Affordable Care Act Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for the Week of November 1-5

The following is an update of selected state health policy developments in Pennsylvania for the week of November 1-5, 2021. (Some of the language used below is taken directly from state documents.)

Governor Wolf

The Wolf administration announced that “Pennie,” the state’s new health insurance exchange, has now begun operations as this year’s Affordable Care Act open enrollment period begins. Find Pennie here.

General Assembly

The House and Senate will be in session next week on Monday (10/8), Tuesday (10/9), and Wednesday (10/10). The following health care-related committee meetings have been scheduled:
- The Senate Majority Policy Committee will hold an informational meeting on Monday, November 8 at 10:00 a.m. to examine COVID-19 vaccine mandates and their impact on the workforce. The hearing will be live-streamed here.
- The Senate Health & Human Services Committee will convene on Monday, November 8 at 12:30 p.m. to consider Senate Bill 471, which prohibits the mandatory vaccination of Pennsylvania residents by the state or as a condition of employment. The committee will also consider House Bill 220, which specifies that a person does not need to test positive for drugs to begin addiction treatment.
- The Senate Aging & Youth Committee will meet on Tuesday, November 9 at 12:00 p.m. to consider, among other bills, House Bill 1260, which increases the maximum income eligibility limits for PACENET from $27,500 to $33,500 for individuals and from $35,500 to $41,500 for married couples.

The House of Representatives is planning to consider a few key behavioral health bills next week, including House Bill 1561 and House Bill 1563, which amend the Mental Health Procedures Act and the Drug and Alcohol Abuse Control Act, respectively, to align them with HIPAA and give providers, facilities, and insurers the ability to more easily share patient mental health and substance use disorder treatment information. The House is also planning to consider House Bill 1308, which enables local communities and agencies to establish overdose fatality review teams.

Department of Human Services

The Department of Human Services (DHS) has issued updated requirements on the information needed to evaluate prior authorization requests for certain medications based on actions taken by its Pharmacy and Therapeutics Committee during its September 14 meeting. These updated requirements take effect on January 3, 2022.
DHS has updated its collection of regulations that have been suspended as a result of the COVID-19 emergency.
DHS has announced changes in fee schedule rates for selected personal assistance services procedure codes in the Medical Assistance OBRA Waiver and the Act 150 Program. The changes in the fee schedule rates for these services will take effect on January 1, 2022. Learn about the changes in this Pennsylvania Bulletin notice.
DHS’s Office of Long-Term Living has distributed the following message to stakeholders via its Community HealthChoices listserv:

This communication is intended for Department of Human Services (DHS) Sandata Electronic Visit Verification (EVV) and DHS Aggregator users for informational purposes regarding how the DHS Aggregator will be handling the end of Daylight Savings Time (DST) which is set to occur at 2:00 AM this Sunday, November 7, 2021.

For scheduled and completed visits that occur during or crossover the end of DST, the scheduling hours will appear to be short by an hour. This is expected behavior since DHS Aggregator times are calculated based on Coordinated Universal Time (UTC). Provider agencies and/or administrators should not adjust visit times related to DST. Visits during this event will continue to be calculated based on the actual visit times so there are no issues with billing requirements.

Any questions related to this can be submitted to RA-PWEVVNOTICE@pa.gov

Department of Health

The Department of Health has rescinded a May 26, 2021 order that required skilled nursing facilities to make weekly reports of specified data on supplies and equipment. The department has launched a new data dashboard with facility-level COVID-19 resident and staff cases, deaths, and vaccination rates that uses data that nursing homes are already required to report to the federal government. The Survey 123 reporting requirement was eliminated effective October 29, 2021.

COVID-19: By the Numbers

While there has been a modest downward trend in new COVID-19 cases in recent weeks, the past two days have seen the two highest single-day counts of new cases since mid-October.
Approximately 32,710 of the state’s total cases to date have been among health care workers.
The number of COVID-19 cases among school-aged children (between 5-18 years old) is nearly three times greater this year than in 2020. Between October 27 and November 2, 2020 there were 1,683 COVID-19 cases in school-aged children compared to 4,918 cases in the same age group during the same week this year.
In licensed nursing and personal care homes there have been 79,250 resident cases of COVID-19 to date and 17,449 cases among employees for a total of 96,699 at 1,642 facilities in all 67 counties.
The number of new COVID-19-related deaths remains high but did not rise during the past week.
Sixty-six of Pennsylvania’s 67 counties currently are experiencing high rates of community transmission of COVID-19; Philadelphia County is experiencing “only” a substantial rate of community transmission.
The number of Pennsylvanians hospitalized, in hospital ICUs, and on ventilators because of COVID-19 has fallen slightly since the first of the month.
72.2 percent of Pennsylvanians 18 years of age and older are now fully vaccinated – more than 6.5 million people. 38,000 Pennsylvanians were recorded as completing a vaccine regimen in the past week.

Department of Drug and Alcohol Programs

The state’s Independent Regulatory Review Commission has approved the Department of Drug and Alcohol Programs’ proposed regulations for drug and alcohol recovery house licensure. See the approval in this Pennsylvania Bulletin notice.

Stakeholder Events

Pharmaceutical Assistance Advisory Board – November 15

The Department of Aging’s Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, November 15, 2021 at 8:30 a.m. To participate virtually or by phone, go here for further information.

Health Research Advisory Committee – November 15

The Department of Health’s Health Research Advisory Committee will hold a virtual public meeting on Monday, November 15 at 1:00 p.m. For information on how to attend virtually, see this Pennsylvania Bulletin notice.

Pennsylvania Rural Health Redesign Center Authority Board – November 16

The Department of Health’s Pennsylvania Rural Health Redesign Center Authority Board, which is charged with administering the Pennsylvania Rural Health Model, will hold a virtual public meeting on Tuesday, November 16 at 10:00 a.m. For information on how to attend virtually, see this Pennsylvania Bulletin notice.

Newborn Screening and Follow-Up Technical Advisory Board – November 18

The Department of Health’s Newborn Screening and Follow-Up Technical Advisory Board will hold a virtual public meeting on Thursday, November 18 at 10:00 a.m. For information on how to attend virtually, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee Meeting – December 2

The Medical Assistance Advisory Committee’s managed long-term services and supports subcommittee will hold a virtual public meeting on Thursday, December 2 at 10:00 a.m. To register to participate, go here.

jsteinbock2021-11-05T21:56:42+00:00November 5th, 2021|Affordable Care Act, Coronavirus, COVID-19, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid|Comments Off

Eliminate Medicaid DSH Cut, SNAP Asks PA Delegation

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states, and the Safety-Net Association of Pennsylvania has written to the state’s congressional delegation asking its members to convey this message to congressional leaders.

The cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to the delegation, SNAP wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured, including nearly 700,000 Pennsylvanians – a number thought to be rising because of the job loss associated with COVID-19. When these people are sick or injured, most will turn to the state’s 41 private safety-net hospitals for care. These hospitals depend heavily on their Medicaid DSH payments to underwrite the cost of care for their uninsured patients, so they have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never permitted those cuts to go into effect. The most recent delay expires after November 30..

Because they serve so many uninsured and underinsured patients, Medicaid DSH payments from the state are especially important for Pennsylvania’s safety-net hospitals.

PA Safety Net Admin2020-09-15T06:00:16+00:00September 15th, 2020|Affordable Care Act, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Azar: Budget Proposes Reducing Medicaid Matching $

The federal government would reduce its financial commitment to state Medicaid programs under the FY 2021 budget the Trump administration proposed earlier this month.

While testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services and Education, Health and Human Services Secretary Alex Azar acknowledged that the administration’s proposed FY 2021 would eliminate the enhanced rate at which the federal government matches state funds used to serve individuals who enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion provision. That enhanced rate calls for the federal government to pay 100 percent of the costs associated with the Medicaid population during the first year of Medicaid expansion, eventually scaling down to 90 percent after 2020. Nationally, the federal government’s matching rate for the pre-expansion population is 57 percent; that matching rate would not be affected by this proposal.

This aspect of the administration’s proposed FY 2021 budget has mostly flown under the radar since the budget’s release and has received little public attention.

In explaining the proposal, Azar said that enhanced funding for the Affordable Care Act’s Medicaid expansion population was biased against the disabled, women, and children.

Such a policy change could be a blow to safety-net hospitals in states like Pennsylvania, which added more than a half-million people to its Medicaid program through the Affordable Care Act’s Medicaid expansion provision.

Learn more about what Secretary Azar said about federal matching funds for state Medicaid programs in the McKnight’s Long-Term Care News article “Official confirms Trump budget proposed to eliminate enhanced Medicaid match.”

PA Safety Net Admin2020-02-28T06:00:34+00:00February 28th, 2020|Affordable Care Act, Federal Medicaid issues|Comments Off

Interview With Seema Verma

In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma. Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more. Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma.”

PA Safety Net Admin2020-01-09T06:00:16+00:00January 9th, 2020|Affordable Care Act, Federal Medicaid issues, Health care reform|Comments Off

Medicaid DSH Cut Delayed

Scheduled cuts in Medicaid DSH payments to hospitals will be delayed until at least late May under new federal spending legislation.

The cuts in Medicaid disproportionate share allotments to the states, mandated by the Affordable Care Act and delayed several times by Congress – including twice in FY 2020 alone under continuing resolutions to fund the federal government – are among a number of so-called “extenders” included in spending bills passed by Congress this week and sent to the president for his signature.

Authorization for delaying the cut in allotments to the states, which would have resulted in reduced Medicaid DSH payments for many hospitals – including private safety-net hospitals – would expire on May 22. Congress is expected to address Medicaid DSH, along with surprise medical bills, the price of prescription drugs, and other health care matters, before that time.

SNAP has argued against Medicaid DSH cuts for a number of years, doing so most recently in an October 2019 message to members of Pennsylvania’s congressional delegation in which it wrote that

Should the Medicaid DSH cut take effect, Pennsylvania would lose 40 percent of its federal Medicaid DSH allotment in FY 2020 and 80 percent of its allotment each year from FY 2021 to FY 2025. Such devastating cuts could jeopardize access to care for the state’s uninsured and jeopardize the ability of the state’s safety-net hospitals to serve them. It is essential, for the sake of Pennsylvania’s health care safety net and the communities and patients that safety net serves, that the Medicaid DSH cut continue to be delayed.

Learn more about the delay in Medicaid DSH cuts and other aspects of this recent health care spending legislation in the Becker’s Hospital Review article “Congress unveils $1.3T spending deal: 5 healthcare takeaways.”

PA Safety Net Admin2019-12-19T06:00:58+00:00December 19th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid|Comments Off

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20.

A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress. If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025.

Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals.

Medicaid DSH payments are a vital tool for helping safety-net hospitals care for the low-income residents of their communities. All Pennsylvania safety-net hospitals receive such payments.

The current cut is only temporary and expires when the continuing resolution expires after December 20.

PA Safety Net Admin2019-11-25T06:00:13+00:00November 25th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues|Comments Off

Administration Shares Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”

The statement, an annual OMB document, organizes the priorities as follows:

Facilitating patient-centered markets
Fixing health care financing through protecting private insurance and Medicare
Fixing health care financing through reforming the individual market
Fixing health care financing through making the ACA and Medicaid fiscally sustainable
Bringing value to health care through price and quality transparency
Bringing value to health care through patient-centered health IT
Bringing value to health care through deregulation, especially for coordinated care
Bringing value to health care through tackling the high cost of prescription drugs
Bringing value to health care through accelerated drug and device approval and reimbursement

Promoting health and protecting life

Addressing impactable health challenges: kidney health
Addressing impactable health challenges: combatting the opioid crisis
Protecting conscience and life at all stages
Reducing the disease and death associated with tobacco use

Promoting independence

Returning TANF to promoting work, marriage and family
Supporting adoption
Empowering Americans to improve their nutrition
Promoting flexibility for states, grantees, and regulated entities

Learn more about the regulatory directions the administration intends to take for the rest of its 2020 fiscal year in the newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” Go here to see the complete list of regulations that the Department of Health and Human Services intends to pursue in FY 2020, including 55 by the Centers for Medicare & Medicaid Services (CMS).

PA Safety Net Admin2019-11-22T06:00:11+00:00November 22nd, 2019|Affordable Care Act, Federal Medicaid issues, Medicare|Comments Off

Medicaid Expansion Brings Improvements to Expansion States

States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study.

Specifically, they experienced:

a 3.1 percent decline in inpatient days
a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia
a reduction of nearly three percent in hospital costs.

Pennsylvania is one of those expansion states, and Medicaid expansion has greatly enhanced the ability of Pennsylvania safety-net hospitals to serve their communities.

Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated With Reductions in Preventable Hospitalizations.”

PA Safety Net Admin2019-11-06T06:00:14+00:00November 6th, 2019|Affordable Care Act, Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

ACA May be Improving, Saving Lives

The insurance expansion made possible by the Affordable Care Act may be improving and even saving lives, some studies and anecdotal evidence suggest.

While observers warn that it is difficult to attempt to render a final verdict on the reform law’s insurance expansion and its impact, various studies and observations point to encouraging developments. Among them:

High blood pressure is being detected at a higher rate now among people who bought insurance as a result of the ACA than it was prior to the law’s passage.
Fewer 19-26 year-olds, now permitted to remain on their parents’ health insurance, are choosing not to see a doctor about their asthma because of the cost of seeking care.
Women in Michigan report having an easier time obtaining birth control pills.
Participants in a Michigan program are reporting an increased likelihood of learning they have chronic medical conditions than was the case before they were insured.
People between their mid-50s and mid-60s living in states that expanded their Medicaid programs, and who took advantage of that expansion, had a lower death rate than similar people in non-expansion states.

Pennsylvania is among the 37 states (including the District of Columbia) that took advantage of the Affordable Care Act to expand its Medicaid program.

Learn more about some of the documented and observed benefits of the Affordable Care Act’s improved access to health insurance in the Washington Post article “With the Affordable Care Act’s future in doubt, evidence grows that it saves lives.”

PA Safety Net Admin2019-10-02T15:52:54+00:00October 2nd, 2019|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

CMS Adopts Methodology for Medicaid DSH Cuts

Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services.

But it is not clear when that new methodology may actually be used.

Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several occasions delayed the required Medicaid DSH cut.

That cut is now scheduled to take effect next week, on October 1, but a continuing resolution to fund the federal government, passed last week by the House and now under consideration by the Senate, would delay that cut again – at least until November 22.

Should the cut be implemented, Pennsylvania would lose 40 percent of its Medicaid DSH allotment from the federal government in FY alone and that cut would rise to 80 percent a year from FY 2021 through FY 2025. Pennsylvania safety-net hospitals view Medicaid DSH as an important part of their effort to care for the uninsured and underinsured residents of the low-income communities in which they are located.

Learn more about the new regulation governing the future allotments of Medicaid DSH money to the states and the prospects for Medicaid DSH allocation cuts being made anytime soon in the Healthcare Dive article “CMS finalizes Medicaid DSH cuts, but Congress could still delay” and see the regulation itself here.

PA Safety Net Admin2019-09-25T10:59:52+00:00September 25th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

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