Uncategorized Archives - Page 21 of 29 - Safety-Net Association of Pennsylvania

MACPAC Looks at Medicaid, CHIP Issues

The non-partisan federal agency charged with advising Congress, the Department of Health and Human Services, and the states on matters involving Medicaid and the Children’s Health Insurance Program (CHIP) met last week in Washington, D.C.
The Medicaid and CHIP Payment and Access Commission (MACPAC) addressed a number of CHIP-related issues during its September 18-19 meetings, including the future of the program, its funding, state experiences with CHIP changes, and consumer protections.
MACPAC also looked at a variety of Medicaid issues, including state Medicaid expansions through premium assistance, enrollment so far in 2014, the Centers for Medicare & Medicaid Services’ Medicaid program integrity plan, early experiences of new enrollees, and future reductions in Medicaid disproportionate share payments (Medicaid DSH).
CHIP and Medicaid are especially important for Pennsylvania’s safety-net hospitals because they serve so many low-income patients. Those hospitals also are very concerned about future reductions in Medicaid DSH payments.
For a summary of the commission’s deliberations, see this CQ HealthBeat article presented by the Commonwealth Fund.
To see the presentations made during the two-day session go here, to MACPAC’s web site.

PA Safety Net Admin2014-09-23T06:00:28+00:00September 23rd, 2014|Uncategorized|Comments Off

Feds Provide More Info on Short Stay Settlement Offer

The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays.
The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals. Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute. The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care. Hospitals that wish to take advantage of the CMS offer must drop their claims for all such cases; they cannot selectively choose to drop some appeals and continue to pursue others.
Now, CMS has outlined how the process of filing for settlement of the cases will work, including the information hospitals must provide and the format in which they must provide it, the forms they must use, and descriptions of the processes it will employ to address discrepancies and reconcile claims.
CMS also has posted an FAQ, a recording of a teleconference on the subject, and the email address for questions.
Learn more about CMS’s offer and this process and find the materials cited above and additional documents available for download in this announcement on the CMS web site.

PA Safety Net Admin2014-09-12T06:00:11+00:00September 12th, 2014|Uncategorized|Comments Off

Medicare Offers Hospitals a Deal

Faced with an 18-month backlog of hundreds of thousands of appeals on cases in which auditors say hospitals billed Medicare for inpatient services that should have been billed at outpatient rates, the Centers for Medicare & Medicaid Services (CMS) is offering hospitals a deal: drop your appeals and accept a payment of 68 percent of the amount in dispute.
Under the offer, acute-care and critical access hospitals have until October 31 to accept CMS’s terms, and once the paperwork is completed, they should receive their payments within 60 days. Hospitals must be willing to relinquish all of their short stay-related claims; they cannot seek payment for some but continue to appeal others.
The offer has both appeal and risk: on one hand, hospitals that have large sums of money – millions – tied up in appeals could receive a welcome infusion of cash; on the other hand, accepting the agreement means foregoing the possibility of additional money they might have received if their appeals succeeded.
The cases all involve Medicare-covered short hospitals stays in which hospitals billed Medicare for inpatient stays but Medicare’s auditors – contractors that perform audits for the agency under its Recovery Audit Program (RAC) – concluded that such care should have been billed at less-costly outpatient rates. Only appeals of this type of case are eligible for the settlement offer.
To learn more about the appeals backlog and Medicare’s plan for addressing it, read this notice on CMS’s web site.

PA Safety Net Admin2014-09-08T06:00:22+00:00September 8th, 2014|Uncategorized|Comments Off

Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

Medicaid patients use hospital emergency rooms more frequently than privately insured and uninsured patients but are not overusing or abusing ER services.
So says the Medicaid and CHIP Payment and Access Commission (MACPAC) in a recent report that contradicts the widely held belief that Medicaid patients abuse hospital ER services.
According to “Revisiting Emergency Department Use in Medicaid,” “Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured.”
In addition, MACPAC found, “High ED use also can be a sign of poor access to primary, specialty, dental, and outpatient mental health care in other settings.” In 2012, for example, “…about one in four adult Medicaid enrollees who reported a recent visit to the ED went there because of difficulty accessing another provider, not because of a serious health problem.”
MACPAC also concluded that “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention…Non-urgent visits account for just 10 percent of all Medicaid-covered ED visits for non-elderly patients, a proportion comparable to that of privately insured patients.”
Pennsylvania’s safety-net hospitals serve far more Medicaid patients than the typical acute-care hospital and therefore face far greater challenges in meeting these patients’ needs.
Learn more about MACPAC’s findings in “Revisiting Emergency Department Use in Medicaid,” which can be found here.

PA Safety Net Admin2014-09-02T06:00:03+00:00September 2nd, 2014|Uncategorized|Comments Off

PA Introduces New ER Pain Treatment Guidelines

The Pennsylvania Department of Health and Department of Drug and Alcohol Programs have released new guidelines for the treatment of pain in hospital emergency rooms.
The guidelines, proposed by the Safe and Effective Prescribing Practices and Pain Management Task Force, were developed by the Pennsylvania College of Emergency Physicians and presented by a task force that included representatives of government, health care professions, and associations.
See a state news release about the guidelines here and download the guidelines themselves here.

PA Safety Net Admin2014-08-27T06:00:47+00:00August 27th, 2014|Uncategorized|Comments Off

Clock Ticking for 12,600 Newly Insured Pennsylvanians

12,600 Pennsylvanians newly insured through the Affordable Care Act will lose their health insurance at the end of September if they cannot prove their eligibility for that insurance.
Most of these cases involve questions about whether the newly insured are living in the U.S. legally.
These 12,600 Pennsylvanians are among approximately 300 ,000 people nation-wide whose eligibility for insurance and insurance subsidies is currently under review by the federal government and who have not yet responded to requests for information about citizenship, immigration status, or income.
The affected people have until September 5 to provide the requested information. Those who fail to do so, and those who do not meet the requirements, will lose their health insurance as of September 30.
Learn more about this situation in this Pittsburgh Business Times article.

PA Safety Net Admin2014-08-26T09:58:21+00:00August 26th, 2014|Uncategorized|Comments Off

CMS Seeks to Jump-Start Medicaid Innovation

A new federal program seeks to encourage states to work faster to find ways to improve care and improve the health of their Medicaid patients and to reduce health care costs through payment and service delivery reforms.
The Center for Medicare & Medicaid Services’ (CMS) new Medicaid Innovation Accelerator Program is a collaboration between the Center for Medicaid and CHIP Services, the Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office, and other federal agencies and centers. According to a CMS fact sheet, the program

…aims to jumpstart innovation in key areas while supporting states in their efforts to improve health, improve health care, and lower costs. In consultation with states and stakeholders, the IAP will develop strategically targeted functions aimed at advancing delivery system and associated payment reforms, aligned with transformation efforts underway in Medicare and the commercial market.

The program will develop resources to support innovation through four key functions: identifying and advancing new models of care delivery and payment; data analytics; improving quality measurement; and state-to-state learning, rapid-cycle improvement, and federal evaluation.
Learn more about the launch of the Medicaid Innovation Accelerator Program from this CMS fact sheet and go here for a more detailed description of the program and a summary of the resources surrounding it.

PA Safety Net Admin2014-07-17T14:49:18+00:00July 17th, 2014|Uncategorized|Comments Off

340B Program Under the Microscope

Federal officials continue to cast a wary eye on a program that gives discounts on prescription drugs to hospitals that care for large numbers of low-income patients.
The federal 340B Prescription Drug Program requires drug manufacturers to give discounts to eligible providers for the prescriptions they provide patients on an outpatient basis; the hospitals then provide their low-income patients with their prescriptions at a discount or free of charge. The program has grown a great deal in recent years and now, critics argue that some hospitals that currently receive the discounts should not qualify for them and others are not reinvesting the savings the program generates in care for low-income patients.
Hospitals, meanwhile, note that program savings enable them to fund clinics and otherwise unaffordable programs and services and help them absorb the cost of uncompensated care.
The controversy has drawn congressional interest, and the federal agency that administers the program, the Health Resources and Services Administration, was expected to produce new guidelines governing eligibility and the use of prescription drug discounts. Those guidelines have been delayed in the wake of a federal court ruling involving orphan drug sales that has called into question the agency’s regulation-issuing authority.
Most Pennsylvania safety-net hospitals participate in the program.
Learn more about the 340B Prescription Drug Program, its growth in recent years, the concerns raised about it amid that growth, and what to expect next in this Kaiser Health News article.

PA Safety Net Admin2014-06-25T06:00:32+00:00June 25th, 2014|Uncategorized|Comments Off

Stop Hurting Hospitals That Serve the Poor, HHS Told

Medicare’s hospital readmissions reduction program is unfairly penalizing hospitals that serve especially large numbers of low-income patients, 34 members of Congress have written in a letter to recently appointed Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner.
The letter, sponsored by Rep. James Renacci (R-Ohio), notes that while the program has

…incentivized hospitals to reduce readmissions, there are some factors outside of a hospital’s control that make it difficult for the patient to avoid readmission. The current penalty methodology…has created an unintended consequence for hospitals that service our most vulnerable populations – dual-eligible beneficiaries; low-income seniors, or people with disabilities that are eligible for both Medicare and Medicaid.

The letter also notes financial penalties imposed by the program “jeopardizes the viability of hospitals that service our nation’s most vulnerable population” and that H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program,

…adjusts the penalty methodology for hospitals servicing larger amounts of dual-eligible beneficiaries and excludes patients with certain extenuating circumstances from the penalty calculations. Adjusting the penalty to account for certain disparities in patient population can make a big difference to hospitals across the country and the nine million dually-eligible beneficiaries that rely on these hospitals for their critical care needs.

Pennsylvania’s safety-net hospitals are among those hurt by the program in its current form.
Read the House letter to Secretary Burwell and Administrator Tavenner here.

PA Safety Net Admin2014-06-19T06:00:16+00:00June 19th, 2014|Uncategorized|Comments Off

PHC4 Issues Report on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued its annual report on the financial performance of the state’s acute-care hospitals.
Among the highlights:

The state-wide average operating margin of hospitals fell from 5.73 percent in FY 2012 to 4.69 percent in FY 2013.
Uncompensated care rose 5.41 percent, to more than $1 billion, and up from an average of 2.72 percent of hospital net patient revenue in FY 2012 to 2.81 percent in FY 2013.
35 percent of hospitals reported negative operating margins.
22 percent reported negative operating margins over the latest three-year period.

Find the complete PHC4 report here.

PA Safety Net Admin2014-05-22T09:20:26+00:00May 22nd, 2014|Uncategorized|Comments Off

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