Pennsylvania Medicaid policy Archives - Page 26 of 43 - Safety-Net Association of Pennsylvania

Mackereth Explains PA Medicaid Expansion

In a letter to the editor of the York Daily Record, Pennsylvania Department of Welfare Secretary Beverly Mackereth has outlined the rationale for the Corbett administration’s “Healthy Pennsylvania” health care reform plan and its approach to expanding access to Medicaid services.
In the letter, Secretary Mackereth stresses the importance of a program tailored to Pennsylvania and describes the thinking behind the state’s approach to benefit packages, encouraging enrollees to engage in healthy behaviors, Medicaid premiums, and the use of private health insurance instead of the general expansion of Medicaid many other states are employing.
See Secretary Mackereth’s letter to the York Daily Record here.

PA Safety Net Admin2014-09-05T06:00:29+00:00September 5th, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Medicaid Benefit Cuts Coming?

While the federal government has approved the Corbett administration’s proposal to expand Medicaid eligibility in Pennsylvania and serve the newly eligible through private insurance plans, it did not rule on a key component of the administration’s Healthy Pennsylvania proposal: reducing benefits for some Medicaid recipients.
Instead, any changes in the state’s Medicaid benefits must still be negotiated with the federal government and remain subject to federal approval.
For a closer look at the state’s Medicaid expansion plan and its implications, see this report in the “State House Sound Bites” section of the web site of public radio station WITF.

PA Safety Net Admin2014-09-03T10:50:47+00:00September 3rd, 2014|Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Medicaid Expansion Approved by Feds

Pennsylvania’s request for federal approval of its Medicaid expansion plan has been approved by the federal government.
The plan, part of the Corbett administration’s “Healthy Pennsylvania” health care reform proposal, calls for an expanded population of Pennsylvanians who are newly eligible for Medicaid to obtain subsidized coverage through the private health insurance market – managed care organizations approved by the state to serve the new Medicaid expansion population.
The letter of approval from Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner to Pennsylvania Department of Public Welfare Secretary Beverly Mackereth notes that

…the state aims to modify Pennsylvania’s Medicaid program and expand access to coverage to adults in Pennsylvania with incomes through 133 percent of the federal poverty level (FPL) beginning January 1, 2015.

The terms of the demonstration have been incorporated into the accompanying Special Terms and Conditions (STCs) and waiver authorities for the demonstration approval. The approved demonstration authorizes the state to charge premiums to newly eligible individuals up to 133 percent of FPL with access to health care coverage through managed care health plans. Specifically, beginning in January 2016 of the demonstration, the state may charge monthly premiums in an amount not to exceed 2 percent of household income for certain adults with incomes above 100 percent of the FPL.

Beneficiaries subject to a premium as authorized by the demonstration will not be charged copayments (with the exception of an $8 copayment for non- emergency use of the emergency room, which the state may authorize within the Medicaid state plan). Individuals failing to pay the monthly premiums for three consecutive months may be disenrolled from coverage, and may re-enroll without a waiting period. The Commonwealth is not imposing premiums on individuals with incomes at or below 100 percent of the FPL.

The Healthy Pennsylvania demonstration includes an incentive program that is intended to improve the use of preventive services and other healthy behaviors. Enrollees who complete specified healthy behaviors during the first year of enrollment in the demonstration shall have their premium obligations reduced in their second year. For each subsequent year, enrollees will have the opportunity to complete healthy behaviors to reduce their amount of financial obligations.

We have provided authority for the state to not offer non-emergency medical transportation (NEMT) during the first year of the demonstration. This authority will sunset on December 31,2015, and the state will provide NEMT to these beneficiaries beginning in year 2 of the demonstration. The changes in the Pennsylvania demonstration are consistent with those in other demonstrations.

The Commonwealth will deliver services to the newly eligible population through contracts with managed care organizations. Individuals covered will have the choice of an approved health plan in their region. Medicaid managed care rules continue to apply under the demonstration although as stipulated in the demonstration the Commonwealth may rely on state or federal commercial standards when those standards are at least as robust as the Medicaid standards.

Benefits provided to individuals eligible under the expansion will be consistent with federal statutory requirements effectuated through amendments to the Commonwealth’s state plan, rather than the approved demonstration. The expansion population, including those who are subject to this demonstration and those who are medically frail and covered outside of this demonstration, will receive the full complement of health services required under the law. Medically frail individuals will receive coverage from the state through a “high risk” benefit plan.

CMS and the state have been in active consultation on the state plan amendments needed to effectuate this change and have reached agreement on the overall benefits approach, pending final submission of documents by the state consistent with the agreement that has been reached.

In addition, outside this demonstration, the state aims to encourage employment through incentives for job training and work-related activities, including access to Healthy Pennsylvania Career Coaches, for Healthy Pennsylvania beneficiaries who choose to participate in the state’s Encouraging Employment program. Health coverage provided by the Medicaid program and this demonstration will not be affected by this state initiative.

The complete approval letter and a second document describing the special terms and conditions the federal government has attached to the waiver approval can be found here, on the Healthy Pennsylvania web site.

PA Safety Net Admin2014-08-29T06:00:52+00:00August 29th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

New Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest newsletter.
Among the articles are stories about the preservation of the state’s Medical Assistance for Workers with Disabilities Program (MAWD); new funding for home- and community-based services for people with disabilities; a clarification of Children’s Health Insurance Program (CHIP) benefits; and more.
Find the newsletter here.

PA Safety Net Admin2014-08-18T06:00:24+00:00August 18th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Aging Waiver Program Struggles With Backlog

A Pennsylvania program to help the elderly remain in their own homes instead of moving into nursing homes is struggling with backlogs.
The state’s Aging Waiver Program is a Medicaid program that enables those who meet certain medical and financial criteria to receive assistance in their own homes from nurses and home health aides rather than go into a nursing home.
Currently the program serves more than 32,000 people – nearly twice as many as it did six years ago – but applications are taking as long as two months to process. The biggest challenge is verifying financial eligibility, but the state recently added staff to help address the backlog.
Learn more about Pennsylvania’s Aging Waiver Program in this Pittsburgh Tribune-Review article.

PA Safety Net Admin2014-08-11T06:00:49+00:00August 11th, 2014|Pennsylvania Medicaid policy|Comments Off

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”
So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.
The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education. It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.
In the report, the IOM proposes six goals for improving GME financing.

Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. 
Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1. 
Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals. 
Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds. 
Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment. 
Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods.

To fulfill these goals, the report offers three specific recommendations:

Investing strategically: Maintain Medicare GME funding at its current level, but modernize payment methods to reward performance, ensure accountability, and incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out. 
Building an infrastructure to facilitate strategic investment: Establish a two-part governance infrastructure for federal GME financing. A GME Policy Council in the Office of the Secretary of the Department of Health and Human Services should oversee policy development and decision making. A GME Center within the Centers for Medicare & Medicaid Services should function as an operations center with the capacity to administer payment reforms and manage demonstrations of new payment models. 
Establishing a two-part Medicare GME fund: Allocate Medicare GME funds to two distinct subsidiary funds—a GME Operational Fund to finance ongoing residency training activities and a Transformation Fund to finance development of new programs, infrastructure, performance methods, payment demonstrations, and other priorities identified by the GME Policy Council.

Graduate medical education is an important issue for the Pennsylvania safety-net hospitals that also are teaching hospitals. The state’s Medicaid program is an important source of medical education funding for these hospitals as well.
To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.

PA Safety Net Admin2014-08-01T06:00:22+00:00August 1st, 2014|Pennsylvania Medicaid policy|Comments Off

GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.

PA Safety Net Admin2014-07-31T06:00:42+00:00July 31st, 2014|Pennsylvania Medicaid policy|Comments Off

Keep Medicaid Pay Boost, Docs Ask Congress

Physician groups and other health care organizations are asking Congress to continue the increase in Medicaid payments that primary care providers have been receiving for nearly two years.
The pay raise, mandated by the Affordable Care Act, was instituted to help induce more primary care providers to serve Medicaid patients in anticipation of the reform law’s significant expansion of Medicaid eligibility. That pay raise, which brings Medicaid rates up to the level of Medicare rates and is paid for entirely by the federal government, expires at the end of 2014.
Now, primary care physicians have written to the leaders of the Senate Finance Committee and the House Energy and Commerce Committee asking them to extend the raises and add ob/gyns to providers eligible for the enhanced payments.
See their letter here.

PA Safety Net Admin2014-06-30T13:00:37+00:00June 30th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

SNAP Warns of Challenges Ahead

As Pennsylvania lawmakers contemplate the state’s FY 2015 budget, the Safety-Net Association of Pennsylvania has issued a new position paper reminding those officials of the challenges the state’s private safety-net hospitals face in the current environment and the need for adequate, stable funding as they tackle those challenges.
Among those challenges are low-income patients with distinct needs, major cuts in federal Medicare payments that especially target safety-net hospitals, and powerful economic forces marshaled by government, insurers, and others that seek to compel hospitals to deliver care in different ways, be paid differently for their efforts, align their incentives differently with other providers, and invest heavily in information technology.
Pennsylvania’s safety-net hospitals are prepared to do all these things, but to achieve such progress, they need financial stability and predictability: they need to know that their Medical Assistance funding will not be at risk as the state experiences various budget challenges.
Read SNAP’s perspective on these issues in its new position paper, “Pennsylvania’s Safety-Net Hospitals: The Need for Stable and Predictable Funding Amid Increasing Challenges,” which can be found here, on SNAP’s web site.

PA Safety Net Admin2014-06-30T06:00:31+00:00June 30th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

Protect Uncompensated Care Payments, SNAP Tells State Officials

Although only 25 percent of the state’s acute-care hospitals, Pennsylvania’s private safety-net hospitals account for 45 percent of the $1 billion in uncompensated care those hospitals provide to uninsured Pennsylvanians every year.
And now, as the governor and legislature consider the state’s FY 2015 budget, the Safety-Net Association of Pennsylvania is urging those officials to preserve state payments that help qualified hospitals with those uncompensated care costs and enable them to continue constituting the core of Pennsylvania’s health care safety net.
Tobacco Uncompensated Care Fund payments are supplemental state payments to hospitals that provide significant amounts of uncompensated care; they are underwritten by proceeds from the national master tobacco settlement of 1998 and matched by the federal government. As lawmakers work on the state’s FY 2015 budget, SNAP is urging them to expend available FY 2014 funding already authorized for this purpose and not to use FY 2015 tobacco settlement funding for any purpose other than what was prescribed in Act 71 of 2013.
These views and background information on the role private safety-net hospitals play in caring for low-income, Medicaid-covered, and uninsured Pennsylvanians are addressed in a new SNAP position paper, “The Importance of Preserving Uncompensated Care Payments.” Find that position paper here.

PA Safety Net Admin2014-06-27T06:00:37+00:00June 27th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

SNAPShots

SNAPShots

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

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