Pennsylvania Medicaid Archives - Page 12 of 22 - Safety-Net Association of Pennsylvania

Medicaid Directors Look at Value-Based Purchasing

One of the tools many states are using to attempt to reduce their Medicaid costs and improve the quality of the care delivered to their Medicaid beneficiaries is value-based purchasing.
In a new issue brief, the National Association of Medicaid Directors takes a closer look at Medicaid value-based purchasing: what it is, how it works, why it is attractive to state Medicaid programs, what alternative payment models the states are employing as part of their value-based purchasing efforts, and what state Medicaid programs need from the federal government to continue such efforts.
Pennsylvania is in the process of introducing more value-based purchasing into its Medicaid program, doing so through new contracts currently being negotiated with the managed care organizations recently chosen to serve the state’s Medicaid population through the HealthChoices physical health program.
For a closer look at Medicaid value-based purchasing, go here to read the National Association of Medicaid Directors’ issue brief “Medicaid Value-based Purchasing: What Is It & Why Does It Matter?”

PA Safety Net Admin2017-02-17T06:00:19+00:00February 17th, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Expanded Access to Hep C Drugs Isn’t the Answer for Medicaid, Study Says

A new study suggests that greatly expanding access to new drugs that essentially “cure” Hepatitis C would cost Pennsylvania’s Medicaid program a great deal of money but save relatively few lives.
The study found that in many cases, Hepatitis C progresses so slowly that by the time many of the people who suffer from it truly need the new generation of expenses drugs they will be old enough for Medicare, which would leave the federal government, rather than the state, with the cost of paying for the treatment.
Prescription Medication Spilling From an Open Medicine Bottle Patient advocates maintain that all Medicaid beneficiaries with Hepatitis C should have access to the drugs and Pennsylvania’s Medicaid program appears to be on a path toward making that possible.
Learn more about the study and its findings in this Philadelphia Inquirer story.

PA Safety Net Admin2017-01-03T06:00:29+00:00January 3rd, 2017|Pennsylvania Medicaid policy|Comments Off

Impact of “Repeal and Replace” on PA?

With the president-elect and congressional leaders vowing to repeal and replace the Affordable Care Act, the question arises about how such actions might affect Pennsylvania.
Health Benefits Claim Form That includes 680,000 Pennsylvanians who enrolled in the state’s Medicaid program after the reform law allowed for that program’s expansion, more than 400,000 people who signed up for insurance on the federal health insurance exchange, the state’s taxpayers who might be left with the bill for some or all of these costs if the reform law’s financial support were to disappear in the near future, and others.
The Pittsburgh Tribune-Review considers these and other questions and offers answers from some of those closest to the situation. See its story here.

PA Safety Net Admin2016-12-19T06:00:38+00:00December 19th, 2016|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

PA Improves Access to Contraceptives

Citing the challenges and risks associated with unplanned pregnancies that occur within two years of a delivery, Pennsylvania’s Medicaid program is making long-acting contraceptives more readily available to program participants.
Pennsylvania State Map Beginning on December 1, Medicaid will pay for long-acting contraceptives administered after delivery and also will increase payments to doctors who provide those contraceptives. Currently, those costs are generally borne by hospitals in the lump-sum payment Medicaid makes for deliveries.
Learn more about the state’s new policy for encouraging the use of contraceptives among Medicaid beneficiaries who have delivered babies in this Lancaster Online article.

PA Safety Net Admin2016-12-09T06:00:58+00:00December 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2016 newsletter.
phlp Included in this edition are stories about problems older adults are encountering when they seek to enroll in the state’s Aging Waiver program; an update on the implementation of Community HealthChoices, the new state program of managed long-term services and supports for qualified seniors; upcoming Medicare changes and enrollment and application deadlines; coverage of diabetes testing supplies for dual eligibles; new state guidelines addressing access to treatment for mental health conditions and substance abuse disorders; and more.
Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2016-11-03T06:00:54+00:00November 3rd, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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

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