordable Care Act, which also offers states the option of expanding Medicaid eligibility for their residents. Individual states decide whether to extend this authority, which is typically wielded by hospitals, schools, clinics, other providers of care to the Medicaid and CHIP population, Head Start programs, and others.
This policy could benefit many Pennsylvania safety-net hospitals because they serve much higher proportions of low-income patients than the average hospital. Currently, 52 acute-care hospitals in the state are authorized to determine presumptive eligibility.
To learn more about changes in extending presumptive eligibility to low-income patients, see the policy brief “Hospital Presumptive Eligibility” from the Robert Wood Johnson Foundation and the publication Health Affairs.

PA Safety Net Admin2014-01-16T12:31:52+00:00January 16th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

SNAP Comments on Proposed Medicaid Waiver

The Safety-Net Association of Pennsylvania has submitted extensive comments to the Pennsylvania Department of Public Welfare regarding the state’s application for a section 1115 Medicaid waiver needed to enable the state to expand its Medicaid program through private market insurers.
The highlights of SNAP’s comments include its call for extending retroactive eligibility to those who obtain Medicaid coverage through the private market; easing proposed limits on benefits and penalties for non-payment of premiums; retaining the current supplemental Medicaid payments qualified hospitals receive; and pursuing greater investment in the health care infrastructure of communities with especially high proportions of low-income patients.
See SNAP’s complete written submission here..

PA Safety Net Admin2014-01-14T11:47:11+00:00January 14th, 2014|Health care reform, Healthy PA, Medicaid supplemental payments, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

Pennsylvania, the Uninsured, and the Affordable Care Act

How will the Affordable Care Act expand health insurance coverage in Pennsylvania?
How many Pennsylvanians might be eligible for subsidized insurance under the reform law?
These questions and others are addressed in the new Kaiser Family Foundation report “How Will the Uninsured in Pennsylvania Fare Under the Affordable Care Act?” Find that report here.

PA Safety Net Admin2014-01-13T06:00:54+00:00January 13th, 2014|Affordable Care Act, Health care reform|Comments Off

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