Pennsylvania Medicaid policy Archives - Page 39 of 43 - Safety-Net Association of Pennsylvania

Shift to HealthChoices Hits Bumps in the Road

Pennsylvania’s switch to HealthChoices to serve nearly the entire state Medicaid population is running into short-term obstacles in parts of the state.
Some recipients, for example, failed to choose a participating managed care plan, were assigned to plans, and now are confused about where to go and how to obtain care. In other instances, physicians are still negotiating with those plans or waiting to be credentialed for participation.
Some Pennsylvania safety-net hospitals, because of where they are located and their especially large numbers of Medicaid patients, may experience these problems more than the average hospital.
Read more about the challenges Medicaid recipients are encountering during this transition in this Erie-Times News article .

PA Safety Net Admin2012-11-08T06:00:02+00:00November 8th, 2012|Pennsylvania Medicaid policy|Comments Off

Medicaid Primary Care Pay Raise Set; OB/GYNs, ER Docs Excluded

When the Affordable Care Act’s mandatory rate increase for primary care services provided to Medicaid patients takes effect on January 1, ob/gyns and emergency room physicians will not be among the beneficiaries of the temporary raise in pay.
Under a new regulation issued last week, only family doctors, internists, and pediatricians will receive the pay increase, which was established as a short-term (two years) incentive to attract more physicians to serve Medicaid patients in anticipation of the significant increase in enrollment expected when many states expand their Medicaid eligibility criteria in 2014.
When working under the supervision of eligible primary care physicians, nurse practitioners and physician assistants also will receive the enhanced Medicaid payments.
State Medicaid payments for primary medical care typically fall well below comparable Medicare rates. Under the reform law, Medicaid payments for such services will be raised to Medicare levels for two years, with the federal government footing the bill for the difference.
Because they serve so many Medicaid patients and the state’s outpatient fees are so much lower than those paid by Medicare, Pennsylvania’s safety-net hospitals and the primary care physicians they employ should benefit greatly from this new policy.
Read more about who will and won’t benefit from the primary care fee increase and how it will be implemented in this Kaiser Health News article .

PA Safety Net Admin2012-11-05T06:00:03+00:00November 5th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.
Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.
At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.
The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.
Many physicians serving communities with large numbers of Medicaid patients, and those employed by Pennsylvania’s safety-net hospitals, are expected to benefit from this pay increase. Currently, Medicaid primary care physician payments in Pennsylvania are just 56 percent of comparable Medicare payments.
Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News article.

PA Safety Net Admin2012-10-29T06:00:15+00:00October 29th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Lawsuit Challenges Social Services Block Grants and the End of General Assistance Payments

A lawsuit has been filed in Pennsylvania’s Commonwealth Court challenging the state’s termination of General Assistance payments to low-income Pennsylvanians and the redirection of some state social services funding into block grants for selected counties.
General Assistance grants are small sums of money that were paid monthly to low-income Pennsylvanians. Many were thought to use this money for food, medicine, and other necessities.
Pennsylvania’s counties have long received social services funding from the state. Now, some counties have voluntarily agreed to accept less money in exchange for greater flexibility in how they spend it. Some of the services provided with this money are delivered by hospitals, including the state’s private safety-net hospitals.
The legal challenge is on procedural rather than policy grounds, with the plaintiffs alleging that the legislation that ended the General Assistance grants and created the social services block grant program violated a provision in the state constitution that requires legislation to address only a single issue.
Read more about the General Assistance and social services block grant lawsuit in this Philadelphia Inquirer article .

PA Safety Net Admin2012-10-26T06:00:16+00:00October 26th, 2012|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

Pennsylvanians Who Lost Medicaid Eligibility Given Path to Restoration

More than 100,000 Pennsylvanians who were dropped from the state’s Medical Assistance rolls in the latter part of 2011 will receive a new opportunity to regain eligibility.
Under an agreement between the Pennsylvania Department of Public Welfare and lawyers for advocacy groups, 100,000 people who lost their eligibility will receive a letter describing their right of appeal. Those who appeal successfully will be restored to the state’s Medicaid rolls and could have their medical bills resolved for the period during which they were off those rolls.
Read more about why these 100,000 people lost their eligibility and how advocates won this opportunity for restoration in this Philadelphia Inquirer article .

PA Safety Net Admin2012-10-24T09:33:38+00:00October 24th, 2012|Pennsylvania Medicaid policy|Comments Off

Philadelphia Hospitals Hoping for Medicaid Expansion

Hospitals in the greater Philadelphia want the state to expand its Medicaid program as envisioned in the Affordable Care Act, the Philadelphia Business Journal reports.
According to a spokesman for the Delaware Valley Healthcare Council, Philadelphia-area hospitals are concerned that the state might not expand Medicaid eligibility. That expansion, mandated by the 2010 health care reform law, was made optional earlier this year by a Supreme Court decision.
Read more about why Philadelphia-area hospitals – many of which are safety-net hospitals – are eager for the state to embrace the reform law’s Medicaid eligibility expansion in this Philadelphia Business Journal article .

PA Safety Net Admin2012-10-22T06:00:32+00:00October 22nd, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

PA Relents on New Co-Pays for Selected Medicaid Recipients

The Pennsylvania Department of Public Welfare (DPW) has announced that it will not require selected Medical Assistance recipients with incomes 200 percent above the federal poverty level to pay co-payments for Medicaid services.
The new co-pay policy, implemented October 1, affected about 48,000 families and especially targeted children with autism and other disabilities.
Instead of seeking co-payments, DPW intends to seek federal permission to charge insurance premiums to the same patients.
Read more about the controversy and the decision that temporarily ends it in this Pittsburgh Post-Gazette article .

PA Safety Net Admin2012-10-10T06:00:13+00:00October 10th, 2012|Pennsylvania Medicaid policy|Comments Off

DPW Announces Selected Co-Payments

The Department of Public Welfare (DPW) has issued a Medical Assistance Bulletin to announce that it “is implementing copayments for services provided to children with disabilities, under the age of 18, who are eligible for Medical Assistance (MA) under the PH95 category” – that is, with incomes greater than 200 percent of the federal poverty level. Find that bulletin here. The state further elaborates on why it has adopted this policy in this Pennsylvania Bulletin notice .

PA Safety Net Admin2012-10-02T06:00:44+00:00October 2nd, 2012|Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

DPW Notice Confirms FY 2012 Burn Center, Trauma Payment Cuts

The Pennsylvania Department of Public Welfare has published final notices confirming FY 2012 reductions in payments to burn centers and trauma disproportionate share (DSH) payments.
Both notices were published in the Pennsylvania Bulletin: the burn center notice here and the trauma notice here .

PA Safety Net Admin2012-09-28T06:00:36+00:00September 28th, 2012|Medicaid supplemental payments, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

DPW Issues Notice Governing Revised Payment Methodologies

The Pennsylvania Department of Public Welfare (DPW) has published a notice providing final notice of implementation of its revised Medical Assistance (MA) payment methodology for inpatient hospital services provided, on a fee-for-service (FFS) basis, in acute care general hospitals. Additionally, the Department is giving final notice of its amended qualifying criteria and payment methodology for inpatient disproportionate share hospital (DSH), outpatient DSH supplemental and direct medical education (DME) payments and allocated funding for Fiscal Year (FY) 2010-2011 for these payments. The Department is also providing final notice of the establishment of additional types of DSH and supplemental payments.”
This notice essentially describes the new eligibility criteria and payment methodologies arising from Act 49 and can be seen in its entirety in this Pennsylvania Bulletin notice.

PA Safety Net Admin2012-09-27T06:00:59+00:00September 27th, 2012|Medicaid supplemental payments, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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