Pennsylvania Medicaid policy Archives - Page 19 of 44 - Safety-Net Association of Pennsylvania

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
The December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more.
Find the newsletter here.

PA Safety Net Admin2015-12-28T06:00:32+00:00December 28th, 2015|Pennsylvania Medicaid policy|Comments Off

CHIP On the Move

Pennsylvania Governor Tom Wolf has signed a bill that shifts responsibility for Pennsylvania’s Children’s Health Insurance Program (CHIP) from the state’s Insurance Department to its Department of Human Services (DHS).
The move is designed to streamline the administration of the program and improve the delivery of services for the more than 150,000 children currently enrolled in CHIP.
DHS already administers the state’s Medicaid program, which serves more than 2.5 million Pennsylvanians.
Go here to see a state news release announcing the change.

PA Safety Net Admin2015-12-23T11:38:14+00:00December 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

Latest Edition of Health Law PA News

The Pennsylvania Health Law Project has released the latest edition of its newsletter. The November 2015 edition includes new Children’s Health Insurance Program (CHIP) benefits, Pennsylvania Medicaid’s new specialty pharmacy drug program, and Pennsylvania’s receipt of a federal planning grant for certified community behavioral health clinics.
Find the latest Health Law PA News here.

PA Safety Net Admin2015-11-23T06:00:47+00:00November 23rd, 2015|Pennsylvania Medicaid policy, Uncategorized|Comments Off

Study: Medicaid Denying Expensive Hepatitis C Drugs

A new study has found that state Medicaid programs are rejecting nearly 50 percent of requests to administer expensive hepatitis C drugs to patients.
According to a review of prescription data for Pennsylania, Delaware, Maryland, and New Jersey, 46 percent of requests for such treatment for Medicaid patients were denied. Only five percent of similar requests were denied for Medicare patients and 10 percent for those with private insurance.
The study represents the first documentation of a concern raised when the expensive drugs first hit the market: that insurers would limit access to them.
The U.S. Department of Health and Human Services recently sent letters to state Medicaid programs expressing concern about the possible denial of expensive prescription drugs to Medicaid patients.
For more information about access to hepatitis C medicine and the recently completed study, see this Philadelphia Inquirer article.

PA Safety Net Admin2015-11-20T06:00:54+00:00November 20th, 2015|Pennsylvania Medicaid policy|Comments Off

Better Medicaid Data Needed, Governors Say

States need better data to meet the needs of Medicaid recipients with complex medical needs, according to the National Governors Association (NGA).
One of the biggest costs in state Medicaid programs is “super-utilizers”: patients who consume a significant amount of health care services. Although relatively few in number, these patients account for a significant proportion of state Medicaid expenditures.
The group’s conclusion is based on the NGA Center for Best Practices’ experience working with seven states to find better ways to meet the needs of these patients with better but less-expensive care.
According to the report,

Before state leaders can begin to address their super-utilizer populations, they first need to understand who those patients are, how they use the health care system, and how the state might adapt its system to meet patient needs.

To do this, state Medicaid programs need more and better data so they can

understand the characteristics of complex populations
identify and target specific patients
ensure effective management and evaluation

Pennsylvania’s safety-net hospitals routinely serve significant numbers of such patients.
To learn more about the NGA’s recommendation and how it reached it, go here to see its report Using Data to Better Serve the Most Complex Patients: Highlights from NGA’s Intensive Work with Seven States.

PA Safety Net Admin2015-10-01T06:00:52+00:00October 1st, 2015|Pennsylvania Medicaid policy|Comments Off

DHS Explains Latest Medicaid Initiatives

The Pennsylvania Department of Human Services describes two recent steps to improve the delivery of health care to low-income Pennsylvanians – the introduction of its new “Community HealthChoices” program and the re-bidding of managed care organization contracts for its HealthChoices physical health program – in the latest edition of its newsletter The Impact.
Find that edition here.

PA Safety Net Admin2015-09-29T06:00:21+00:00September 29th, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

PA Seeks to Modernize, Improve Medicaid Program Integrity

The Pennsylvania Department of Human Services (DHS) has announced new steps to enhance its program integrity efforts and reduce improper and fraudulent payments, including Medicaid payments.
The proposed new approach will rely heavily on automation, analytics, and technology. Major changes include:

Consolidation of the Office of Program Integrity and Bureau of Program Integrity
Issuing a request for information for program integrity data analysis of provider payments
Implementation of a customer portal for third-party liability
Implementation of “identity proofing” of program recipients
Automating provider enrollment
Eliminating manual updating of milestone changes

In the state’s 2015 fiscal year it prevented nearly $600 million in improper payments, 74 percent of which were potential provider payments.
For a closer look at the state’s plans, see this DHS news release.

PA Safety Net Admin2015-08-07T06:00:01+00:00August 7th, 2015|Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the July edition of Health Law News, its monthly newsletter.
Included in this edition are articles about the continued expansion of Pennsylvania’s Medicaid program; the next steps in Pennsylvania’s managed long-term services and supports (MLTSS) initiative; the state’s selection of its benchmark essential health benefits insurance plan for 2017; and about how the state will phase out its current AIDS waiver while continuing to serve those covered by the waiver.
Find the latest edition of Health Law News here.

PA Safety Net Admin2015-08-05T06:00:29+00:00August 5th, 2015|Affordable Care Act, long-term care, Pennsylvania Medicaid policy|Comments Off

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.
In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.
Access to behavioral health care can be an especially major challenge in the low-income communities typically served by Pennsylvania’s safety-net hospitals.
Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

PA Safety Net Admin2015-07-24T06:00:04+00:00July 24th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

State Shares Preliminary Thoughts on HealthChoices Procurement

In anticipation of releasing a request for proposals later this year seeking health insurers interested in participating in Pennsylvania’s HealthChoices program for Medicaid beneficiaries, the state’s Department of Human Services (DHS) issued a request for information (RFI) in late May seeking input from stakeholders and interested parties on what the state might do through its next generation of HealthChoices contracts to improve the program and its delivery of care.
Now that the deadline for submitting comments has passed, DHS has released a new document that shares the comments offered most frequently by those who responded to the RFI along with brief descriptions of some of the changes the department is considering when it solicits bids for HealthChoices managed care plans later this year.
Find the original May RFI here, SNAP’s response to that RFI here, and the recent DHS follow-up document here.

PA Safety Net Admin2015-07-02T06:00:19+00:00July 2nd, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

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