Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.
Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.
The combination of Congress attempting either to repeal and replace or repair the Affordable Care Act and Pennsylvania facing a multi-billion budget shortfall has led some policy-makers in Harrisburg to begin talking about ways to better manage or reduce the state’s Medicaid costs.
Those costs climbed from $3.9 billion in 2004 to $6 billion in 2014.
Among the possibilities state lawmakers are discussing: tighter rules for participation, greater efficiency, work and work search requirements for able-bodied Medicaid recipients, charging premiums for high-income families for which Medicaid provides coverage for their profoundly disabled children, and a pilot program to test whether a recipient care management program might eliminate medical errors, improve recipient health, and reduce health care costs.
Learn more about some of the Medicaid ideas Pennsylvania policy-makers are considering in this PennLive article.
The Pennsylvania Health Law Project has published its latest Health Law News.
Included in the June/July edition are articles about the status of Pennsylvania’s FY 2018 budget, including possible changes in the state human services code; a delay in awarding new HealthChoices contracts; new quality initiatives in the state’s contracts with HealthChoices managed care organizations; an update on the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports; and more.
Find the newsletter here.
The Pennsylvania Health Law Project has published its May newsletter.
Included in this edition are articles on new criteria for Medicaid coverage of high-cost hepatitis C drugs and the release of a draft of the state’s proposed Medicaid quality strategy; an update on Community HealthChoices, Pennsylvania’s new program of Medicaid managed long-term services and supports; an overview of Medicaid-covered behavioral health services; a summary of recent federal proposals with implications for the state’s Medicaid program; and a report on the nomination of Teresa Miller to lead the new Department of Health and Human Services that Governor Wolf has proposed establishing.
Find the newsletter here.
Pennsylvania’s Medicaid program will make treatment for hepatitis C more readily available to Medicaid beneficiaries beginning on July 1, state officials have announced.
In recent years, new drugs have become available that effectively cure hepatitis C but their exceptionally high costs led many insurers, including most state Medicaid programs, to limit access to those drugs until patients show more advanced signs of the disease. A year ago the Pennsylvania Department of Human Services’ pharmacy and therapeutics committee recommended expanding access to these drugs for Pennsylvania Medicaid beneficiaries and now, that recommendation has been adopted and that expansion will begin with the new state fiscal year on July 1.
Under the new criteria, patients with lower scores of severity of hepatitis C will become eligible for treatment. Previously, Medicaid patients were required to show more advanced signs of illness before the medicine was provided to them.
Learn more about the Pennsylvania Medicaid program’s revised approach to serving Medicaid patients with hepatitis C in this Philadelphia Inquirer article.
The Pennsylvania Health Law Project has published its April 2017 newsletter.
Included in this edition are articles about:
Find the latest edition of PA Health Law News here.
Medicaid payments to hospitals are comparable to or even higher than Medicare payments.
Or at least they are once supplemental Medicaid payments are included.
So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues.
In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that
The MACPAC analysis also concluded that
Learn more about what MACPAC found – and how Pennsylvania Medicaid payments stack up – in the new MACPAC report “Medicaid Hospital Payment: A Comparison across States and to Medicare,” which can be found here, on MACPAC’s web site.
The Pennsylvania Health Law Project has published its March 2017 newsletter.
Included in this edition are stories about:
Find the latest edition of PA Health Law News here.
Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs. This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit.
According to CMS,
This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients.
The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments. This is consistent with the statutory requirements governing Medicaid DSH and applicable limits.
All Pennsylvania safety-net hospitals receive Medicaid DSH payments.
See the full rule here.
Pennsylvania’s Medicaid program is moving toward greater use of value-based purchasing in its Medicaid behavioral health programs.
Last week, the state’s Office of Mental Health and Substance Abuse Services held a webinar to offer information about the state’s plan for employing value-based purchasing in Medicaid and how it will do so for behavioral health services in particular. Go here to see the presentation delivered at that webinar.