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

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

SNAP Testifies About Healthy Pennsylvania

The Safety-Net Association of Pennsylvania (SNAP) has weighed in on Governor Corbett’s Healthy Pennsylvania health care reform and insurance expansion proposal.
Testifying at a January 9 public hearing in Harrisburg, SNAP president Michael Chirieleison expressed general support for the Healthy Pennsylvania proposal and addressed four aspects of it that safety-net hospitals would like to see improved:

extension of retroactive eligibility to the Medicaid expansion population;
including inpatient services provided to that same population as “Medicaid days” for the purpose of determining eligibility for supplemental Medicaid payments and other government programs;
reconsideration of proposed benefit limits and suspension of eligibility for non-payment of premiums; and
the addition of a Delivery System Reform Incentive Program or a similar program to support the development of health care infrastructure in communities with large numbers of low-income Pennsylvanians.

Read SNAP’s testimony here.

PA Safety Net Admin2014-01-09T14:14:05+00:00January 9th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Concern About Churn

State government and health insurers are worried about a process called “churning” – people moving back and forth between Medicaid and private insurers as their income changes. With more people now qualified for Medicaid, observers believe that as many as nine million people may move back and forth between Medicaid and private insurance in 2014.
In the past, people whose income rose enough to lose their Medicaid eligibility often could not afford private insurance and joined the ranks of the uninsured. Now, some will be eligible for subsidies that may enable them to purchase health insurance on their own. People who move back and forth between insurers, however, may be at risk of gaps in coverage and loss of continuity of care.
Churn may be especially prevalent in the lower-income communities served by Pennsylvania’s safety-net hospitals.
How does churn work and what are the states doing to anticipate and address it? Learn more in this Washington Post article.

PA Safety Net Admin2014-01-08T06:00:58+00:00January 8th, 2014|Affordable Care Act|Comments Off

Supply of Doctors to be Tested by the Newly Insured

With various aspects of the Affordable Care Act helping millions of people obtain health insurance, it remains to be seen whether there will be enough doctors to care for them.
In particular, primary care physicians, dentists, and mental health professionals could be in short supply, leaving some newly insured patients struggling to find providers to help them exercise their new access to care. Many parts of the country, in fact, have been certified by the federal government as health professional shortage areas. Pennsylvania has many health professional shortage areas and federally designated medically underserved areas.
Learn more about the potential shortage of physicians, where that problem arises, and what is being done about it in this Stateline report .

PA Safety Net Admin2014-01-07T06:00:49+00:00January 7th, 2014|Affordable Care Act|Comments Off

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