Pennsylvania Medicaid policy Archives - Page 19 of 43 - Safety-Net Association of Pennsylvania

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

SNAP Calls for HealthChoices Improvements

The Safety-Net Association of Pennsylvania has urged Pennsylvania’s Department of Human Services to pursue transformative innovation in the state’s HealthChoices Medicaid managed care program.
In particular, SNAP has called on DHS to create regional health collaboratives consisting of both insurers and providers to work together to deliver better, more coordinated care to Pennsylvania’s Medicaid population.
SNAP also recommended that the state finance innovation by implementing a Delivery System Reform Incentive Payments program, better known as DSRIP, to fund innovation in the state’s Medicaid program.
SNAP’s suggestions came in response to a request for information issued by the state seeking recommendations for how to improve the HealthChoices program in anticipation of the state’s plan to rebid HealthChoices managed care contracts later this year.
See the state’s request for information here and find SNAP’s comment letter here.

PA Safety Net Admin2015-06-29T06:00:03+00:00June 29th, 2015|HealthChoices PA, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the June edition of Health Law News, its monthly newsletter.
Included in this edition are articles about access to drug and alcohol treatment services for Pennsylvania Medicaid beneficiaries; the lack of habilitative services made available to people with disabilities or significant health problems by health insurance plans offered by insurers serving Pennsylvanians through the federal health insurance exchange; and the state’s recent proposal for managed long-term services and supports (MLTSS).
Find the latest edition of Health Law News here.

PA Safety Net Admin2015-06-23T06:00:44+00:00June 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

Variations on Medicaid Expansion

While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways.
Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more.
In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 Waivers to Implement Medicaid Expansion Under the ACA, the Urban Institute takes a close look at the six states that have taken this alternative path; among the states reviewed is Pennsylvania and its now-discarded “Healthy Pennsylvania” Medicaid expansion plan. In addition, the Commonwealth Fund has published “The Promise and Pitfalls of Alternative State Approaches to Medicaid Reform,” a commentary on the efforts of the states that have followed this alternative path.

PA Safety Net Admin2015-06-17T06:00:02+00:00June 17th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures. It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
With virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here; and see this CMS fact sheet on the draft regulation.

PA Safety Net Admin2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

GAO Examines Medicaid Section 1115 Waivers

The U.S. Department of Health and Human Services (HHS) frequently exercises the authority granted to it under section 1115 of the Social Security Act to authorize Medicaid expenditures for uses not strictly permitted under that law if those uses extend Medicaid coverage to populations not already served by Medicaid or promote Medicaid objectives.
Pennsylvania’s Medicaid program has long taken advantage of section 1115 waivers.
At the request of the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee, the U.S. Government Accountability Office (GAO) examined recently approved section 1115 waivers to evaluate whether those waivers met the criteria for the exemptions and whether the documents HHS issues when approving those waiver requests adequately convey what the approved expenditures are for and how they will promote Medicaid’s objectives.
As part of its investigation, GAO reviewed waiver requests from 25 states covering 150 programs and found that HHS lacked formal, written criteria for waivers and suggested that the agency more clearly express, in its approval documents, the objectives it expects programs to achieve in return for their exemption from some federal Medicaid requirements.
For a closer look at the study and its findings, see the report Medicaid Demonstrations: Approval Criteria and Documentation Need to Show How Spending Furthers Medicaid Objectives here, on the GAO web site.

PA Safety Net Admin2015-05-19T06:00:33+00:00May 19th, 2015|Pennsylvania Medicaid policy|Comments Off

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments.
That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources. Pennsylvania is not among the states that continued paying the enhanced rates.
The question of whether the fee increase accomplished its objective and is worth re-establishing remains unanswered. The brief nature of the experiment – only two years – and the delays many states experienced before they started paying the enhanced rates left little time for meaningful research. One quantitative analysis suggests the rate increase helped, there have been several more qualitative approaches to research, and some studies remain under way.
Because they care for so many more Medicaid patients than the typical hospital, the adequacy of Medicaid payments has long been of special concern to Pennsylvania safety-net hospitals.
For a closer look at the Affordable Care Act’s Medicaid primary care fee bump, how it worked, its impact, and its future, see the new health policy brief “Medicaid Primary Care Parity” here, on the web site of the journal Health Affairs.

PA Safety Net Admin2015-05-15T06:00:54+00:00May 15th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April edition of Health Law PA News, its monthly newsletter.
Included in this edition are articles about the status of Pennsylvania’s latest Medicaid expansion effort; an explanation of state policy for calculating applicants’ income for the purpose of determining whether they are eligible for Medicaid; health insurance options for immigrants; and more.
Find the latest edition of Health Law PA News here.

PA Safety Net Admin2015-05-12T06:00:12+00:00May 12th, 2015|HealthChoices PA, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Minutes of MAAC Fee-For-Service Subcommittee Meeting

The Fee for Service Subcommittee of Pennsylvania’s Medical Assistance Advisory Committee (MAAC) has approved the minutes of the subcommittee’s February 11 meeting.
That meeting addressed the introduction of in-house radiology review in the state’s Medicaid fee-for-service program, Medicaid expansion in the state, provider enrollment and revalidation efforts as required by the Affordable Care Act, and more.
See those minutes here.

PA Safety Net Admin2015-05-07T06:00:28+00:00May 7th, 2015|Pennsylvania Medicaid policy|Comments Off

SNAPShots

SNAPShots

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us