SNAP Comments on Proposed Medicaid Observation Care Payment

The Safety-Net Association of Pennsylvania has written to the state’s Department of Human Services about DHS’s proposal to establish a payment policy for hospital observation services covered by the state’s Medicaid fee-for-service program.
While SNAP has long supported the concept of a Medicaid fee-for-service rate for observation services and welcomes DHS’s decision to create such a rate and associated policies, it expressed a number of concerns about DHS’s proposal, including about:

  • Safety-Net Association of Pennsylvania logothe proposed observation rate
  • the classification of observation care as an outpatient service
  • the manner in which the state proposes financing observation care
  • program integrity issues

To learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.

2016-06-20T06:00:37+00:00June 20th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on SNAP Comments on Proposed Medicaid Observation Care Payment

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the May 2016 edition of Health Law News, its monthly newsletter.
phlpIncluded in this edition are articles about a new federal managed care regulation and federal policy governing balance billing of dual-eligible (Medicare- and Medicaid-covered) individuals. The newsletter also takes a look at Pennsylvania one year after the state expanded its Medicaid program and offers an update on Community HealthChoices, the new program of managed long-term services and supports the state intends to implement.
Find the latest edition of Health Law News here.

2016-06-16T06:00:37+00:00June 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project Releases Monthly Newsletter

PA Proposes Medicaid Observation Rate

Pennsylvania_Bulletin_logoUnder a newly proposed policy, Pennsylvania would pay hospitals and physicians an observation rate for Medicaid patients who are treated in their emergency departments but for whom they cannot make an immediate decision on the need for admission.
As described in a Pennsylvania Bulletin notice published last Saturday,

Observation services are a well-defined set of clinically appropriate and medically necessary services, which include short-term treatment, assessment and reassessment, that are furnished while a decision is made as to whether to admit an MA beneficiary to the inpatient hospital setting for further treatment or to discharge the MA beneficiary from the hospital outpatient setting. The Department is recognizing the need for observation services because a physician may not be able to initially determine whether an inpatient hospital admission is medically necessary.

The proposed policy, to take effect at the beginning of the state’s 2017 fiscal year (July 1, 2016), addresses and prescribes payments for hospitals and physicians, including new procedure codes.
According to the notice, Pennsylvania anticipates spending $10.229 million in state funds, and $28.28 million overall, for such services in FY 2017.
Interested parties have 30 days from the notice’s publication (May 14) to submit written comments about the proposed policy.
Find the Pennsylvania Bulletin notice introducing this proposed policy here.

2016-05-16T06:00:04+00:00May 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Proposes Medicaid Observation Rate

New Tools for Addressing Old Medicaid Problems

The new federal Medicaid managed care regulation gives state Medicaid programs new tools with which to address longstanding Medicaid challenges.
In an article titled “The Medicaid Managed Care Rule: The Major Challenges States Face,” the Commonwealth Fund describes the tools the rule does and does not offer for addressing five major Medicaid challenges:

  • commonwealth fundreaching medically underserved communities
  • unstable eligibility and enrollment
  • organizing coverage an care and developing effective payment incentives
  • aligning managed care with health, education, nutrition, and social services
  • information technology

Find the article here, on the Commonwealth Fund’s web site.

2016-05-10T06:00:30+00:00May 10th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on New Tools for Addressing Old Medicaid Problems

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures.  It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
Bookshelf with law booksWith virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here;  and see this CMS fact sheet on the draft regulation.

2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on Feds Propose New Medicaid Managed Care Regs

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April edition of Health Law PA News, its monthly newsletter.
Included in this edition are articles about the status of Pennsylvania’s latest Medicaid expansion effort; an explanation of state policy for calculating applicants’ income for the purpose of determining whether they are eligible for Medicaid; health insurance options for immigrants; and more.
Find the latest edition of Health Law PA News here.

2015-05-12T06:00:12+00:00May 12th, 2015|HealthChoices PA, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Law Project Releases Monthly Newsletter

PA Moves to Streamline Medicaid Provider Enrollment

In response to the challenges the state has encountered processing Medicaid provider enrollment applications, the Pennsylvania Department of Human Services (DHS) has unveiled what it believes will be an improved approach to tackling this problem.
The improvements include electronic enrollment, standardization of policies and procedures, and additional provider enrollment staffing.
At the heart of the backlog are Affordable Care Act requirements.
Go here to see a message from DHS acting secretary Theodore Dallas on this subject.

2015-04-23T06:00:08+00:00April 23rd, 2015|Affordable Care Act, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Moves to Streamline Medicaid Provider Enrollment

Healthy Pennsylvania Medicaid Benefits Posted

Bookshelf with law booksThe Pennsylvania Department of Human Services has published materials describing Medicaid benefits under the state’s Healthy Pennsylvania Medicaid expansion.
A Medical Assistance Bulletin (#99-15-02) describing the “Interim Healthy Benefit Plan” can be found here and tables comparing the benefits packages under the “Healthy” (low risk), “Healthy Plus” (high risk), and Private Coverage Option plans (PCO) can be found here.

2015-01-22T06:00:53+00:00January 22nd, 2015|Healthy PA, Meetings and notices, Pennsylvania Medicaid laws and regulations|Comments Off on Healthy Pennsylvania Medicaid Benefits Posted

PA Officially Ends Enhanced Medicaid Payments

The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31.
Bookshelf with law booksWhile some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1.
See the Medical Assistance Bulletin notice here.

2014-12-29T06:00:31+00:00December 29th, 2014|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Officially Ends Enhanced Medicaid Payments

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments:  a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Issues Bulletin Detailing Healthy PA Benefits
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