health care reform Archives - Page 3 of 4 - Safety-Net Association of Pennsylvania

Medicaid Primary Care Pay Raise Set; OB/GYNs, ER Docs Excluded

When the Affordable Care Act’s mandatory rate increase for primary care services provided to Medicaid patients takes effect on January 1, ob/gyns and emergency room physicians will not be among the beneficiaries of the temporary raise in pay.
Under a new regulation issued last week, only family doctors, internists, and pediatricians will receive the pay increase, which was established as a short-term (two years) incentive to attract more physicians to serve Medicaid patients in anticipation of the significant increase in enrollment expected when many states expand their Medicaid eligibility criteria in 2014.
When working under the supervision of eligible primary care physicians, nurse practitioners and physician assistants also will receive the enhanced Medicaid payments.
State Medicaid payments for primary medical care typically fall well below comparable Medicare rates. Under the reform law, Medicaid payments for such services will be raised to Medicare levels for two years, with the federal government footing the bill for the difference.
Because they serve so many Medicaid patients and the state’s outpatient fees are so much lower than those paid by Medicare, Pennsylvania’s safety-net hospitals and the primary care physicians they employ should benefit greatly from this new policy.
Read more about who will and won’t benefit from the primary care fee increase and how it will be implemented in this Kaiser Health News article .

PA Safety Net Admin2012-11-05T06:00:03+00:00November 5th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.
Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.
At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.
The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.
Many physicians serving communities with large numbers of Medicaid patients, and those employed by Pennsylvania’s safety-net hospitals, are expected to benefit from this pay increase. Currently, Medicaid primary care physician payments in Pennsylvania are just 56 percent of comparable Medicare payments.
Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News article.

PA Safety Net Admin2012-10-29T06:00:15+00:00October 29th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Philadelphia Hospitals Hoping for Medicaid Expansion

Hospitals in the greater Philadelphia want the state to expand its Medicaid program as envisioned in the Affordable Care Act, the Philadelphia Business Journal reports.
According to a spokesman for the Delaware Valley Healthcare Council, Philadelphia-area hospitals are concerned that the state might not expand Medicaid eligibility. That expansion, mandated by the 2010 health care reform law, was made optional earlier this year by a Supreme Court decision.
Read more about why Philadelphia-area hospitals – many of which are safety-net hospitals – are eager for the state to embrace the reform law’s Medicaid eligibility expansion in this Philadelphia Business Journal article .

PA Safety Net Admin2012-10-22T06:00:32+00:00October 22nd, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Medicare DSH Cuts Loom for PA Safety-Net Hospitals

Safety-net hospitals across the country will soon lose important funding that helps them care for many of their low-income and uninsured patients: their Medicare disproportionate share hospital payments (Medicare DSH).
Come 2014, the Affordable Care Act mandates a significant cut in hospitals’ Medicare DSH payments. The underlying rationale for this cut is that once the health care reform law’s individual insurance mandate takes effect and states begin greatly expanding Medicaid eligibility (a reform law mandate made optional by this year’s Supreme Court decision), hospitals will have fewer such patients and less need for supplemental DSH funding.
But as a Kaiser Health News article points out, hospital officials are concerned that the funding will phase out before the expanded insurance phases in, leaving them with fewer resources to care for their low-income, still-uninsured patients.
Pennsylvania’s safety-net hospitals, which care for large numbers of low-income and uninsured patients, figure to suffer considerably under such circumstances.
Learn more about the phase-down of Medicare DSH payments and the challenges hospitals will face in its wake in this Kaiser Health News article .

PA Safety Net Admin2012-10-17T06:00:13+00:00October 17th, 2012|Health care reform|Comments Off

PA Lags in Developing Health Insurance Exchange

Pennsylvania is unlikely to have a health insurance exchange (HIE) up and running when the individual insurance requirement mandated by the Affordable Care Act takes effect in 2014.
According to state insurance commissioner Michael Consedine, while Pennsylvania has laid considerable groundwork for developing its own exchange, its efforts have been hampered by lack of direction from the federal government on a number of key exchange-related issues. An August letter from Mr. Consedine to U.S. Health and Human Services Secretary Kathleen Sebelius has not yet been answered. In addition, the state legislature has not passed necessary enabling legislation.
If Pennsylvania does not establish its HIE by 2014, residents of the state will be served by an exchange established by the federal government. The state would still be free to establish its own exchange at a later date.
Read more about the situation in Pennsylvania today, what the state has done so far, and the obstacles to completing developing of the HIE in this Pittsburgh Post-Gazette report.

PA Safety Net Admin2012-10-15T10:42:06+00:00October 15th, 2012|Health care reform|Comments Off

Physician Reluctance Threatens Medicaid Expansion in PA

If Pennsylvania moves ahead and expands Medicaid eligibility as envisioned in the Affordable Care Act, the ability of newly enrolled recipients to obtain medical care may be jeopardized by the reluctance of some physicians to take on more Medicaid patients.
According to a recent article in the journal Health Affairs, 68 percent of the state’s doctors are currently accepting new Medicaid patients. Those who are not cite low reimbursement rates and already-high patient loads among the reasons they are not accepting new Medicaid patients.
Pennsylvania Governor Tom Corbett has not revealed whether he intends to expand Medicaid eligibility in the state and is not expected to do so until after the November election. The mandatory Medicaid expansion, part of the 2010 health care reform law, was ruled unconstitutional by the U.S. Supreme Court, leaving expansion decisions to the individual states.
The Pennsylvania Department of Health says that 94 percent of rural doctors and 84 percent of the state’s urban doctors currently care for Medicaid patients.
Read more about the situation in Pennsylvania today and its implications for Medicaid expansion in this Pittsburgh Post-Gazette article .

PA Safety Net Admin2012-09-11T06:00:28+00:00September 11th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

DSH and the Affordable Care Act

The National Health Law Program has prepared a useful Q&A about how the Affordable Care Act and its Medicaid expansion will affect Medicare disproportionate share (Medicare DSH) and Medicaid disproportionate share (Medicaid DSH) payments, both of which are so important to Pennsylvania’s safety-net hospitals.

Download that summary here .

PA Safety Net Admin2012-07-19T06:00:21+00:00July 19th, 2012|Health care reform, Medicaid supplemental payments|Comments Off

Court Affirms Reform Law, Changes Medicaid Provision

The Supreme Court has upheld the constitutionality of the 2009 Affordable Care Act – including the much-disputed mandate that everyone obtain health insurance.
The court’s only disagreement with the reform law was with its provision requiring states to expand Medicaid eligibility as a future condition of obtaining federal Medicaid matching funds. The court ruled that expanding Medicaid eligibility should be optional and that states that choose not to expand their Medicaid programs would still receive the federal matching funds to which they have always been entitled.
In the wake of this decision, SNAP is very concerned about the interplay between the loss of the mandated Medicaid expansion and the Affordable Care Act’s requirement that Medicare DSH and Medicaid DSH payments be cut significantly in the coming years. Those cuts were predicated on the Medicaid expansion adding as many as 20 million people to the ranks of the insured, which was expected to provide additional revenue to hospitals that would help offset a reduction in their Medicare DSH and Medicaid DSH revenue.
For now, all eyes will be on Pennsylvania state officials as they decide what to do in light of the greatly enhanced federal matching funds still available for states that choose to expand Medicaid eligibility.

PA Safety Net Admin2012-06-28T15:19:30+00:00June 28th, 2012|Health care reform, Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

Supreme Court Decision Has Huge Medicaid Implications

When the Supreme Court rules on the challenge to the Affordable Care Act, its decision will have enormous implications for states, low-income and uninsured people, and health care providers.
Among the many features of the health care reform act on which the Supreme Court will rule is the single biggest expansion of eligibility since Medicaid was introduced in the mid-1960s.
As they await the court’s decision, many states already are laying the groundwork for the addition of between 15 million and 20 million people to the nation’s Medicaid rolls.
Pennsylvania’s safety-net hospitals have a considerable stake in the court’s decision because the planned Medicaid expansion could add as many as a half-million people to the state’s Medical Assistance rolls.
The New York Times has taken a closer look at the stakes in the court’s upcoming decision. Read that Times article here .

PA Safety Net Admin2012-06-18T10:11:29+00:00June 18th, 2012|Health care reform, Uncategorized|Comments Off

Safety-Net Hospitals Await Medicaid DSH Cuts

Across Pennsylvania, safety-net hospitals are bracing for major cuts in their Medicaid disproportionate share (DSH) payments starting in FY 2014, when a provision of the Affordable Care Act requiring such cuts takes effect.
Under the Affordable Care Act, the number of uninsured patients hospitals treat is expected to decline as health insurance becomes more affordable and accessible, theoretically reducing hospitals’ need for Medicaid DSH revenue. Under the reform law, federal spending on Medicaid DSH will be slashed $18 billion over six years.
Historically, Medicaid DSH has been viewed as a program to help hospitals that treat especially large numbers of uninsured and Medicaid patients. The cut will be implemented, however, before it is clear how many currently uninsured people will purchase health insurance – and at a time when the number of Medicaid patients safety-net hospitals serve is expected to rise significantly, not fall, when the Affordable Care Act’s new criteria for Medicaid eligibility take effect.
The scheduled cut in Medicaid DSH payments is of particular concern to the Safety-Net Association of Pennsylvania (SNAP) and Pennsylvania’s private safety-net hospitals.
Read more about the anticipated reduction of Medicaid DSH payments and its implications for safety-net hospitals in this CQ report presented by the Commonwealth Fund.

PA Safety Net Admin2012-06-13T06:00:48+00:00June 13th, 2012|Health care reform, Medicaid supplemental payments, Safety-Net Association of Pennsylvania|Comments Off

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