Pennsylvania Medicaid policy Archives - Page 13 of 45 - Safety-Net Association of Pennsylvania

PA Introduces Medicaid PDL on January 1

Beginning tomorrow, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon: the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1. Here’s why.”

PA Safety Net Admin2019-12-31T06:00:53+00:00December 31st, 2019|Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November-December 2019 newsletter.

Included in this month’s edition are articles about:

Changes in care coordination in the Community HealthChoices program in southeastern Pennsylvania beginning on January 1.
Changes in the delivery of Medicaid-covered intensive behavioral health services in homes, schools, and the community for children and adolescents.
The switch from Medicaid to Medicare as primary payer for medication-assisted treatment for opioid use disorder for dually eligible (Medicare and Medicaid) patients.
Pennsylvania’s request for a delay in implementation of electronic visit verification for Medicaid-covered personal assistance services and home health aides.
The delay in implementation of the new public charge rule and its implications for taking advantage of Medicaid benefits among potentially affected individuals.

Read about these subjects and more in the Pennsylvania Health Law Project’s November-December newsletter.

PA Safety Net Admin2019-12-23T06:00:51+00:00December 23rd, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

DHS Unveils Strategic Plan

Pennsylvania’s Department of Human Services has a new strategic plan for 2019 through 2022.

While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas:

Provide every child with a strong foundation for physical and behavioral well-being
Bend the health care cost curve
Drive innovative whole-person care
Holistically assess needs and connect to resources
Address the social determinants of health
Expand health care beyond the doctor’s office and into the places people live, work, and play
Coordinate physical health care, behavioral health care, and long-term services and supports
Promote health equity
Lead the health care system toward value-based purchasing coordinated across payers
Serve more people in the community
Enhance access to health care and services that help Pennsylvanians lead healthy, productive lives
Coordinate services seamlessly across programs and agencies
Expand services and supports for individuals with mental illness
Expand services and supports for individuals with substance use disorder

Learn more about what Pennsylvania has in mind for its Medicaid program in the coming years, and for the Pennsylvania safety-net hospitals that serve so many participants in that program, by reading DHS’s new strategic plan for 2019 through 2022.

PA Safety Net Admin2019-11-14T06:00:50+00:00November 14th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2019 newsletter.

Included in this month’s edition are articles about:

the state’s release of a request for applications for insurers to serve participants in Pennsylvania’s HealthChoices physical health care program
Pennsylvania’s new Medicaid preferred drug list
legislation to expand the state’s Medical Assistance for Workers Program
the expansion of the state’s Living Independence for the Elderly (LIFE) program to 14 new counties over the next 18 months.

Read about these subjects and more in the Pennsylvania Health Law Project’s October newsletter.

PA Safety Net Admin2019-11-13T06:00:20+00:00November 13th, 2019|HealthChoices, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA to Help Medicaid Beneficiaries Who Want to Work

While Pennsylvania does not have a mandatory work requirement for its Medicaid population, the state is taking a new approach to encouraging Medicaid beneficiaries to pursue work.

It is asking them if they want to work and then, if they say they do, directing them to help finding training an jobs.

As reported by Kaiser Health News,

Starting early next year, the Pennsylvania Medicaid agency under Democratic Gov. Tom Wolf will ask people when they enroll if they want job training assistance. It will then require its private Medicaid managed-care organizations to connect those who want help to local employment specialists and follow up to make sure they got it.

The Wolf administration has resisted legislative efforts to impose a work requirement on the state’s Medicaid population, with the governor twice vetoing legislation that would establish such a mandate. The legislature is expected to take up a similar bill next year because, as one of the bill’s co-sponsors explained, “What they are suggesting is a tiny step in the right direction, but we need to do so much more.”

Learn more in the Kaiser Health News story “States Try A Gentler Approach To Getting Medicaid Enrollees To Work.”

PA Safety Net Admin2019-10-29T06:00:57+00:00October 29th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law books The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Safety Net Admin2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its September 2019 newsletter.

Included in this month’s edition are articles about:

changes in federal “public charge” regulations and their implications for immigrants who are currently enrolled in Medicaid or considering applying to participate in the program;
the right of participants in programs sponsored by the state’s Department of Drug and Alcohol Programs to continue receiving services while they appeal denials of services or reductions of services;
changes in the application process for state-paid home and community-based services; and
the continued implementation of the Community HealthChoices program of managed long-term services and supports for low-income seniors.

Go here for articles about these and other subjects.

PA Safety Net Admin2019-10-10T06:00:31+00:00October 10th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Shifting PA Medicaid to a PDL

Pennsylvania’s planned shift to a preferred drug list for its Medicaid program is the subject of a new analysis of the projected impact of such a change.

Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.

During this year’s budget proceedings, Pennsylvania’s Human Services Code was amended to require an analysis of “the projected cost to the medical assistance managed care organization [sic] and the projected supplemental rebates that could be obtained” by moving to a PDL.

That analysis has now been completed. It concluded that the state

…will save $85 million annual through implementation of a Statewide PDL. The Statewide PDL will allow the Department [of Human Services] to receive an additional $261 million in pharmacy rebates, which will more than offset the estimated increase to managed care organization (MCO) expenditures of $176 million, considering their additional costs and loss of market share rebates.

The analysis commissioned by DHS is now available. To learn more about the implications of a state-wide PDL for the state, for Medicaid managed care organization, and for Medicaid beneficiaries, read “Fiscal Impact Analysis of Medical Assistance Program Uniform Statewide Preferred Drug List, 2019 Report.”

The PDL will take effect on January 1, 2020 and has been posted on a DHS web site here.

PA Safety Net Admin2019-10-09T06:00:03+00:00October 9th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

New in Medicaid Medical Transportation: Uber and Lyft

State Medicaid programs focused on ensuring that beneficiaries keep their doctor appointments are increasingly looking to ride-sharing services to supplement the providers already participating in their medical transportation programs.

Today, Lyft is working with approximately 35 state Medicaid programs while Uber, at least so far, participates only in Arizona’s program.

While ride-sharing is not going to replace other medical transportation programs – for one thing, most Uber and Lyft cars are not equipped to serve individuals with serious disabilities – they can help supplement services that today typically require patients to reserve rides days ahead of time and then share van rides with other patients.

To facilitate the use of ride-sharing services, several state governments have eased regulations that require people who drive Medicaid beneficiaries to undergo first-aid training and drug testing.

While ride-sharing is not yet a formal part of Pennsylvania’s Medical Assistance Transportation Program, pilot programs using such services are currently under way in Allegheny County and Philadelphia.

Learn more about how ride-sharing is moving into the Medicaid medical transportation industry in the Kaiser Health News article “Uber And Lyft Ride-Sharing Services Hitch Onto Medicaid.”

PA Safety Net Admin2019-10-08T06:00:17+00:00October 8th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

SNAP Asks PA Delegation to Support Another Medicaid DSH Cut Delay

In a letter to members of Pennsylvania’s congressional delegation, SNAP has asked those members to support another two-year delay of Medicaid disproportionate share (Medicaid DSH) cuts mandated by the Affordable Care Act.

In the message, SNAP notes the important role Medicaid DSH payments play in helping private safety-net hospitals care for the many uninsured patients who continue to turn to them for care.

If the cut is not delayed, Pennsylvania will see its Medicaid DSH allotment from the federal government fall 40 percent in FY 2020 and 80 percent annually from FY 2021 through FY 2025.

See SNAP’s message to PA delegation members here.

PA Safety Net Admin2019-10-04T06:00:52+00:00October 4th, 2019|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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