Affordable Care Act Archives - Page 9 of 15 - Safety-Net Association of Pennsylvania

Enrolling in PA’s Medicaid Expansion Program

On December 1, Pennsylvanians who believes they may be eligible for Medicaid under the state’s expanded eligibility criteria – part of the Healthy Pennsylvania program – can begin submitting applications for coverage, which will begin on January 1.
People can apply in four ways:

the state’s online application process – at https://www.compass.state.pa.us/
the healthcare.gov site
a dedicated call center set up by the Affordable Care Act – 866-550-4355
a paper application at any county assistance office

PA Safety Net Admin2014-10-02T06:00:05+00:00October 2nd, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

GAO Questions Cost of Private Market Medicaid Expansion

Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Hospitals, Charitable Groups to Pay Insurance Premiums?

Hospitals and charitable groups such as the United Way are exploring the possibility of paying the health insurance premiums of uninsured patients who come through hospital doors.
Such an approach would enhance access to care for the uninsured while helping hospitals get paid for care they will be providing regardless of whether the patients in question have health insurance.
Such a practice is not entirely new. A United Way organization in Wisconsin raised $2 million to help low-income residents purchase health insurance and hospital groups in New York and Florida are exploring a similar approach.
Health insurers oppose the idea, maintaining that hospitals selectively choosing whom to help will skew the pool of insured people toward those with greater health problems that incur greater costs to serve.
The federal government has not been clear about its perspective on the idea of anyone other than those seeking insurance paying their own premiums. While it requires insurers to accept premiums paid by selected federal programs, it issued an FAQ last year discouraging hospitals from taking the same approach. Regulations issued after that FAQ, however, did not fully clarify the federal position.
Learn more about the issue, how such payments work, and the perspectives of hospitals, insurers, charitable organizations, and the federal government, in this Kaiser Health News article.

PA Safety Net Admin2014-09-04T06:00:20+00:00September 4th, 2014|Affordable Care Act|Comments Off

PA Medicaid Expansion Approved by Feds

Pennsylvania’s request for federal approval of its Medicaid expansion plan has been approved by the federal government.
The plan, part of the Corbett administration’s “Healthy Pennsylvania” health care reform proposal, calls for an expanded population of Pennsylvanians who are newly eligible for Medicaid to obtain subsidized coverage through the private health insurance market – managed care organizations approved by the state to serve the new Medicaid expansion population.
The letter of approval from Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner to Pennsylvania Department of Public Welfare Secretary Beverly Mackereth notes that

…the state aims to modify Pennsylvania’s Medicaid program and expand access to coverage to adults in Pennsylvania with incomes through 133 percent of the federal poverty level (FPL) beginning January 1, 2015.

The terms of the demonstration have been incorporated into the accompanying Special Terms and Conditions (STCs) and waiver authorities for the demonstration approval. The approved demonstration authorizes the state to charge premiums to newly eligible individuals up to 133 percent of FPL with access to health care coverage through managed care health plans. Specifically, beginning in January 2016 of the demonstration, the state may charge monthly premiums in an amount not to exceed 2 percent of household income for certain adults with incomes above 100 percent of the FPL.

Beneficiaries subject to a premium as authorized by the demonstration will not be charged copayments (with the exception of an $8 copayment for non- emergency use of the emergency room, which the state may authorize within the Medicaid state plan). Individuals failing to pay the monthly premiums for three consecutive months may be disenrolled from coverage, and may re-enroll without a waiting period. The Commonwealth is not imposing premiums on individuals with incomes at or below 100 percent of the FPL.

The Healthy Pennsylvania demonstration includes an incentive program that is intended to improve the use of preventive services and other healthy behaviors. Enrollees who complete specified healthy behaviors during the first year of enrollment in the demonstration shall have their premium obligations reduced in their second year. For each subsequent year, enrollees will have the opportunity to complete healthy behaviors to reduce their amount of financial obligations.

We have provided authority for the state to not offer non-emergency medical transportation (NEMT) during the first year of the demonstration. This authority will sunset on December 31,2015, and the state will provide NEMT to these beneficiaries beginning in year 2 of the demonstration. The changes in the Pennsylvania demonstration are consistent with those in other demonstrations.

The Commonwealth will deliver services to the newly eligible population through contracts with managed care organizations. Individuals covered will have the choice of an approved health plan in their region. Medicaid managed care rules continue to apply under the demonstration although as stipulated in the demonstration the Commonwealth may rely on state or federal commercial standards when those standards are at least as robust as the Medicaid standards.

Benefits provided to individuals eligible under the expansion will be consistent with federal statutory requirements effectuated through amendments to the Commonwealth’s state plan, rather than the approved demonstration. The expansion population, including those who are subject to this demonstration and those who are medically frail and covered outside of this demonstration, will receive the full complement of health services required under the law. Medically frail individuals will receive coverage from the state through a “high risk” benefit plan.

CMS and the state have been in active consultation on the state plan amendments needed to effectuate this change and have reached agreement on the overall benefits approach, pending final submission of documents by the state consistent with the agreement that has been reached.

In addition, outside this demonstration, the state aims to encourage employment through incentives for job training and work-related activities, including access to Healthy Pennsylvania Career Coaches, for Healthy Pennsylvania beneficiaries who choose to participate in the state’s Encouraging Employment program. Health coverage provided by the Medicaid program and this demonstration will not be affected by this state initiative.

The complete approval letter and a second document describing the special terms and conditions the federal government has attached to the waiver approval can be found here, on the Healthy Pennsylvania web site.

PA Safety Net Admin2014-08-29T06:00:52+00:00August 29th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Charity Care? Wait a Minute

Many hospitals are considering whether they should continue to provide charity care to people who were eligible for Affordable Care Act subsidies to purchase health insurance but chose instead to remain uninsured.
The issue for many is whether the availability of charity care is an inducement for some people not to purchase health insurance and whether such patients are unwilling or unable to pay for care.
Some hospitals have decided not to provide non-emergency charity care to those who chose not to purchase subsidized health insurance. Others are currently considering whether they need to revise their approach to charity care. Still others have decided that they will not change their charity care policies.
Charity care is an especially critical issue for the state’s safety-net hospitals because they serve so many more low-income and uninsured patients than the typical Pennsylvania hospital.
Learn more about this latest phase in the evolution of charity care and how hospitals are approaching it in this Kaiser Health News report.

PA Safety Net Admin2014-08-28T06:00:40+00:00August 28th, 2014|Affordable Care Act|Comments Off

Readmissions and Quality: Are They Related?

A new study casts doubt on a major principle underlying a good deal of recent federal health care policy.
That principle holds that hospitals that have lower rates of 30-day readmissions of Medicare patients provide better, more economical care than those with higher readmission rates.
But that may not be true.
According to an examination of the performance of safety-net hospitals in California published in the journal Health Affairs, those safety-net hospitals are more likely than others to be penalized by Medicare’s hospital readmissions reduction and value-based purchasing programs.
At the same time, however, these same hospitals had lower 30-day, risk-adjusted mortality rates for patients treated for myocardial infarction, heart failure, and pneumonia. The safety-net hospitals also had marginally lower adjusted Medicare costs.
Find out more about the findings of the study “California Safety-Net Hospitals Likely to be Penalized by ACA Value, Readmission, and Meaningful-Use Programs,” which can be found here, on the web site of the journal Health Affairs.

PA Safety Net Admin2014-08-21T06:00:31+00:00August 21st, 2014|Affordable Care Act, Health care reform|Comments Off

Translating Insurance Into Care

While the Affordable Care Act is enabling millions of Americans to obtain health insurance – many of them for the first time – many of the newly insured do not understand how their insurance works or how to use it to get the care they need.
Across the country, advocacy groups, insurers, hospitals, and clinics are encountering newly insured people struggling to translate their new health insurance into health care, and many are employing outreach and educational programs to teach people how to enjoy the benefits of their new coverage.
Learn more about the new challenges health care providers are encountering, and about how a group of organizations in Philadelphia is responding to that challenge, in this New York Times article.

PA Safety Net Admin2014-08-14T06:00:44+00:00August 14th, 2014|Affordable Care Act|Comments Off

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

PA Safety Net Admin2014-07-25T06:00:35+00:00July 25th, 2014|Affordable Care Act|Comments Off

Foundation to Track Effect of ACA on Hospitals

The Robert Wood Johnson Foundation has launched a project to measure the impact of the Affordable Care Act on hospitals.
Working with 24 state hospital associations, the foundation’s Hospital ACA Monitoring Project will collect quarterly hospital data on admissions, emergency room visits, and selected diagnoses and procedures. The project will collect data from different types of hospitals with different payer mixes.
According to the foundation, the project “is designed to shed light on some of the effects of health reform on hospitals and provide extremely timely data to researchers, policymakers and hospital leaders.”
Learn more about the Robert Wood Johnson Foundation’s Hospital ACA Monitoring Project from this notice on the foundation’s web site.

PA Safety Net Admin2014-07-14T06:00:42+00:00July 14th, 2014|Affordable Care Act, Health care reform|Comments Off

Keep Medicaid Pay Boost, Docs Ask Congress

Physician groups and other health care organizations are asking Congress to continue the increase in Medicaid payments that primary care providers have been receiving for nearly two years.
The pay raise, mandated by the Affordable Care Act, was instituted to help induce more primary care providers to serve Medicaid patients in anticipation of the reform law’s significant expansion of Medicaid eligibility. That pay raise, which brings Medicaid rates up to the level of Medicare rates and is paid for entirely by the federal government, expires at the end of 2014.
Now, primary care physicians have written to the leaders of the Senate Finance Committee and the House Energy and Commerce Committee asking them to extend the raises and add ob/gyns to providers eligible for the enhanced payments.
See their letter here.

PA Safety Net Admin2014-06-30T13:00:37+00:00June 30th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

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