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Help on the Way for Those With Hepatitis C?

Pennsylvanians insured by Medicaid who have Hepatitis C have often found themselves blocked from access to new treatments that can cure the disease.
But that may be changing.
Prescription Medication Spilling From an Open Medicine BottleWhile states’ finances have been groaning under the cost of new budget-busting treatments, a growing trend is to increase access to the costly treatments rather than keep it very limited.
Last week the Pharmacy and Therapeutics Committee of the state’s Medicaid program voted to ease the state’s current limits on access to treatment that costs between $31,000 and $58,000 a patient. Currently, about 30,000 Pennsylvania Medicaid beneficiaries suffer from Hepatitis C and another 10,000 are thought to be infected but not yet suffering.
The committee’s vote is advisory; the final decision rests with Department of Human Services Secretary Ted Dallas.
Learn more about the state of Hepatitis C treatment in Pennsylvania’s Medicaid program and the changes that may be coming in this Philadelphia Inquirer article.
 

2016-05-25T06:00:28+00:00May 25th, 2016|Pennsylvania Medicaid policy|Comments Off on Help on the Way for Those With Hepatitis C?

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

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April 2016 edition of Health Law News, its monthly newsletter.
phlpIncluded in this edition are articles about a new, faster process the state has introduced for people to enroll in Medicaid; the awarding of contracts to managed care organizations to participate in the state’s HealthChoices program; an update on the Community HealthChoices program that will help nursing home-eligible seniors remain independent in the community; new funding for the state’s “Money Follows the Person” demonstration program; and more.
Find the latest edition of Health Law News here.

2016-05-06T06:00:03+00:00May 6th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off on Pennsylvania Health Law Project Releases Monthly Newsletter

PA Awards HealthChoices Managed Care Contracts

Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program.
healthchoicesEight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions.
All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members.
Learn more about who won the contracts and how the winners will be expected to perform differently than HealthChoices managed care organizations have in the past in this state news release.

2016-05-05T06:00:56+00:00May 5th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off on PA Awards HealthChoices Managed Care Contracts

PA Medicaid: One Year, 625,000 New Beneficiaries

Last week marked the one-year anniversary of Pennsylvania’s Affordable Care Act-authorized expansion of its Medicaid program.
In that year, nearly 625,000 Pennsylvanians enrolled in the program.
Among them,

  • 46 percent are under the age of 35
  • 109,000 are parents
  • 300,000 are employed

pa healthchoices regions
If past Medicaid utilization patterns hold true, most of these new Medicaid beneficiaries will receive most of their health care benefits from the state’s private safety-net hospitals.
Learn more about Pennsylvania’s Medicaid expansion, who has taken advantage of it, and how the program has changed in the past three years in this state news release.
 

2016-05-04T06:00:05+00:00May 4th, 2016|Affordable Care Act, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on PA Medicaid: One Year, 625,000 New Beneficiaries

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
phlpThe February edition includes features about Governor Wolf’s proposed FY 2017 Medicaid budget, the launch of a new “fast track” Medicaid enrollment program, the state’s plans for a new approach to providing managed long-term services and supports, and more.
Find the newsletter here.

2016-03-03T06:00:55+00:00March 3rd, 2016|Pennsylvania Medicaid policy, Pennsylvania proposed FY 2017 budget|Comments Off on Latest Edition of Health Law News

PA Introduces Improvement to Medicaid Provider Enrollment

The Pennsylvania Department of Human Services has launched a new online portal to facilitate provider enrollment in the state’s Medicaid program.
PA-logoAccording to DHS officials, the new portal will enable the state to enroll providers electronically and automate the provider enrollment process. Under the new approach, documents previously transmitted by mail or fax will be uploaded to the portal, providers will be able to view the status of their application, and the time needed to review and process provider applications will be reduced.
Learn more about the new Medicaid provider portal from this state news release.

2016-02-22T06:00:00+00:00February 22nd, 2016|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off on PA Introduces Improvement to Medicaid Provider Enrollment

Report on One Year of Medicaid Expansion in PA

Taking advantage of the Affordable Care Act, Pennsylvania expanded its Medicaid program a little more than a year ago. Now, Department of Human Services Secretary Ted Dallas reflects on that year, offering statistics on how many people have taken advantage of enhanced access to Medicaid coverage, who those people are, and where they live.
ted dallasSecretary Dallas also offers his perspectives on how the transition to the expanded Medicaid program went and how the new program differs from the old.
Read Secretary Dallas’s report here, on the Wolf administration’s blog.

2016-02-12T06:00:38+00:00February 12th, 2016|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off on Report on One Year of Medicaid Expansion in PA

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the January 2016 edition of Health Law News, its monthly newsletter. Included in this edition are an update on the state’s proposed Community HealthChoices program, which would require dual-eligible Pennsylvanians to receive long-term services and supports through new managed care organizations; a summary of the Pennsylvania Health Law Project’s formal comments about that proposed program; and information about the state’s Medical Assistance Transportation Program and its proposed transition plan for home and community-based services.
phlpFind the latest edition of Health Law News here.

2016-01-28T17:41:49+00:00January 28th, 2016|HealthChoices PA, long-term care, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project Releases Monthly Newsletter
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