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PA Health Law Project Newsletter

phlp The Pennsylvania Health Law Project has published its November-December 2016 newsletter.
Included in this edition are stories about a new effort to enroll children in the state’s Medicaid and Children’s Health Insurance Program, the new fees for Medicare Part A and Part B for 2017, a delay in the implementation of the state’s proposed Community HealthChoices program of managed long-term services and supports, and more.
Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2016-12-28T06:00:04+00:00December 28th, 2016|Medicare, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Chosen for Behavioral Health Services Demo

Pennsylvania will be one of eight states to participate in a new federal two-year Certified Community Behavioral Health Clinic demonstration program.
samhsa According to the federal Substance Abuse and Mental Health Services Administration, the program is

…designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.

A federal spokesperson explained that

The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their health and well-being.

The program is authorized under Section 223 of the Protecting Access to Medicare Act of 2014. Last year the federal government awarded 24 states planning grants under the law. Nineteen of those states applied to participate in the program and eight, including Pennsylvania, were ultimately chosen.
As part of its application, Pennsylvania designated ten sites for program implementation:

Berks Counseling Center, Berks County
Cen Clear Child Services, Clearfield County
Cen Clear Punxsy, Jefferson County
Community Council Health Systems, Philadelphia County
NHS Human Services, Delaware County
Northeast Treatment Centers, Philadelphia County
Pittsburgh Mercy, Allegheny County
Resources for Human Development, Montgomery County
Safe Harbor Behavioral Health of UPMC Hamot, Erie County
The Guidance Center, McKean County

According to the state, the programs at these sites will:

enhance access to behavioral health services for Medicaid and CHIP beneficiaries,
help individuals with mental health and substance use disorders obtain the health care they need to maintain their health and well-being,
allow individuals to have access to a wide array of services at one location, and
remove the barriers that too often exist across physical and behavioral health systems.

Learn more about the demonstration from this news release from the U.S. Department of Health and Human Services. Learn more about Pennsylvania’s plans for its demonstration program from this news release from the state’s Department of Human Services.

PA Safety Net Admin2016-12-27T06:00:17+00:00December 27th, 2016|Pennsylvania Medicaid, Uncategorized|Comments Off

PA Improves Access to Contraceptives

Citing the challenges and risks associated with unplanned pregnancies that occur within two years of a delivery, Pennsylvania’s Medicaid program is making long-acting contraceptives more readily available to program participants.
Pennsylvania State Map Beginning on December 1, Medicaid will pay for long-acting contraceptives administered after delivery and also will increase payments to doctors who provide those contraceptives. Currently, those costs are generally borne by hospitals in the lump-sum payment Medicaid makes for deliveries.
Learn more about the state’s new policy for encouraging the use of contraceptives among Medicaid beneficiaries who have delivered babies in this Lancaster Online article.

PA Safety Net Admin2016-12-09T06:00:58+00:00December 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Profile of Nominee to Head CMS

President-elect Donald Trump has nominated Seema Verma, a health care consultant, to serve as administrator of the Centers for Medicare & Medicaid Services. That agency runs the Medicare and Medicaid programs.
In this capacity she would have enormous influence on the development of new Medicare and Medicaid initiatives, including many proposals for change from the incoming administration and Congress – all matters of vital concern to Pennsylvania safety-net hospitals.
Go here to see a Kaiser Health News profile of Ms. Verma and learn more about her past work, especially on Medicaid issues.

PA Safety Net Admin2016-12-06T06:00:58+00:00December 6th, 2016|Medicare, Pennsylvania Medicaid|Comments Off

PA Uninsured Rate Declines

Pennsylvania’s uninsured rate has fallen to 6.4 percent, according to the U.S. Census Bureau.
That’s less than half the state-wide rate of 13 percent in 2011 and 2012.
Since that time the state’s Medicaid expansion has added 670,000 Pennsylvanians to the ranks of the insured, with others purchasing insurance through the federal health insurance marketplace.
Learn more about the decline in the number of uninsured Pennsylvanians in this news release from the office of Governor Tom Wolf.

PA Safety Net Admin2016-10-19T09:30:43+00:00October 19th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

phlp The Pennsylvania Health Law Project has published its September 2016 newsletter.
Included in this edition are stories about the selection of managed care organizations to participate in the state’s new Community HealthChoices program to provide community-based managed long-term services and supports to individuals who receive both Medicaid and Medicare and who are eligible for nursing home care; the open enrollment period for Medicare and Medicare Part D drug plans; the awarding of six “Navigator grants” to Pennsylvania organizations that counsel people interested in obtaining health insurance through the federal health insurance marketplace; and actions take by the state to improve access to pediatric shift nursing and home health aide services for children covered by Medicaid.
Find the newsletter here.

PA Safety Net Admin2016-10-10T06:00:18+00:00October 10th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations. Such payments are often used to distribute the proceeds from state hospital taxes.
The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely.
In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions that meet specific new criteria.
In announcing the policy, CMS acknowledges the challenges inherent in ending the use of such payments and indicates its intention to address this issue, and the phase-out process, in future regulations
Such pass-through payments are an important of Pennsylvania’s Medicaid program and the state’s private safety-net hospitals benefit considerably from them.
Go here to see the CMS bulletin on a subject of interest to many high-volume Medicaid hospitals.

PA Safety Net Admin2016-08-09T06:00:39+00:00August 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its June 2016 newsletter.
phlp Included in this edition are stories about the delay in implementation of the state’s Community HealthChoices program of managed long-term services and supports for the dually eligible; challenges for those seeking home and community-based services from state waiver programs; and more.
Find the newsletter here.

PA Safety Net Admin2016-06-30T06:00:21+00:00June 30th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

SNAP Comments on Proposed Medicaid Observation Care Payment

The Safety-Net Association of Pennsylvania has written to the state’s Department of Human Services about DHS’s proposal to establish a payment policy for hospital observation services covered by the state’s Medicaid fee-for-service program.
While SNAP has long supported the concept of a Medicaid fee-for-service rate for observation services and welcomes DHS’s decision to create such a rate and associated policies, it expressed a number of concerns about DHS’s proposal, including about:

the proposed observation rate
the classification of observation care as an outpatient service
the manner in which the state proposes financing observation care
program integrity issues

To learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.

PA Safety Net Admin2016-06-20T06:00:37+00:00June 20th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

New MLTSS Program Delayed Six Months

The launch of Community HealthChoices, Pennsylvania’s new approach to the delivery of managed long-term services and supports for seniors eligible for both Medicare and Medicaid, will be delayed six months.
The program was scheduled to begin in southwestern Pennsylvania on January 1, 2017 but state officials recently announced that they have pushed back the start date to July 1, 2017.
In a message to interested parties, state officials wrote that

The decision to extend our start date builds on this approach and allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved. We will continue to work with all stakeholders, such as the Area Agencies on Aging and Centers for Independent Living, on a robust CHC education and outreach effort to ensure that we reach as many consumers and caregivers as possible.

The time-frame for implementation in other parts of the state remains unchanged.
To learn more about what Community HealthChoices is and why its launch has been delayed, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2016-06-15T06:00:05+00:00June 15th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

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