Uncategorized Archives - Page 16 of 29 - Safety-Net Association of Pennsylvania

GAO Identifies Medicaid Challenges

As Medicaid marks its 50th anniversary, the U.S. Government Accountability Office (GAO) testified recently before the House Energy and Commerce Committee’s Health Subcommittee on the major challenges facing the program.
GAO’s testimony focused on four major issues:

access to care
transparency and oversight
program integrity
federal financing

The GAO concluded that it

…considers Medicaid a high-risk program due to its size, growth, diversity, and gaps in oversight…

See GAO’s complete testimony here.

PA Safety Net Admin2015-07-16T06:00:43+00:00July 16th, 2015|Uncategorized|Comments Off

Study Finds Shortage of Nurses in PA

A study commissioned by the Pennsylvania State House of Representatives has found a shortage of nurses in Pennsylvania hospitals.
The study, performed by the Joint State Government Commission, found

…a clear relationship between nurse staffing and patient outcomes. Although there is not an overall shortage of nurses in Pennsylvania, Pennsylvania hospitals vary significantly from one to the next in terms of nurse staffing, which contributes to disparities in quality of care across the state. This variation is much greater than can be justified by differences in patient need and is not in the public interest.

Based on these findings, the Joint State Government Commission offered the following recommendations:

Pennsylvania should improve nurse workforce data collection and analysis.
Pennsylvania should consider implementing a public reporting system for hospital staffing levels.
Hospitals should consider consistency of nurse staffing “off-shifts” (nights, weekends, holidays).
Pennsylvania hospitals should make improvements to the nurse work environment.
Pennsylvania should increase the percent of nurses with a Bachelor’s of Science degree in nursing.
Pennsylvania should extend the whistleblower protection law to include nurses.

Go here for the Joint State Government Commission report Professional Bedside Nursing in Pennsylvania: A Staff Study.

PA Safety Net Admin2015-07-15T06:00:33+00:00July 15th, 2015|Uncategorized|Comments Off

Medicaid Highlighted in Latest Health Affairs

The journal Health Affairs has dedicated its July 2015 edition to “Medicaid’s Evolving Delivery Systems.”
The edition includes the following articles about different aspects of Medicaid:

“Medicaid’s Growing Role in Care Delivery”
Once a Welfare Add-On, Medicaid Takes Charge in Reinventing Care”
“Medicaid at 50: Remarkable Growth Fueled by Unexpected Politics”
“Medicaid Moving Forward”
“Community Health Centers and Medicaid at 50: An Enduring Relationship Essential for Health System Transformation”
“Many Medicaid Beneficiaries Receive Care Consistent With Attributes of Patient-Centered Medical Homes”
“MetroHealth Care Plus: Effects of a Prepared Safety Net on Quality of Care in a Medicaid Expansion Population”
“Lessons From Medicaid’s Divergent Paths on Mental Health and Addiction Services”
“The Supreme Court Ruling That Blocked Providers From Seeking Higher Medicaid Payments Also Undercut the Entire Program”
“An Examination of Medicaid Delivery System Reform Incentive Payment Initiatives Under Way in Six States”
“Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care”
“Reducing Medicaid Churning: Extending Eligibility for Twelve Months or to End of Calendar Year is Most Effective”

Medicaid is, of course, among Pennsylvania safety-net hospitals’ most important payers.
Find the July edition of Health Affairs here.

PA Safety Net Admin2015-07-14T06:00:48+00:00July 14th, 2015|Uncategorized|Comments Off

Medicaid Cost-Sharing Re-Emerges

States are beginning to look anew at imposing cost-sharing requirements on their Medicaid population.
Indiana now requires Medicaid recipients to contribute to health savings accounts, Arkansas and Iowa have cost-sharing requirements, and Arizona, Ohio, and Utah are considering introducing cost-sharing.
This new trend is emerging after years out of favor when cost-sharing in Medicaid and children’s health insurance programs led to declining enrollment in Florida, Kentucky, New Hampshire, Oregon, and Wisconsin.
The new “Healthy Indiana Plan” is receiving a good deal of attention for its use of health savings accounts instead of premiums and co-pays. People who put money in their health savings accounts essentially get free care while those who engage in certain preventive activities can see their required contributions fall and those who fail to make the payments can lose some benefits.
Learn more about the renewed interest in requiring Medicaid patients to pay for some of their health care and the potential implications of such an effort in this Los Angeles Times article.

PA Safety Net Admin2015-07-10T06:00:01+00:00July 10th, 2015|Uncategorized|Comments Off

Medicaid Limits on High-Cost Drugs Illegal?

With the recent proliferation of high-cost drugs threatening many states’ Medicaid budgets, some of those states have attempted to impose limits on the use of those drugs.
But are those limits legal?
That is the question addressed in a new report in the Annals of Internal Medicine, which notes that

Current restrictions seem to violate federal Medicaid law, which requires states to cover drugs consistent with their U.S. Food and Drug Administration labels.

So are those limits legal? Or will patients and their advocates have grounds to challenge limits to their access to potentially life-saving or life-improving drugs?
Learn more about this situation in the new report “Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States” here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2015-07-06T06:00:46+00:00July 6th, 2015|Uncategorized|Comments Off

Report on Public Health and Health Care

The Institute of Medicine (IOM) has published a report summarizing its February workshop that explored the relationship between public health and health care.
According to the IOM, the workshop

… was designed to discuss and describe the elements of successful collaboration between health care and public health organizations and professionals; reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table. The workshop presentations reflected on collaboration in four contexts: payment reform, the Million Hearts initiative, hospital – public health collaboration, and asthma control.

Because of the nature of the communities they serve and the work they do, Pennsylvania safety-net hospitals are often important parts of public health efforts throughout the commonwealth.
Find the IOM report Collaboration between Health Care and Public Health: Workshop Summary here.

PA Safety Net Admin2015-07-01T06:00:05+00:00July 1st, 2015|Uncategorized|Comments Off

CMS Issues Guidance on Medicaid Managed Care Rate-Setting

The federal government has provided new guidance to states concerning how to ensure that the rates they pay Medicaid managed care organizations are adequate.
While federal law has long required that such rates be “actuarially sound,” the Centers for Medicare & Medicaid Services (CMS), which issued the draft guidance, has released new guidance to advise states about the information it seeks to ensure that proposed rates are truly actuarially sound.
The guidance notes that CMS will follow three principles when evaluating proposed rates to be paid to Medicaid managed care organizations.

The capitation rates are reasonable and comply with all applicable laws (statutes and regulations) for Medicaid managed care;
the rate development process complies with all applicable laws (statutes and regulations) for the Medicaid program, including but not limited to eligibility, benefits, financing, any applicable waiver or demonstration requirements, and program integrity; and
the documentation is sufficient to demonstrate that the rate development process meets generally accepted actuarial practices and principles.

See the CMS document “Draft 2016 Medicaid Managed Care Rate Development Guide” here. The National Association of Medicaid Directors has conveyed its concerns about some aspects of the proposed guidance to CMS; find its letter here.

PA Safety Net Admin2015-06-24T06:00:47+00:00June 24th, 2015|Uncategorized|Comments Off

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP).
In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers.
Find a summary of the MACPAC report and a link to the complete report here.

PA Safety Net Admin2015-06-19T06:00:18+00:00June 19th, 2015|Uncategorized|Comments Off

Medicaid Expansion Not Significantly Improving Hospital Financial Health

While the Affordable Care Act’s Medicaid expansion has helped millions of Americans gain health insurance, it has not translated (so far) into improved financial health for the hospitals providing those Medicaid services.
This is the conclusion drawn recently by Moody’s Investor Services, the credit-rating company.
According to Moody’s, hospital financial performance has improved across the board since implementation of the Affordable Care Act but has not improved more in states that expanded their Medicaid programs than it has in states that chose not to expand Medicaid eligibility. As a result, hospital operating margins in states that have expanded their Medicaid programs have not improved more than those in states that did not expand.
What hospitals in expansion states have experienced in many cases is reduced uncompensated care as more of the patients who come through their doors have Medicaid coverage. The financial benefits this brings, though, are often offset, in part or in whole, because Medicaid underpays providers so much in many states.
This suggests that Pennsylvania’s Affordable Care Act-inspired Medicaid expansion, which took effect on January 1, may not give the state’s private safety-net hospitals the financial boost many observers often assume.
Learn more about how Medicaid expansion is and is not affecting hospital financial performance in this Moody’s news release and this Wall Street Journal article.

PA Safety Net Admin2015-06-10T06:00:05+00:00June 10th, 2015|Uncategorized|Comments Off

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the May edition of Health Law News, its monthly newsletter.
Included in this edition are articles about the Wolf administration’s newly released Medicaid managed long-term supports and services proposal; the increase in Medicaid enrollment since the state’s Medicaid expansion began on January 1; the Medical Assistance Transportation Program; and the state’s application to the federal government to establish Pennsylvania’s own health insurance marketplace.
Go here to see the latest edition of PA Health Law News.

PA Safety Net Admin2015-06-09T06:00:56+00:00June 9th, 2015|Uncategorized|Comments Off

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