Affordable Care Act Archives - Page 5 of 16 - Safety-Net Association of Pennsylvania

MACPAC Not Yet Sold on Continuing Medicaid Primary Care Pay Increase

The independent federal agency that advises Congress on Medicaid and the Children’s Health Insurance Program is not ready to endorse continuing the Affordable Care Act’s two-year increase in Medicaid primary care fees as a means of encouraging more doctors to serve Medicaid patients.
At its October 30-31 public meeting in Washington, D.C., the staff of the Medicaid and Children’s Health Insurance Program Payment and Access Commission (MACPAC) reported that it has begun looking into the effectiveness of the temporary pay increase in persuading more doctors to care for Medicaid recipients. Among its preliminary findings are that

The payment increase had at best, a modest effect on provider participation according to states and MCOs
Most states reported that the provision had no effect on the use of primary care services

Consequently, MACPAC did not offer any recommendations on this issue at the public meeting and intends to continue studying the impact of enhanced Medicaid primary care fees on physician willingness to serve Medicaid patients.
For the two years ending on December 31, 2014, the federal government has paid for 100 percent of the fee increases. Some states have already decided to continue making the enhanced payments at their own expense, some will make enhanced payments but not necessarily at the level authorized by the Affordable Care Act, and some intend to restore the payments to their previous levels.
Pennsylvania plans to return its Medicaid primary care fee-for-service rates to their 2012 level.
The MACPAC presentation on Medicaid primary care physician payments can be found here.

PA Safety Net Admin2014-11-04T06:00:10+00:00November 4th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

To Increase or Not to Increase? That is the Question

To induce more primary care providers to serve Medicaid patients at a time when Medicaid enrollment was about to increase significantly nation-wide, the Affordable Care Act raised Medicaid primary care reimbursement to the same level as Medicare rates for 2013 and 2014, with the federal government to pick up the tab for 100 percent of the increase in state spending for these services.
With that two-year increase coming to an end, states now must decide whether to continue the increase and pay for it themselves or let their Medicaid primary care rates return to their old levels.
According to a survey taken by the Kaiser Family Foundation, 15 states will continue the increases either in part or in full; 24 do not plan to continue the increases; and 12 still have not decided.
Some states that are continuing the increases in some form also are changing the types of primary care providers that will receive the enhanced Medicaid payments.
Pennsylvania is among the 24 states not planning to continue the rate increase.
For a closer look at the issue, including a map that illustrates each state’s intentions, see the Kaiser Family Foundation report “The ACA Primary Care Increase: State Plans for SFY 2015” here, on the foundation’s web site.

PA Safety Net Admin2014-11-03T06:00:34+00:00November 3rd, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Medicare Announces Readmissions Penalties

Medicare will impose financial penalties in FY 2015 on the majority of U.S. hospitals for excessive patient readmissions.
In all, 2610 hospitals face penalties that range from one one-hundredth of one percent to three percent of all Medicare payments. Last year, the maximum penalty was two percent.
The majority of hospitals in 29 states will be penalized and 39 hospitals face the maximum penalty of three percent. Overall, the penalties will amount to $428 million. Many hospitals will be penalized even though they reduced their readmissions in the past year.
Medicare’s hospital readmissions reduction program was mandated by the Affordable Care Act in the belief that penalizing hospitals for what were considered avoidable readmissions would spur them to take steps to prevent such readmissions. Readmissions cost Medicare $26 billion a year, of which $17 billion is considered unavoidable.
Concerns have been raised that the readmissions penalties are unfair to safety-net hospitals because they serve more low-income patients with more complex medical problems and who, after discharge, face financial and logistical challenges during their recovery that make them more likely to require readmission. Some studies have verified this view and some groups – including the Medicare Payment Advisory Commission (MedPAC) – have called on Congress to revise the program with this consideration in mind.
For a closer look at FY 2015’s readmissions penalties, including links to a file that lists individual hospital penalties nation-wide, see this Kaiser Health News report.

PA Safety Net Admin2014-10-06T06:00:33+00:00October 6th, 2014|Affordable Care Act|Comments Off

GAO Questions Cost of Private Market Medicaid Expansion

Permitting states to use Medicaid money to enable newly eligible Medicaid recipients to purchase health insurance on the private market may cost more than expansion of traditional state Medicaid programs.
Or so says the U.S. Government Accountability Office (GAO).
Writing in response to a request from the chairman of the House Energy and Commerce Committee and the ranking minority member of the Senate Finance Committee to look at the approved federal waiver that will permit Arkansas to expand its Medicaid program through the purchase of private insurance for newly eligible recipients, the GAO concluded that the federal government may spend $778 million more over three years on such an approach than it would have spent if the state had expanded its traditional Medicaid program.
The GAO said that the U.S. Department of Health and Human Services (HHS) did not perform a budget-neutrality calculation, which would have revealed the increased cost, instead accepting the state’s alternative methodology for determining cost-effectiveness.
Arkansas officials rejected the GAO’s conclusions, asserting that newly eligible Medicaid recipients would have been unable to find providers willing to serve them under a traditional Medicaid expansion.
GAO concluded that CMS may be approving waivers that are not budget-neutral. CMS disagreed with this conclusion.
The GAO letter, written before HHS granted Pennsylvania its Medicaid waiver, specifically mentions Pennsylvania as another state seeking to expand its Medicaid program through the purchase of private insurance for newly eligible Medicaid recipients.
Learn more about the GAO analysis, why it was undertaken, and what it found by reading the GAO letter to the two members of Congress who requested the analysis.

PA Safety Net Admin2014-09-16T06:00:21+00:00September 16th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Hospitals, Charitable Groups to Pay Insurance Premiums?

Hospitals and charitable groups such as the United Way are exploring the possibility of paying the health insurance premiums of uninsured patients who come through hospital doors.
Such an approach would enhance access to care for the uninsured while helping hospitals get paid for care they will be providing regardless of whether the patients in question have health insurance.
Such a practice is not entirely new. A United Way organization in Wisconsin raised $2 million to help low-income residents purchase health insurance and hospital groups in New York and Florida are exploring a similar approach.
Health insurers oppose the idea, maintaining that hospitals selectively choosing whom to help will skew the pool of insured people toward those with greater health problems that incur greater costs to serve.
The federal government has not been clear about its perspective on the idea of anyone other than those seeking insurance paying their own premiums. While it requires insurers to accept premiums paid by selected federal programs, it issued an FAQ last year discouraging hospitals from taking the same approach. Regulations issued after that FAQ, however, did not fully clarify the federal position.
Learn more about the issue, how such payments work, and the perspectives of hospitals, insurers, charitable organizations, and the federal government, in this Kaiser Health News article.

PA Safety Net Admin2014-09-04T06:00:20+00:00September 4th, 2014|Affordable Care Act|Comments Off

Charity Care? Wait a Minute

Many hospitals are considering whether they should continue to provide charity care to people who were eligible for Affordable Care Act subsidies to purchase health insurance but chose instead to remain uninsured.
The issue for many is whether the availability of charity care is an inducement for some people not to purchase health insurance and whether such patients are unwilling or unable to pay for care.
Some hospitals have decided not to provide non-emergency charity care to those who chose not to purchase subsidized health insurance. Others are currently considering whether they need to revise their approach to charity care. Still others have decided that they will not change their charity care policies.
Charity care is an especially critical issue for the state’s safety-net hospitals because they serve so many more low-income and uninsured patients than the typical Pennsylvania hospital.
Learn more about this latest phase in the evolution of charity care and how hospitals are approaching it in this Kaiser Health News report.

PA Safety Net Admin2014-08-28T06:00:40+00:00August 28th, 2014|Affordable Care Act|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

Translating Insurance Into Care

While the Affordable Care Act is enabling millions of Americans to obtain health insurance – many of them for the first time – many of the newly insured do not understand how their insurance works or how to use it to get the care they need.
Across the country, advocacy groups, insurers, hospitals, and clinics are encountering newly insured people struggling to translate their new health insurance into health care, and many are employing outreach and educational programs to teach people how to enjoy the benefits of their new coverage.
Learn more about the new challenges health care providers are encountering, and about how a group of organizations in Philadelphia is responding to that challenge, in this New York Times article.

PA Safety Net Admin2014-08-14T06:00:44+00:00August 14th, 2014|Affordable Care Act|Comments Off

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

PA Safety Net Admin2014-07-25T06:00:35+00:00July 25th, 2014|Affordable Care Act|Comments Off

Foundation to Track Effect of ACA on Hospitals

The Robert Wood Johnson Foundation has launched a project to measure the impact of the Affordable Care Act on hospitals.
Working with 24 state hospital associations, the foundation’s Hospital ACA Monitoring Project will collect quarterly hospital data on admissions, emergency room visits, and selected diagnoses and procedures. The project will collect data from different types of hospitals with different payer mixes.
According to the foundation, the project “is designed to shed light on some of the effects of health reform on hospitals and provide extremely timely data to researchers, policymakers and hospital leaders.”
Learn more about the Robert Wood Johnson Foundation’s Hospital ACA Monitoring Project from this notice on the foundation’s web site.