Pennsylvania safety-net hospitals Archives - Page 7 of 14 - Safety-Net Association of Pennsylvania

Court Rejects 340B Cuts

A federal court has ruled that the Centers for Medicare & Medicaid Services overstepped its authority in reducing Medicare payments for prescription drugs covered by the section 340B prescription drug discount program.

While the court conceded that CMS has the authority to address 340B payments, it found that CMS’s drastic payment cuts, introduced in FY 2018, “…fundamentally altered the statutory scheme established by Congress…” for determining 340B payment rates.

The court suggested that CMS either change its methodology for determining 340B payments to justify the specific cuts it proposes or raise its objections with Congress, which created the program and has the authority to change it.

According to documents submitted to the court by the parties that filed the suit, eligible hospitals have seen their 340B payments reduced $1.6 billion since the cuts began in FY 2018. The court asked the federal government and those who filed the suit to suggest remedies for compensating participating hospitals for their losses.

The ruling has major implications for the Pennsylvania safety-net hospitals, most of which participate in the 340B program.

Learn more about the 340B litigation, the court’s ruling, and its impact in the New York Times story “Court Rejects Trump’s Cuts in Payments for Prescription Drugs.”

PA Safety Net Admin2019-01-11T06:00:43+00:00January 11th, 2019|Medicare, Pennsylvania safety-net hospitals|Comments Off

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report.

According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially.

The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices.

Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices.

Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit.”

PA Safety Net Admin2019-01-09T15:54:59+00:00January 9th, 2019|Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

Senators Seek 340B Reprieve

A bipartisan group of senators has written to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer expressing concern about cuts in Medicare Medicare prescription drug payments to qualified providers as a result of new regulations governing the section 340B prescription drug discount program. Those cuts have been adopted by regulation by the Centers for Medicare & Medicaid Services and will take effect beginning on January 1, 2018.
Under the regulation adopted by CMS, Medicare payments for prescription drugs dispensed on an outpatient basis to low-income patients will be reduced to qualified providers by $1.6 billion in the coming year. While acknowledging problems with how the 340B program has evolved over the years, the senators ask their leaders to partner “…with CMS and other stakeholders to ensure the 340B program continues to support safety-net providers in helping low-income individuals access quality health care services with proper oversight and transparency.”
All Pennsylvania safety-net hospitals participate in the 340B program.
Neither Pennsylvania senator signed the letter.
See the letter here.

PA Safety Net Admin2017-12-12T06:00:31+00:00December 12th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs.
So concludes a new study in Annals of Internal Medicine.
According to the report,

Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.

This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce.
Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize access to care in some communities. That, in turn, could have implications for Pennsylvania safety-net hospitals and the communities they serve.
Learn more about the study, its findings, and its implications by going here to see the Annals of Internal Medicine report “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities.”

PA Safety Net Admin2017-12-07T06:00:27+00:00December 7th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts.
But that may be changing.
The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients.
Because they serve so many low-income patients, Pennsylvania safety-net hospitals are especially interested in policy changes that might enable them to serve such patients more effectively.
The Commonwealth Fund has taken a closer look at how the 2016 Medicaid managed care regulation may facilitate addressing the psycho-social needs of Medicaid beneficiaries. Go here to see its report “Addressing the Social Determinants of Health Through Medicaid Managed Care.”

PA Safety Net Admin2017-12-05T06:00:32+00:00December 5th, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

The Battle Over 340B

Hospitals and other health care providers say it is an essential tool in ensuring access to care, and to prescription drugs, for their low-income patients.
Pharmaceutical companies say it has expanded beyond its original purpose and is being used by hospitals to pad their profits.
Members of Congress are divided: some are supportive and some are skeptical.
The section 340B program that requires drug companies to provide discounts to selected hospitals and other providers that serve large numbers of low-income patients has been the subject of controversy in recent years. During that time, the administration has generally sided with hospitals and maintained the program.
That support was tempered recently when the Centers for Medicare & Medicaid Services proposed a 28 percent cut in Medicare payments to hospitals for drugs provided to low-income patients through the 340B program. Hospital industry groups responded by suing the federal government and will have their day in court later this month.
Pennsylvania safety-net hospitals participate in the 340B program and consider it essential to their ability to serve their communities.
What are the issues? Why do hospitals and other providers consider 340B so essential to their well-being while pharmaceutical companies and now, CMS, view the program with increasing skepticism?
Kaiser Health News has taken a look at these and other 340B questions. Read its story here.

PA Safety Net Admin2017-11-30T06:00:12+00:00November 30th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program.
Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments. If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients.
The 340B program is an essential source of resources for private Pennsylvania safety-net hospitals and many stand to lose hundreds of thousands of dollars, or even millions of dollars a year, if the payment cut is not reversed.
Go here to see Rep. McKinley’s news release on the bill and here to see the bill itself, which is H.R. 4392, “To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.”

PA Safety Net Admin2017-11-17T06:00:20+00:00November 17th, 2017|Pennsylvania safety-net hospitals|Comments Off

CMS Guidance on MCO Payments is Good News for PA Hospitals

New guidance from the Centers for Medicare & Medicaid Services on the use of directing additional Medicaid resources to hospitals through Medicaid managed care organizations is good news for Pennsylvania safety-net hospitals.
Such payments have been routed through the state’s Medicaid managed care plans for several years, but as the state and hospital industry continue negotiating renewal of the state’s hospital tax – its “Quality Care Assessment” – it was not entirely clear whether the federal government would permit continued use of this mechanism.
An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Go here to see the CMS memo “Delivery System and Provider Payment Initiatives under Medicaid Managed Care Contracts.”

PA Safety Net Admin2017-11-16T14:19:15+00:00November 16th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

340B Changes Would Hurt Hospital Margins

Proposed changes in the federal section 340B prescription drug discount program would hurt hospital margins.
So says Moody’s Investors Service, the credit rating agency.
According to Moody’s, the margins of non-profit hospitals are already under pressure because revenue increases are not keeping pace with prescription drug costs. Reductions of payments under the 340B program recently proposed by the Centers for Medicare & Medicaid Services would make a challenging situation worse, Moody’s speculates.
Under the 340B program, eligible hospitals purchase prescription drugs at a discount, supply them to eligible outpatients, and use the savings they gain to provide additional services and outreach to the low-income residents of their communities.
Skeptics maintain that hospitals simply pocket the savings.
Under the regulation proposed by CMS, federal payments to 340B-eligible hospitals would be greatly reduced.
All Pennsylvania safety-net hospitals participate in the 340B program and benefit considerably for it.
Learn more about the issue and Moody’s report on the potential impact of changes in the program in this Healthcare Finance News article.

PA Safety Net Admin2017-10-10T06:00:45+00:00October 10th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

Leave 340B Alone, CMS Advisory Group Says

The Centers for Medicare & Medicaid Services should not significantly reduce Medicare payments for some prescription drugs.
Or so says one of CMS’s own advisory panels.
The agency’s Advisory Panel on Outpatient Prospective Payment reached this conclusion after listening to testimony from hospital industry stakeholders who told of the savings the federal government’s 340B prescription drug discount program produces and how those savings enable hospitals in low-income areas to help low-income patients who would not otherwise be able to afford their drugs and help improve access to care for low-income patients with very limited health care options.
The panel’s recommendation came just a month after CMS proposed reducing Medicare reimbursement for 340B drugs from its current level, average sales price plus six percent, to average sales price less 22.5 percent..
Critics of the program maintain that it is abused by hospitals, which are not required to reinvest their 340B savings in health care for the poor. Program supporters maintain that hospitals do use those savings for this very purpose.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it an essential part of their overall effort to serve the many low-income residents of the communities they serve.
CMS called for the change in the 340B program in a proposed regulation published in July. Interested parties have until September 11 to comment on the proposal.
Learn more about this issue and the CMS advisory panel’s recommendation in this Fierce Healthcare article.

PA Safety Net Admin2017-09-01T06:00:36+00:00September 1st, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

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