Pennsylvania Medicaid policy Archives - Page 18 of 45 - Safety-Net Association of Pennsylvania

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

Medicaid Expansion Producing Benefits for Safety-Net Providers

Seeing fewer uninsured patients, safety-net hospitals in states that have expanded their Medicaid programs as provided for under the Affordable Care Act are finding themselves able to use money previously caring for the uninsured for things like more and better primary and behavioral health services, more staff, new or improved health centers and clinics, and better equipment.
This conclusion is drawn in a new study from the Georgetown University Health Policy Institute based on interviews with leaders of eleven hospital systems and federally qualified health centers (FQHCs) in seven states: four that expanded their Medicaid programs and three that did not.
While Pennsylvania was not one of the states included in the study, it is one of more than 30 states that has expanded its Medicaid program.
To learn more about what the study revealed, go here to read Beyond the Reduction in Uncompensated Care: Medicaid Expansion is Having a Positive Impact on Safety Hospitals and Clinics.

PA Safety Net Admin2016-06-21T06:00:03+00:00June 21st, 2016|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

SNAP Comments on Proposed Medicaid Observation Care Payment

The Safety-Net Association of Pennsylvania has written to the state’s Department of Human Services about DHS’s proposal to establish a payment policy for hospital observation services covered by the state’s Medicaid fee-for-service program.
While SNAP has long supported the concept of a Medicaid fee-for-service rate for observation services and welcomes DHS’s decision to create such a rate and associated policies, it expressed a number of concerns about DHS’s proposal, including about:

the proposed observation rate
the classification of observation care as an outpatient service
the manner in which the state proposes financing observation care
program integrity issues

To learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.

PA Safety Net Admin2016-06-20T06:00:37+00:00June 20th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the May 2016 edition of Health Law News, its monthly newsletter.
phlp Included in this edition are articles about a new federal managed care regulation and federal policy governing balance billing of dual-eligible (Medicare- and Medicaid-covered) individuals. The newsletter also takes a look at Pennsylvania one year after the state expanded its Medicaid program and offers an update on Community HealthChoices, the new program of managed long-term services and supports the state intends to implement.
Find the latest edition of Health Law News here.

PA Safety Net Admin2016-06-16T06:00:37+00:00June 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

New MLTSS Program Delayed Six Months

The launch of Community HealthChoices, Pennsylvania’s new approach to the delivery of managed long-term services and supports for seniors eligible for both Medicare and Medicaid, will be delayed six months.
The program was scheduled to begin in southwestern Pennsylvania on January 1, 2017 but state officials recently announced that they have pushed back the start date to July 1, 2017.
In a message to interested parties, state officials wrote that

The decision to extend our start date builds on this approach and allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved. We will continue to work with all stakeholders, such as the Area Agencies on Aging and Centers for Independent Living, on a robust CHC education and outreach effort to ensure that we reach as many consumers and caregivers as possible.

The time-frame for implementation in other parts of the state remains unchanged.
To learn more about what Community HealthChoices is and why its launch has been delayed, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2016-06-15T06:00:05+00:00June 15th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Hepatitis C Treatment Challenges PA’s Medicaid Program

The cost of treating Medicaid patients who suffer from hepatitis C is posing a challenge to Pennsylvania’s Medicaid program.
As new, more expensive, but more effective hepatitis C drugs reach the market, the state’s costs for treating Medicaid patients with the disease have doubled since 2013.
Meanwhile, the state continues to consider at what point in the progression of their hepatitis C Medicaid patients should be offered the most expensive drugs.
Prescription Medication Spilling From an Open Medicine Bottle Current guidelines are evolving both in the state and nationally, with medical authorities and federal regulators weighing in with their views. Recently, an advisory committee to the Pennsylvania Department of Human Services offered its own recommendations for criteria for prescribing the most expensive drugs.
Learn more about the issue, the cost of treatment, and current Pennsylvania Medicaid policy on when hepatitis C patients must be offered the most expensive drugs and how that policy might be changing in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2016-06-14T11:23:40+00:00June 14th, 2016|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Uncategorized|Comments Off

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 Bottle While 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.

PA Safety Net Admin2016-05-25T06:00:28+00:00May 25th, 2016|Pennsylvania Medicaid policy|Comments Off

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