Pennsylvania Medicaid policy Archives - Page 16 of 43 - Safety-Net Association of Pennsylvania

Integrating Medicaid Supplemental Payments into Value-Based Purchasing

New health care delivery and reimbursement systems and new federal regulations will result in changes in how states deploy their Medicaid resources through supplemental payments in the coming years.
A new Commonwealth Fund report describes the kinds of supplemental Medicaid payments states currently make to hospitals – such as disproportionate share and upper payment limit payments – and notes the differing degree to which individual states use such supplemental payments.
It also describes how those supplemental payments may be restructured in the coming years to foster greater use of value-based purchasing and to reward achieving state-created quality goals through new delivery and reimbursement systems such as accountable care organizations, bundled payments, shared savings program, capitated arrangements, and shared risk.
Such changes have potentially serious implications for Pennsylvania safety-net hospitals – as SNAP members learned first-hand from state Medicaid director Leesa Allen when she met with them in November in Philadelphia to discuss the commonwealth’s plans for value-based purchasing and changes in Medicaid reimbursement.
Learn more about what the future may have in store for Medicaid supplemental payments in the Commonwealth Fund report Integrating Medicaid Supplemental Payments into Value-Based Purchasing.

PA Safety Net Admin2016-12-07T06:00:49+00:00December 7th, 2016|Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2016 newsletter.
phlp Included in this edition are stories about problems older adults are encountering when they seek to enroll in the state’s Aging Waiver program; an update on the implementation of Community HealthChoices, the new state program of managed long-term services and supports for qualified seniors; upcoming Medicare changes and enrollment and application deadlines; coverage of diabetes testing supplies for dual eligibles; new state guidelines addressing access to treatment for mental health conditions and substance abuse disorders; and more.
Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2016-11-03T06:00:54+00:00November 3rd, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Uninsured Rate Declines

Pennsylvania’s uninsured rate has fallen to 6.4 percent, according to the U.S. Census Bureau.
That’s less than half the state-wide rate of 13 percent in 2011 and 2012.
Since that time the state’s Medicaid expansion has added 670,000 Pennsylvanians to the ranks of the insured, with others purchasing insurance through the federal health insurance marketplace.
Learn more about the decline in the number of uninsured Pennsylvanians in this news release from the office of Governor Tom Wolf.

PA Safety Net Admin2016-10-19T09:30:43+00:00October 19th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

phlp The Pennsylvania Health Law Project has published its September 2016 newsletter.
Included in this edition are stories about the selection of managed care organizations to participate in the state’s new Community HealthChoices program to provide community-based managed long-term services and supports to individuals who receive both Medicaid and Medicare and who are eligible for nursing home care; the open enrollment period for Medicare and Medicare Part D drug plans; the awarding of six “Navigator grants” to Pennsylvania organizations that counsel people interested in obtaining health insurance through the federal health insurance marketplace; and actions take by the state to improve access to pediatric shift nursing and home health aide services for children covered by Medicaid.
Find the newsletter here.

PA Safety Net Admin2016-10-10T06:00:18+00:00October 10th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.
The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment.
HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.
The Pennsylvania Department of Human Services has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.

PA Safety Net Admin2016-08-18T06:00:42+00:00August 18th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

CMS Urges Improvements in Care for Physically, Mentally Disabled

New guidance issued by the Centers for Medicaid Services outlines how states can make better use of home care in serving physically and mentally disabled Medicaid beneficiaries.
Those steps include establishing open registries of home care workers; establishing qualifications for such workers; and paying wages that will help foster continuity of care for the clients of those home care workers.
cms In making these recommendations, CMS seeks to make greater use of managed long-term services and supports and home- and community-based services when serving individuals who might otherwise need costly nursing home care.
Pennsylvania is in the process of launching a new such program, called Community HealthChoices, that will offer dually eligible Medicare/Medicaid seniors the option of receiving managed long-term services and supports instead of entering nursing homes.
Learn more about CMS’s recommendations and why it made them in this informational bulletin from CMS to state Medicaid directors.

PA Safety Net Admin2016-08-18T06:00:05+00:00August 18th, 2016|Pennsylvania Medicaid policy|Comments Off

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations. Such payments are often used to distribute the proceeds from state hospital taxes.
The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely.
In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions that meet specific new criteria.
In announcing the policy, CMS acknowledges the challenges inherent in ending the use of such payments and indicates its intention to address this issue, and the phase-out process, in future regulations
Such pass-through payments are an important of Pennsylvania’s Medicaid program and the state’s private safety-net hospitals benefit considerably from them.
Go here to see the CMS bulletin on a subject of interest to many high-volume Medicaid hospitals.

PA Safety Net Admin2016-08-09T06:00:39+00:00August 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

PA Pursues New Approach to Opioid Addiction Treatment

Pennsylvania has secured federal funding to underwrite the creation of 20 centers of excellence to help people overcome opioid-related substance abuse problems.
According to a Department of Human Services news release,

The COEs [centers of excellence] coordinate care for people with Medicaid. Rather than just treating the addiction, DHS will treat the entire person through team-based treatment, with the explicit goal of integrating behavioral health and primary care and, when necessary, evidence-based medication assisted treatment.

Prescription Medication Spilling From an Open Medicine Bottle The 20 centers of excellence, which will be licensed by the state’s Department of Drug and Alcohol Programs, are expected to be open by October 1.
To learn more about the state’s new approach to serving those with opioid abuse problems and to find a list of the 20 centers of excellence, see this Department of Human Services news release.

PA Safety Net Admin2016-07-19T06:00:36+00:00July 19th, 2016|Pennsylvania Medicaid policy|Comments Off

Medicaid Directors Seek Help With Hepatitis C Drugs

The combination of new cures for hepatitis C, the high cost of those cures, and the large population of low-income people suffering from the disease has the nation’s Medicaid directors asking for help from Congress.
“Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment,” the National Association of Medicaid Directors declared in a recent news release.
To help them address the high cost of providing a new generation of drugs to the estimated one million Medicaid recipients with hepatitis C, Medicaid directors have asked Congress to introduce policies that reduce the prices of those drugs or give states bigger rebates for purchasing them, noting that states have neither “…the financial capacity to cover the full cost of these treatments” nor “…the clear statutory authority to effectively and efficiently administer the program.”
Pennsylvania is in the midst of examining its policies regarding authorizing the use of expensive drugs to treat Medicaid patients with hepatitis C and is expected to make those drugs more widely available in the near future.
Learn more about the challenges state Medicaid programs face when serving beneficiaries with hepatitis C and the help they seek from Congress in this news release from the National Association of Medicaid Directors.

PA Safety Net Admin2016-07-12T06:00:12+00:00July 12th, 2016|Pennsylvania Medicaid policy, Uncategorized|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its June 2016 newsletter.
phlp Included in this edition are stories about the delay in implementation of the state’s Community HealthChoices program of managed long-term services and supports for the dually eligible; challenges for those seeking home and community-based services from state waiver programs; and more.
Find the newsletter here.

PA Safety Net Admin2016-06-30T06:00:21+00:00June 30th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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