Pennsylvania Medicaid policy Archives - Page 20 of 43 - Safety-Net Association of Pennsylvania

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

Report on Pennsylvania Medicaid Expansion Transition

The Pennsylvania Department of Human Services (DHS) has issued a report on its progress toward stated goals in the transition from the Corbett administration’s Healthy Pennsylvania Medicaid expansion program to the Wolf administration’s Medicaid expansion via the state’s existing HealthChoices managed care program.
See that report here.

PA Safety Net Admin2015-05-05T06:00:59+00:00May 5th, 2015|Pennsylvania Medicaid policy|Comments Off

PA Issues Bulletin on Medicaid Expansion

The Pennsylvania Department of Human Services (DHS) has issued a new Medical Assistance Bulletin on the state’s expansion of its Medicaid program via the HealthChoices managed care program.
The bulletin notifies providers of the introduction of a new adult benefit package that applies to all adult Medicaid recipients in the state, highlighting some of the major changes in benefits from past packages. It also provides information about the state’s plan for a phased transition from the current private care option (PCO) insurance plans to HealthChoices plans over the coming months.
See DHS Medical Assistance Bulletin 99-15-05 here.

PA Safety Net Admin2015-04-30T06:00:10+00:00April 30th, 2015|HealthChoices PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

PA Completes First Phase of Medicaid Transition

Last weekend Pennsylvania’s Department of Human Services (DHS) formally moved more than 121,000 people from the Corbett administration’s Healthy Pennsylvania Medicaid expansion program to the Wolf administration’s expansion of the state’s long-time HealthChoices Medicaid managed care program.
Those who were shifted had enrolled in Healthy Pennsylvania private coverage option (PCO) plans before the end of calendar year 2014. In the next few days they will receive written notification of the shift. All will receive the same Medicaid benefits: a basic adult benefit package.
Individuals will no longer be able to enroll in PCO plans, and over the next few months more than 137,000 Pennsylvanians still in PCO plans will be shifted into HealthChoices plans in stages with completion expected by September 1.
For more information about the continued transition from Healthy Pennsylvania to HealthChoices, see this news release from the governor’s office.

PA Safety Net Admin2015-04-28T06:00:43+00:00April 28th, 2015|HealthChoices PA, Healthy PA, Pennsylvania Medicaid policy|Comments Off

DHS Presents Update on Medicaid Provider Enrollment Efforts

With the state still struggling to enroll and revalidate Medicaid providers, the Pennsylvania Department of Human Services (DHS) presented an update on its efforts to improve that process at the April 23 meeting of its Medical Assistance Advisory Committee (MAAC).
According to the presentation, DHS is focusing its improvements in three primary areas: introducing a new electronic enrollment web portal this fall; standardizing its processes and procedures; and adding staff next month to facilitate enrollments.
DHS staff made a presentation on its latest efforts at the April 23 MAAC meeting. See that presentation here.

PA Safety Net Admin2015-04-27T06:00:56+00:00April 27th, 2015|Pennsylvania Medicaid policy|Comments Off

PA Moves to Streamline Medicaid Provider Enrollment

In response to the challenges the state has encountered processing Medicaid provider enrollment applications, the Pennsylvania Department of Human Services (DHS) has unveiled what it believes will be an improved approach to tackling this problem.
The improvements include electronic enrollment, standardization of policies and procedures, and additional provider enrollment staffing.
At the heart of the backlog are Affordable Care Act requirements.
Go here to see a message from DHS acting secretary Theodore Dallas on this subject.

PA Safety Net Admin2015-04-23T06:00:08+00:00April 23rd, 2015|Affordable Care Act, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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