DPW Issues Notice Governing Revised Payment Methodologies
The Pennsylvania Department of Public Welfare (DPW) has published a notice providing final notice of implementation of its revised Medical Assistance (MA) payment methodology for inpatient hospital services provided, on a fee-for-service (FFS) basis, in acute care general hospitals. Additionally, the Department is giving final notice of its amended qualifying criteria and payment methodology for inpatient disproportionate share hospital (DSH), outpatient DSH supplemental and direct medical education (DME) payments and allocated funding for Fiscal Year (FY) 2010-2011 for these payments. The Department is also providing final notice of the establishment of additional types of DSH and supplemental payments.”
This notice essentially describes the new eligibility criteria and payment methodologies arising from Act 49 and can be seen in its entirety in this Pennsylvania Bulletin notice.
DPW Issues DSH and Supplemental Payment Allocation Notice
The Pennsylvania Department of Public Welfare (DSH) has published a notice “announcing its intent to allocate funding for Fiscal Year (FY) 2012-2013 for several disproportionate share hospital (DSH) and supplemental hospital payments made to qualifying Medical Assistance (MA) enrolled hospitals.”
Among the allocations addressed in this notice are funds for inpatient disproportionate share payments (inpatient DSH), outpatient DSH payments, direct medical education (DME) payments, Medical Assistance stability payments, Medical Assistance dependency payments, Medical Assistance rehab adjustment payments, small and sole-community hospital payments, and enhanced outpatient DSH payments for selected providers.
Find the complete Pennsylvania Bulletin notice here.
DPW Issues DSH Notice
The Pennsylvania Department of Public Welfare (DPW) has published a notice “announcing its intent to allocate funding for several classes of disproportionate share hospital (DSH) payments made to qualifying Medical Assistance (MA) enrolled acute care general hospitals.” These allocations include funding for FY 2013 critical access, OB/NICU, trauma, burn center, academic medical center, and other supplemental DSH payments.
Find the complete Pennsylvania Bulletin notice here.
DPW Issues Bulletin on Peritoneal Dialysis
The Pennsylvania Department of Public Welfare (DPW) has issued a new Medical Assistance Bulletin titled “Information Regarding Peritoneal Dialysis Treatment.” The stated purpose of the bulletin is “to provide information to providers regarding the use of peritoneal dialysis (PD) in treating beneficiaries with kidney failure, the potential benefits of PD over hemodialysis, and the screening of beneficiaries for PD suitability.”
The new bulletin is available here
.
Changes in Fee-for-Service Fee Schedule
The Pennsylvania Department of Public Welfare has released changes in the state’s Medical Assistance fee-for-service fee schedule.
The changes, which took effect September 1, can be found in this Medical Assistance Bulletin notice
.
“Medicaid Works,” Foundation Declares
Medicaid improves access to care and saves lives and deserves to be expanded in the manner envisioned in the Affordable Care Act, according to a new blog entry on the web site of the health care-focused Commonwealth Fund.
According to the blog commentary, Medicaid “fulfills the two main purposes of health insurance – ensuring access to needed care and providing adequate financial protection from burdensome medical expenses.” It also cites research that “confirms that expanding Medicaid not only improves access to care and financial protection of vulnerable individuals and families, but actually saves lives.”
In addition, the blog suggests that Medicaid recipients have only slightly greater cost-related access-to-care problems than individuals with private insurance.
The Safety-Net Association of Pennsylvania (SNAP) and the state’s private safety-net hospitals have eagerly anticipated the expansion of Medicaid eligibility mandated by the Affordable Care Act. In the wake of the Supreme Court decision ruling the expansion mandate unconstitutional, these safety-net hospitals now await for Governor Corbett’s decision on whether Pennsylvania will move ahead with that Medicaid expansion.
The title of this commentary is “Medicaid Works: Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable,” and it can be found here
, on the Commonwealth Fund’s web site.
DPW Issues Medical Assistance Bulletins
The Department of Public Welfare (DPW) has issued a number of new bulletins governing Pennsylvania’s Medical Assistance program.
These new regulations include an amendment to the state’s Medicaid plan for children with disabilities; the process for prior authorization of pituitary suppressive drugs; the process for prior authorization of erythropoiesis stimulating protein; the process for prior authorization of benign prostatic hyperplasia treatments; the process for prior authorization of antibiotics (GI); and the process for the prior authorization of platelet aggregation inhibitors.
In addition, DPW formally announced the expansion of HealthChoices to 13 counties in western Pennsylvania and the termination of ACCESS Plus in those counties effective October 1 and its intention to publish in the near future a new bulletin adding growth factors to the Medical Assistance program’s list of items requiring prior authorization.
PA Releases DSH Eligibility Lists
The Pennsylvania Department of Public Welfare (DPW) has released its annual list of inpatient hospitals that qualify for Medical Assistance disproportionate share (DSH) payments, including the DSH percentages for acute-care general hospitals, psychiatric units of inpatient hospitals, drug and alcohol units of inpatient hospitals, medical rehab units of inpatient hospitals, freestanding rehab hospitals, private psychiatric hospitals, and private drug and alcohol hospitals.
Find the list and the corresponding DSH percentages in this Pennsylvania Bulletin notice.
DPW Updates Dependence Treatment Procedures
The Pennsylvania Department of Public Welfare (DPW) has issued a new Medical Assistance Bulletin updating its procedures for seeking prior authorization for opiate dependence treatment.
The new bulletin, which can be found here, applies to all licensed pharmacies and prescribers enrolled in the state’s Medical Assistance program that provide services through the Medical Assistance fee-for-service program.
An update of the Medical Assistance handbook for prior authorization of these services can be found here.
The new policy takes effect on September 10.