Pennsylvania Medicaid Archives - Page 11 of 20 - Safety-Net Association of Pennsylvania

PA Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.
The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment.
HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.
The Pennsylvania Department of Human Services has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.

PA Safety Net Admin2016-08-18T06:00:42+00:00August 18th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations. Such payments are often used to distribute the proceeds from state hospital taxes.
The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely.
In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions that meet specific new criteria.
In announcing the policy, CMS acknowledges the challenges inherent in ending the use of such payments and indicates its intention to address this issue, and the phase-out process, in future regulations
Such pass-through payments are an important of Pennsylvania’s Medicaid program and the state’s private safety-net hospitals benefit considerably from them.
Go here to see the CMS bulletin on a subject of interest to many high-volume Medicaid hospitals.

PA Safety Net Admin2016-08-09T06:00:39+00:00August 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Medicaid Directors Seek Help With Hepatitis C Drugs

The combination of new cures for hepatitis C, the high cost of those cures, and the large population of low-income people suffering from the disease has the nation’s Medicaid directors asking for help from Congress.
“Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment,” the National Association of Medicaid Directors declared in a recent news release.
To help them address the high cost of providing a new generation of drugs to the estimated one million Medicaid recipients with hepatitis C, Medicaid directors have asked Congress to introduce policies that reduce the prices of those drugs or give states bigger rebates for purchasing them, noting that states have neither “…the financial capacity to cover the full cost of these treatments” nor “…the clear statutory authority to effectively and efficiently administer the program.”
Pennsylvania is in the midst of examining its policies regarding authorizing the use of expensive drugs to treat Medicaid patients with hepatitis C and is expected to make those drugs more widely available in the near future.
Learn more about the challenges state Medicaid programs face when serving beneficiaries with hepatitis C and the help they seek from Congress in this news release from the National Association of Medicaid Directors.

PA Safety Net Admin2016-07-12T06:00:12+00:00July 12th, 2016|Pennsylvania Medicaid policy, Uncategorized|Comments Off

SNAP Comments on Proposed Medicaid Observation Care Payment

The Safety-Net Association of Pennsylvania has written to the state’s Department of Human Services about DHS’s proposal to establish a payment policy for hospital observation services covered by the state’s Medicaid fee-for-service program.
While SNAP has long supported the concept of a Medicaid fee-for-service rate for observation services and welcomes DHS’s decision to create such a rate and associated policies, it expressed a number of concerns about DHS’s proposal, including about:

the proposed observation rate
the classification of observation care as an outpatient service
the manner in which the state proposes financing observation care
program integrity issues

To learn more about SNAP’s concerns, see its entire comment letter to DHS here, on the SNAP web site.

PA Safety Net Admin2016-06-20T06:00:37+00:00June 20th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Help on the Way for Those With Hepatitis C?

Pennsylvanians insured by Medicaid who have Hepatitis C have often found themselves blocked from access to new treatments that can cure the disease.
But that may be changing.
Prescription Medication Spilling From an Open Medicine Bottle While states’ finances have been groaning under the cost of new budget-busting treatments, a growing trend is to increase access to the costly treatments rather than keep it very limited.
Last week the Pharmacy and Therapeutics Committee of the state’s Medicaid program voted to ease the state’s current limits on access to treatment that costs between $31,000 and $58,000 a patient. Currently, about 30,000 Pennsylvania Medicaid beneficiaries suffer from Hepatitis C and another 10,000 are thought to be infected but not yet suffering.
The committee’s vote is advisory; the final decision rests with Department of Human Services Secretary Ted Dallas.
Learn more about the state of Hepatitis C treatment in Pennsylvania’s Medicaid program and the changes that may be coming in this Philadelphia Inquirer article.

PA Safety Net Admin2016-05-25T06:00:28+00:00May 25th, 2016|Pennsylvania Medicaid policy|Comments Off

PA Awards HealthChoices Managed Care Contracts

Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program.
Eight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions.
All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members.
Learn more about who won the contracts and how the winners will be expected to perform differently than HealthChoices managed care organizations have in the past in this state news release.

PA Safety Net Admin2016-05-05T06:00:56+00:00May 5th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
The December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more.
Find the newsletter here.

PA Safety Net Admin2015-12-28T06:00:32+00:00December 28th, 2015|Pennsylvania Medicaid policy|Comments Off

Little Outside Interest in HealthChoices

When Pennsylvania put its HealthChoices contracts up for bid, the sizeable market to be served – more than 2.5 million people – was expected to draw interest from major national managed care organizations that serve Medicaid patients.
It didn’t happen.
Instead, of the nine companies that submitted bids, only one came from a national company that did not already participate in HealthChoices: Centene, a St. Louis company that serves six million Medicaid patients in 21 states.
National Medicaid managed care organizations Anthem, Molina Healthcare, and WellCare did not bid.
Three much smaller organizations submitted bids to enter the Pennsylvania Medicaid market: Accendia, a subsidiary of Capital Blue Cross; Meridien Health Plan, a Detroit-based company serving 700,000 Medicaid recipients in six midwestern states; and Trusted Health Plan, a two-year-old plan currently serving Medicaid beneficiaries in Washington, D.C.
The state is expected to award contracts in its five HealthChoices zones in January.
Read more about the bidding for HealthChoices contracts in this Philadelphia Inquirer article.

PA Safety Net Admin2015-12-01T06:00:16+00:00December 1st, 2015|HealthChoices PA|Comments Off

Latest Edition of Health Law PA News

The Pennsylvania Health Law Project has released the latest edition of its newsletter. The November 2015 edition includes new Children’s Health Insurance Program (CHIP) benefits, Pennsylvania Medicaid’s new specialty pharmacy drug program, and Pennsylvania’s receipt of a federal planning grant for certified community behavioral health clinics.
Find the latest Health Law PA News here.

PA Safety Net Admin2015-11-23T06:00:47+00:00November 23rd, 2015|Pennsylvania Medicaid policy, Uncategorized|Comments Off

DHS Explains Latest Medicaid Initiatives

The Pennsylvania Department of Human Services describes two recent steps to improve the delivery of health care to low-income Pennsylvanians – the introduction of its new “Community HealthChoices” program and the re-bidding of managed care organization contracts for its HealthChoices physical health program – in the latest edition of its newsletter The Impact.
Find that edition here.

PA Safety Net Admin2015-09-29T06:00:21+00:00September 29th, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

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