Pennsylvania Medicaid Archives - Page 10 of 22 - Safety-Net Association of Pennsylvania

PA Introduces Medicaid PDL on January 1

Beginning tomorrow, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon: the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1. Here’s why.”

PA Safety Net Admin2019-12-31T06:00:53+00:00December 31st, 2019|Pennsylvania Medicaid policy|Comments Off

DHS Unveils Strategic Plan

Pennsylvania’s Department of Human Services has a new strategic plan for 2019 through 2022.

While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas:

Provide every child with a strong foundation for physical and behavioral well-being
Bend the health care cost curve
Drive innovative whole-person care
Holistically assess needs and connect to resources
Address the social determinants of health
Expand health care beyond the doctor’s office and into the places people live, work, and play
Coordinate physical health care, behavioral health care, and long-term services and supports
Promote health equity
Lead the health care system toward value-based purchasing coordinated across payers
Serve more people in the community
Enhance access to health care and services that help Pennsylvanians lead healthy, productive lives
Coordinate services seamlessly across programs and agencies
Expand services and supports for individuals with mental illness
Expand services and supports for individuals with substance use disorder

Learn more about what Pennsylvania has in mind for its Medicaid program in the coming years, and for the Pennsylvania safety-net hospitals that serve so many participants in that program, by reading DHS’s new strategic plan for 2019 through 2022.

PA Safety Net Admin2019-11-14T06:00:50+00:00November 14th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law books The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Safety Net Admin2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Shifting PA Medicaid to a PDL

Pennsylvania’s planned shift to a preferred drug list for its Medicaid program is the subject of a new analysis of the projected impact of such a change.

Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.

During this year’s budget proceedings, Pennsylvania’s Human Services Code was amended to require an analysis of “the projected cost to the medical assistance managed care organization [sic] and the projected supplemental rebates that could be obtained” by moving to a PDL.

That analysis has now been completed. It concluded that the state

…will save $85 million annual through implementation of a Statewide PDL. The Statewide PDL will allow the Department [of Human Services] to receive an additional $261 million in pharmacy rebates, which will more than offset the estimated increase to managed care organization (MCO) expenditures of $176 million, considering their additional costs and loss of market share rebates.

The analysis commissioned by DHS is now available. To learn more about the implications of a state-wide PDL for the state, for Medicaid managed care organization, and for Medicaid beneficiaries, read “Fiscal Impact Analysis of Medical Assistance Program Uniform Statewide Preferred Drug List, 2019 Report.”

The PDL will take effect on January 1, 2020 and has been posted on a DHS web site here.

PA Safety Net Admin2019-10-09T06:00:03+00:00October 9th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

SNAP Takes Position on State Medicaid Funding After Hahnemann Closure

Pennsylvania’s Medicaid resources should follow now-closed Hahnemann University Hospital’s Medicaid patients as those patients turn to new providers, the Safety-Net Association of Pennsylvania declared in a position statement issued this week.

Safety-Net Association of Pennsylvania logo According to SNAP,

…the best way to protect access to care and prevent additional financial strain on Philadelphia hospitals is to ensure that all state resources reallocated in the wake of Hahnemann University Hospital’s closure follow the displaced patients.

In preparation for addressing this challenge, SNAP performed a data-based analysis of where Medicaid patients turned for care upon the closing of St. Joseph’s Hospital, like Hahnemann a high-volume Medicaid provider and located in the same community as Hahnemann, in 2016. This analysis identified where patients went when St. Joseph’s closed and in its position statement, SNAP urges state policy-makers to perform similar analyses and ensure that state Medicaid resources, especially supplemental payments made to hospitals that serve especially large numbers of Medicaid patients, be distributed to the hospitals that actually serve displaced Hahnemann patients. Such an approach, SNAP maintains, is the best way to ensure the future of the health care safety net in Philadelphia.

Learn more in the SNAP position statement “Protecting Philadelphia’s Health Care Safety Net From the Financial Implications of the Closing of Hahnemann University Hospital.”

PA Safety Net Admin2019-09-18T13:24:14+00:00September 18th, 2019|Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

PA Senate to Take Up Medicaid Work Requirement

Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation.

This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits.

Harrisburg, PA capital building The proposal will be considered by the Senate Health and Human Services Committee.

The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them.

Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war over Medicaid work requirements.”

PA Safety Net Admin2019-09-17T06:00:13+00:00September 17th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Slams Brakes on Medicaid Transportation Program Overhaul

The plan to introduce major changes in Pennsylvania’s free medical transportation program for the Medicaid population has temporarily been halted.

As envisioned by the state, the current program, in which individual counties contract independently with transportation providers to serve their residents on Medicaid, was to be replaced by a regional approach in which the state contracts with three vendors to serve all of Pennsylvania. Objections by members of the state legislature and county officials, however, led to legislation that requires the Department of Human Services, Department of Transportation, and Department of Aging to study the implications of such a change for patients and taxpayers and to report their preliminary findings to the legislature in September.

Learn more about Pennsylvania’s Medical Assistance Transportation Program, how it works now, how the state sought to change it, and what to expect in the near future in the Philadelphia Inquirer article “Overhaul of PA’s medical transport program on hold after counties raise concerns.”

PA Safety Net Admin2019-08-06T06:00:31+00:00August 6th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Change Coming to PA’s Medicaid Transportation Program

Pennsylvania’s Medicaid transportation program will soon be undergoing major change.

By law, states must provide free non-emergency medical transportation for their Medicaid recipients. The Pennsylvania Medical Assistance Transportation Program has fulfilled that mandate for the past 35 years, with county governments shouldering primary responsibility for providing or arranging for the transportation for their Medicaid-covered residents.

Under a plan adopted by the Pennsylvania Department of Human Services, which administers the state’s Medicaid program, that would change, with the state currently reviewing proposals from private vendors that would serve as brokers and assume this responsibility for large sections of the state: the eastern, central, and western parts of Pennsylvania.

Changing the program in this manner would enable Pennsylvania to change the classification of medical transportation from an administrative cost to a service cost, which would drawn down more federal Medicaid matching funds and save the state about $10 million a year.

Learn more about what the state is doing, why it is doing it, and why some people believe the new approach may be more expensive and less effective in the Philadelphia Inquirer article “As changes come to Pa. Medicaid transportation program, counties fear bumps in road.”

PA Safety Net Admin2019-06-13T06:00:53+00:00June 13th, 2019|Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

SNAP Endorses Governor’s Proposal for Paying for Tobacco Borrowing

Debt service on the state’s borrowing against future proceeds from the national master tobacco settlement agreement should be paid using state sales and use tax revenue, SNAP has declared in a new position statement.

Last year the state borrowed $1.5 billion against future proceeds from the tobacco settlement. Some tobacco settlement money is used to help hospitals with the cost of uncompensated care they provide via tobacco uncompensated care payments and tobacco extraordinary expense payments made to hospitals that meet specific criteria: how much uncompensated care they provide, the proportion of their patients insured by Medicaid, and the proportion of low-income seniors they serve. All Pennsylvania safety-net hospitals qualify for these payments.

Safety-Net Association of Pennsylvania logo Because the state’s borrowing against future tobacco settlement proceeds was never intended to result in a reduction of these payments in the future, SNAP has issued a position statement endorsing the Wolf administration’s suggestion, in its proposed FY 2020 budget, to pay debt service on its tobacco borrowing with sales and use tax revenue.

PA Safety Net Admin2019-04-16T06:00:51+00:00April 16th, 2019|Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2020 budget, Pennsylvania safety-net hospitals, Pennsylvania state budget issues|Comments Off

CMS Guidance on MCO Payments is Good News for PA Hospitals

New guidance from the Centers for Medicare & Medicaid Services on the use of directing additional Medicaid resources to hospitals through Medicaid managed care organizations is good news for Pennsylvania safety-net hospitals.
Such payments have been routed through the state’s Medicaid managed care plans for several years, but as the state and hospital industry continue negotiating renewal of the state’s hospital tax – its “Quality Care Assessment” – it was not entirely clear whether the federal government would permit continued use of this mechanism.
An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Go here to see the CMS memo “Delivery System and Provider Payment Initiatives under Medicaid Managed Care Contracts.”

PA Safety Net Admin2017-11-16T14:19:15+00:00November 16th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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