Affordable Care Act Archives - Page 4 of 16 - Safety-Net Association of Pennsylvania

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments.
That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources. Pennsylvania is not among the states that continued paying the enhanced rates.
The question of whether the fee increase accomplished its objective and is worth re-establishing remains unanswered. The brief nature of the experiment – only two years – and the delays many states experienced before they started paying the enhanced rates left little time for meaningful research. One quantitative analysis suggests the rate increase helped, there have been several more qualitative approaches to research, and some studies remain under way.
Because they care for so many more Medicaid patients than the typical hospital, the adequacy of Medicaid payments has long been of special concern to Pennsylvania safety-net hospitals.
For a closer look at the Affordable Care Act’s Medicaid primary care fee bump, how it worked, its impact, and its future, see the new health policy brief “Medicaid Primary Care Parity” here, on the web site of the journal Health Affairs.

PA Safety Net Admin2015-05-15T06:00:54+00:00May 15th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

States to Have New Reform Tool

Come 2017, states will have a new tool at their disposal through which to pursue health care reform.
At that time, states will be able to seek new state innovation waivers from the federal government that will enable them to change covered benefits and insurance subsidies; replace health insurance exchanges; modify the individual or employer mandate; and do other things so long as their efforts ensure continued access to comprehensive and affordable health insurance. The waivers, created under the Affordable Care Act, are good for five years.
The Commonwealth Fund has published an issue brief that explains the section of the Affordable Care Act that includes state innovation waivers and outlines how states might use innovation waivers to customize health care reform for their own residents. Find that issue brief here.

PA Safety Net Admin2015-04-22T06:00:50+00:00April 22nd, 2015|Affordable Care Act|Comments Off

Administration Blocks No-Hospitals Insurance Plans

Health insurance plans that do not include hospital benefits fail to meet employers’ obligations under the Affordable Care Act and will leave companies that provide such insurance vulnerable to fines of $3000 a year for every worker covered by such a plan, the Centers for Medicare & Medicaid Services (CMS) announced last week.
But in recognition that some employers had arranged such coverage well in advance, the federal government is permitting companies that committed to such plans by November 4 to use them for the next year, after which they must be replaced. In addition, employees who seek to compensate for that shortcoming in their coverage by purchasing supplemental insurance will be eligible for tax credits based on their income.
Such plans have been favored by many companies that employ large numbers of low-wage workers.
In a regulation issued last week, CMS wrote about health insurance without hospital benefits that

A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose of the MV [minimum value] requirement to ensure that an employer-sponsored plan, while not required to cover all EHB [essential health benefits], nonetheless must offer coverage with minimum value at least roughly comparable to that of a bronze plan offered on an Exchange.

For a closer look at the new regulation, why it was issued, and what it means for employers and their workers, see this Kaiser Health News article. Find the regulation announcing the policy here.

PA Safety Net Admin2015-02-26T06:00:21+00:00February 26th, 2015|Affordable Care Act|Comments Off

More That 400,000 Sign Up For Health Insurance in PA

Through early February, 430,000 Pennsylvanians have enrolled in health insurance plans through the federal health insurance marketplace.
Of that number, 81 percent qualified for at least some financial assistance with their premiums. Through December, more than two-thirds obtained insurance for no more than $100.
To learn more about how Pennsylvanians are using the federal exchange to purchase health insurance, see this Central Penn Business Journal article.

PA Safety Net Admin2015-02-09T06:00:51+00:00February 9th, 2015|Affordable Care Act, Health care reform|Comments Off

Medicaid “Pay Bump” Worked, New Study Suggests

A federally mandated increase in Medicaid payments for primary care services appears to have achieved its goal of improving access to care for Medicaid recipients – especially in Pennsylvania.
The increase, part of the Affordable Care Act, called for raising payments for Medicaid primary care services to the same level as Medicare payments in the hope that such an increase would lead more primary care providers to serve Medicaid patients, thereby improving access to primary care services for those patients. Historically, primary care providers have been reluctant to serve Medicaid patients, citing low pay as their reason for avoiding such patients.
That Medicaid pay increase – often referred to as the “Medicaid pay bump” – was mandated for two years and expired at the end of 2014. One of the reasons policy-makers resisted extending it was the lack of proof that it achieved its goal of improving access. Now, a new study in the New England Journal of Medicine provides the first broad look at the program’s impact – and the first proof of its success.
In the study, researchers selected ten states and measured the availability and waiting times for primary care appointments for two limited periods of time. They found that

…The availability of primary care appointments in the Medicaid group increased by 7.7 percentage points, from 58.7% to 66.4%, between the two time periods. The states with the largest increases in availability tended to be those with the largest increases in reimbursements, with an estimated increase of 1.25 percentage points in availability per 10% increase in Medicaid reimbursements.

Among the ten states evaluated in the study was Pennsylvania, where the benefits of the Medicaid pay bump were especially noteworthy: while the availability of appointments rose eight percent overall in the states that were part of the study, appointment availability rose 13 percent in Pennsylvania.
One possible reason: the Medicaid pay bump doubled Medicaid primary care fees.
The study’s conclusion?

Our study provides early evidence that increased Medicaid reimbursement to primary care providers, as mandated in the ACA, was associated with improved appointment availability for Medicaid enrollees among participating providers without generating longer waiting times.

Learn more about the study from this Allentown Morning Call article or find the New England Journal of Medicine article here.

PA Safety Net Admin2015-01-27T06:00:28+00:00January 27th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Millions Live in ACA Coverage Gap

Nearly four million people who were supposed to be helped to health insurance through the Affordable Care Act remain uninsured today because they earn too much to qualify for Medicaid and not enough to qualify for the reform law’s health insurance subsidies.
When the law was passed in 2010, it was supposed to provide Medicaid coverage for those earning up to 138 percent of the federal poverty level and offer subsidies to other low-income earners. But when the Supreme Court made the reform law’s mandatory Medicaid expansion optional for states and some states chose not to expand their Medicaid programs, nearly four million people found themselves wedged between eligibility for Medicaid and eligibility for subsidies, with no help forthcoming.
Among the four million, more than half work at least part-time and two-thirds reside in a household with at least one wage-earner. Most work for small companies that are not required to provide health insurance for their employees and many earn the minimum wage. Many are single adults.
The coverage gap has been a problem in Pennsylvania, which until recently did not expand its Medicaid program. As a result, many people who fell into this gap turned to the state’s safety-net hospitals when they needed care but had no health insurance.
The Washington Post has taken a look at the challenges these low-income and often medically vulnerable people face living in states that have chosen not expanded their Medicaid programs. See its report here.

PA Safety Net Admin2015-01-26T06:00:19+00:00January 26th, 2015|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Medicaid Pay Bump Gone in PA; Will it Affect Access?

The temporary increase in Medicaid provider fees for primary care services ended yesterday, leaving observers to wonder whether it will affect access to care for the nation’s growing Medicaid population.
The increase, mandated by the Affordable Care Act, raised Medicaid primary care rates to the same level as Medicare payments in the hope that more primary care providers would begin serving Medicaid patients in anticipation of significant growth in the Medicaid population. Now that the two-year increase has ended, it is unclear whether providers who began serving Medicaid patients because of the increase will remain Medicaid providers and those who accepted more Medicaid patients will continue doing so.
Because of the relatively short duration of the increase, little research has been completed to determine whether the raise made a difference in access, but some states believe it did: a number will use their own money to continue the raises, which during the two-year experiment were paid entirely by the federal government.
Pennsylvania is not among the states that will continue paying the enhanced Medicaid fees for primary care services.
Kaiser Health News has taken a look at this issue and the potential implications of the end of the Medicaid pay raise; see its report here.

PA Safety Net Admin2015-01-02T06:00:57+00:00January 2nd, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

PA Medicaid Primary Care Fees to Plummet

Payments to Pennsylvania primary care physicians who serve Medicaid patients will fall 52.4 percent after the first of the year, when the Affordable Care Act’s two-year increase in those payments ends.
The temporary fee increase was included in the Affordable Care Act to encourage more primary care physicians to serve Medicaid patients in anticipation of the significant growth of Medicaid as a result of the reform law’s Medicaid expansion. Under that law, Medicaid primary care fees were raised to the level of Medicare primary care rates for two years. Nation-wide, the average Medicaid primary care fee will fall 42.8 percent.
So far, 15 states plan to use their own money to prevent the dramatic reduction of Medicaid primary care payments. Pennsylvania is not among them.
The cut will be especially damaging to the state’s safety-net hospitals because they serve so many more Medicaid patients than the typical hospital and expect to serve even more such patients when the state’s Medicaid program expands beginning on January 1.
Learn more about the upcoming Medicaid payment cut in the new Urban Institute report Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?, which you can find here, on the Urban Institute’s web site.

PA Safety Net Admin2014-12-17T06:00:15+00:00December 17th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

States Face Medicaid Challenges

Fifty American states have 50 different Medicaid programs. While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities.
The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years. Among the areas the survey explored are:

budgets
Affordable Care Act implementation
relationships with others in their state government, federal agencies, and regulators
program integrity
innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and challenges in the area of long-term services and supports

Find out how the country’s 50 Medicaid directors view the challenges they face in the coming year in State Medicaid Operations Survey: Third Annual Survey of Medicaid Directors, which you can find here.

PA Safety Net Admin2014-11-19T06:00:27+00:00November 19th, 2014|Uncategorized|Comments Off

No-Hospitalization Group Plans To Be Banned

Companies will no longer be able to provide their employees with group health insurance plans that do not cover inpatient hospitalization.
This news came in a recent notice published by the Internal Revenue Service.
Recently, many large employers with lower-wage workers were purchasing low-cost health insurance that does not cover hospitalization. The IRS, however, has ruled that such plans do not meet the Affordable Care Act’s minimum value threshold. Companies were only able to purchase such plans because they are not required meet the reform law’s essential health benefits package requirement, which applies only to plans offered to individuals on health insurance exchanges.
The no-hospitalization policies were likely to leave many lower-income workers without the coverage they needed – and with large medical bills. They also were likely to leave hospitals with unexpected uncompensated care. This could have proven especially challenging for Pennsylvania safety-net hospitals because they serve larger numbers of lower-income workers than the typical hospital.
The administration is permitting employers that committed to such plans by November 4 to use them for one year and is offering affected workers access to premium subsidies that some of those workers did not otherwise have if they choose to purchase insurance on an exchange instead.
The IRS will issue regulations formalizing this policy next year.
To learn more about this issue and its implications for large businesses, low-wage workers, and hospitals, see this Kaiser Health News report. Go here to see the IRS notice.

PA Safety Net Admin2014-11-11T06:00:31+00:00November 11th, 2014|Affordable Care Act|Comments Off

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