The Centers for Medicare & Medicaid Services (CMS) has published an FAQ to give providers guidance on the application of its so-called two-midnight rule governing when certain medical situations qualify for patient admission and when they should be classified as Medicare outpatient observation status. See that FAQ here.
The number of ambulatory surgery centers in Pennsylvania grew in FY 2012, and along with that growth in numbers came a growth in profitability.
According to a new report by the Pennsylvania Health Care Cost Containment Council (PHC4), providers added 10 new facilities in FY 2012, raising the number to 281, and the average operating margin of the facilities rose from 24.94 percent to 25.83 percent.
For the latest data on ambulatory surgery centers in Pennsylvania, where they are, who they serve, how many procedures they perform, and who is paying for those procedures, find a PHC4 news release and the agency’s latest report here.
The lack of psychiatric beds in Pennsylvania has contributed to a rise in the number of behavioral health patients turning to hospital emergency rooms for care.
Or so says the Pennsylvania Medical Society.
Patients with nowhere else to turn often visit hospital ERs in search of help.
In response, the medical society hopes to create a tracking system to identify behavioral health and detoxification beds.
Learn more about this problem and physicians’ proposed response to it in this Central Penn Business Journal article.
As the congressional budget conference committee begins its work, SNAP has asked members of Pennsylvania’s congressional delegation to urge their colleagues serving on the committee to protect the state’s safety-net hospitals from any further Medicare and Medicaid cuts.
In the message, SNAP notes the significant Medicare and Medicaid cuts the state’s safety-net hospitals have already suffered and warns that further cuts could jeopardize access to care in communities across the commonwealth.
Read SNAP’s message to the Pennsylvania congressional delegation here, on the SNAP web site.
Pennsylvania Governor Tom Corbett’s “Healthy Pennsylvania” proposal calls for an expansion of the state’s Medicaid program as envisioned when the Affordable Care Act was passed three years ago.
Or does it?
Is it Medicaid expansion or is it something entirely different? In the article “Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way,” Kaiser Health News takes a look at how elected officials, advocates, and others are viewing the recent Healthy Pennsylvania proposal. Find the article here.
Even as Pennsylvania considers a new approach to serving some Medicaid patients, hospitals are complaining about the inadequacy of the state’s Medicaid payments for outpatient services.
Those payments, hospitals note, sometimes amount to only 30-40 percent of the cost of some outpatient services.
While Medicaid inpatient fees have been raised on several occasions over the years, outpatient fees have been the same for more than two decades.
Read more about the challenges Pennsylvania hospitals face in getting adequate reimbursement for Medicaid outpatient services in this Pittsburgh Post-Gazette article.
The Pennsylvania Health Law Project has released its latest edition of its Health Law PA News newsletter.
The September 2013 edition includes articles about the launch of the federal health insurance marketplace, the new Medicaid eligibility rules that took effect on October 1, Governor Corbett’s proposed Medicaid expansion, and more.
Find the latest Health Law PA News here.
Pennsylvania has extended its Children’s Health Insurance Program (CHIP) through the end of 2015.
The law renewing the program, which provides health insurance to all children who needs it, also eliminates the six-month waiting period for eligibility for services.
The state also intends to increase its outreach efforts in an attempt to reverse a recent decline in program enrollment.
Currently, CHIP serves 188,000 children in the state.
Read more about the CHIP renewal and the program itself in this Philadelphia Inquirer article.
More than five million adult Americans will fall into the Affordable Care Act’s Supreme Court-created coverage gap in states that have chosen not to expand their Medicaid programs.
In those 26 states, adults whom the reform law intended to be covered by Medicaid will still earn too much money to qualify for Medicaid yet also will fall below the income level needed to qualify for Affordable Care Act health insurance subsidies.
This gap was created when the Supreme Court made the reform law-mandated Medicaid expansion optional for individual states, and so far, 26 states have chosen not to expand their Medicaid programs. The result, according to a new issue brief from the Kaiser Commission on Medicaid and the Uninsured, is that 5.2 million low-income adults whom the law intended to enroll in Medicaid will remain uninsured.
More than 280,000 of these people reside in Pennsylvania, which has not yet expanded its Medicaid program. Many will continue to be served by the state’s private safety-net hospitals, which will not be paid for the care they provide.
To learn more about these people and why they will remain uninsured, read the study “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Find the study here, on the web site of the Kaiser Family Foundation.
Pennsylvania Department of Public Welfare Secretary Beverly Mackereth has sent the following message to health care providers and other stakeholders that will be affected by the state’s loss of $180 million in national tobacco settlement money as a result of a recent arbitrary decision.
October 2, 2013
I am reaching out to you, our valued stakeholder, to provide you with information about the potential impact of the recent tobacco master settlement agreement (MSA) decision. Please understand this legal action and the potential next steps are in no way a reflection of the quality of your work or actions as a partner with the Department of Public Welfare (DPW). This decision stems back to circumstances that occurred in 2003.
As you may be aware, the Pennsylvania Attorney General’s office recently notified the Governor’s Budget Office that the state’s annual share of the tobacco MSA will be reduced by an estimated $180 million, or 60 percent of the state’s base tobacco payment, as a result of a decision by an arbitration panel to address claims from 2003.
While this decision has immediate impacts to Pennsylvania’s health and human services programs, the Corbett Administration is committed to maintaining direct services and mandatory healthcare programs. I would like to reassure you that we are working diligently to ensure services will continue without interruption for all Pennsylvanians.
The reduction will occur in the state’s April 2014 MSA payment, which supports spending in the current fiscal year. This has forced the state to freeze discretionary funding from the MSA. As of now the only DPW program affected will be uncompensated care payments to hospitals.
Please be assured, this course of action was not arrived at lightly. Immediate action is necessary in the face of such a dramatic decrease in revenues due to the MSA decision. Moving forward, the Attorney General’s Office is preparing an appeal of the decision.
The attached press release provides additional information regarding this issue. I appreciate your time and understanding as we work together on this issue.
Sincerely,
Beverly Mackereth, Secretary
Department of Public Welfare
The loss of uncompensated care payments will pose a major challenge to the state’s safety-net hospitals, which are the primary providers of care to the uninsured in Pennsylvania and the primary recipients of these funds.
Go here for the press release cited above.
