Last November the Centers for Medicare & Medicaid Services proposed a new regulation governing the use of pass-through payments in state Medicaid managed care programs.
The National Association of Medicaid Directors submitted formal comments to CMS about that proposed regulation. See its comments here.
A new study suggests that greatly expanding access to new drugs that essentially “cure” Hepatitis C would cost Pennsylvania’s Medicaid program a great deal of money but save relatively few lives.
The study found that in many cases, Hepatitis C progresses so slowly that by the time many of the people who suffer from it truly need the new generation of expenses drugs they will be old enough for Medicare, which would leave the federal government, rather than the state, with the cost of paying for the treatment.
Patient advocates maintain that all Medicaid beneficiaries with Hepatitis C should have access to the drugs and Pennsylvania’s Medicaid program appears to be on a path toward making that possible.
Learn more about the study and its findings in this Philadelphia Inquirer story.
The Pennsylvania Health Law Project has published its November-December 2016 newsletter.
Included in this edition are stories about a new effort to enroll children in the state’s Medicaid and Children’s Health Insurance Program, the new fees for Medicare Part A and Part B for 2017, a delay in the implementation of the state’s proposed Community HealthChoices program of managed long-term services and supports, and more.
Go here for the latest edition of PA Health Law News.
With the president-elect and congressional leaders vowing to repeal and replace the Affordable Care Act, the question arises about how such actions might affect Pennsylvania.
That includes 680,000 Pennsylvanians who enrolled in the state’s Medicaid program after the reform law allowed for that program’s expansion, more than 400,000 people who signed up for insurance on the federal health insurance exchange, the state’s taxpayers who might be left with the bill for some or all of these costs if the reform law’s financial support were to disappear in the near future, and others.
The Pittsburgh Tribune-Review considers these and other questions and offers answers from some of those closest to the situation. See its story here.
Citing the challenges and risks associated with unplanned pregnancies that occur within two years of a delivery, Pennsylvania’s Medicaid program is making long-acting contraceptives more readily available to program participants.
Beginning on December 1, Medicaid will pay for long-acting contraceptives administered after delivery and also will increase payments to doctors who provide those contraceptives. Currently, those costs are generally borne by hospitals in the lump-sum payment Medicaid makes for deliveries.
Learn more about the state’s new policy for encouraging the use of contraceptives among Medicaid beneficiaries who have delivered babies in this Lancaster Online article.
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.
The Pennsylvania Health Law Project has published its October 2016 newsletter.
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.
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.
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.
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.