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DPW Announces Revisions of Medicaid Fee Schedule

The Pennsylvania Department of Public Welfare (DPW) has published a notice of its intention to implement changes in the Medicaid fee schedule and to update selected prior authorization requirements.
Those notices are published here, in the June 22 edition of the Pennsylvania Bulletin, and the changes took effect on June 24.
DPW also published a Medical Assistance Bulletin on the procedure code updates and a table showing the updates.  Find the bulletin here and the table here.

2013-06-26T06:00:45+00:00June 26th, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Announces Revisions of Medicaid Fee Schedule

Medicaid Pay Raise Isn’t Reaching Docs

The Affordable Care Act-mandated fee increase for primary care physicians serving Medicaid patients is not reaching those physicians.
Or so reports the Washington Post, which writes that only a few states are paying primary care providers more money to serve Medicaid patients.
The pay raise is considered an important tool to help encourage more primary care providers to serve Medicaid patients at a time when Medicaid enrollment is expected to increase significantly because of the Affordable Care Act’s Medicaid expansion provisions.  Under the health reform law, Medicaid payments for primary care services, traditionally very low, are to be raised to the same level as Medicare primary care payments for two years – calendar years 2013 and 2014.
Five months into 2013, however, only Maryland, Massachusetts, Nevada, and Michigan are making the higher payments.
Pennsylvania is among the states still not making the enhanced Medicaid payments, but state officials have promised further information about their plans in the coming days.
Learn more about the thinking behind the pay raise and why most states still are not paying it in this Washington Post article.

2013-05-21T06:00:54+00:00May 21st, 2013|Health care reform, Pennsylvania Medicaid policy|Comments Off on Medicaid Pay Raise Isn’t Reaching Docs

DPW Establishes Exceptions to Monthly Prescription Limit

Since January of last year, Pennsylvania’s Medical Assistance program has limited categorically needy adult recipients over the age of 21 to six prescriptions a month.
While Medical Assistance has established a process for seeking exceptions to this limit, the Department of Public Welfare has now published a new MA Bulletin that lists exceptions that will automatically be granted.
Find that list in thisBookshelf with law books MA Bulletin.

2013-05-03T06:00:51+00:00May 3rd, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Establishes Exceptions to Monthly Prescription Limit

DPW Updates Fee Schedule

The Pennsylvania Department of Public Welfare (DPW) has updated its Medical Assistance fee-for-service fee schedule for a variety of physician services, podiatrist services, surgical services, and more.
See a complete list of changes here, in the Pennsylvania Bulletin.

2013-04-23T06:00:49+00:00April 23rd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Updates Fee Schedule

Court Rules Against State in adultBasic Case

A Pennsylvania judge has concluded that the state violated its own constitution when it ended the adultBasic program without making other provisions to use tobacco settlement funds to help lower-income adults.
The Corbett administration ended adultBasic in 2011 and used money previously designated for that program to support Pennsylvania’s Medicaid program.  Commonwealth Court judge Dan Pelligrini declared the laws that ended the program unconstitutional and said the state must use the money for adultBasic or a similar program.
Learn more about the court decision, the circumstances surrounding the challenge to the end of adultBasic, and what might happen next in this York Daily Record article.

2013-03-07T06:00:28+00:00March 7th, 2013|Uncategorized|Comments Off on Court Rules Against State in adultBasic Case

Medicaid Enrollment Down in PA

Enrollment in Pennsylvania’s Medical Assistance program declined by 55,000 people during the second half of 2012.
While it is not clear why enrollment dropped so significantly, one theory is that some people who lost their General Assistance cash assistance ­– a casualty of the state’s FY 2013 budget – did not reapply for Medical Assistance.  Others point to the inability of county assistance offices to process applications effectively.
Read more about the drop in Medicaid enrollment in Pennsylvania and its possible causes in this Philadelphia Inquirer articleHealth Benefits Claim Form.

2013-02-25T10:54:28+00:00February 25th, 2013|Pennsylvania Medicaid policy|Comments Off on Medicaid Enrollment Down in PA

Report Says PA Medicaid Expansion Would Create Jobs, Foster Economic Activity

Expanding Medicaid as called for in the Affordable Care Act would extend health insurance to nearly 700,000 currently uninsured Pennsylvanians and create more than 41,000 new jobs in the state in 2016 according to a new  report.
Medicaid expansion also would result in $3.3 billion in new health care spending in Pennsylvania and generate $5.1 billion in new economic activity in 2016.
These are among the conclusions presented ind “Pennsylvania’s Economy Will Benefit From Expanding Medicaid,” a new report issued jointly by the Pennsylvania Health Access Network and the national advocacy group Families USA.
Learn more about the report and its analysis and find a link to the entire report here, on the web site of the Pennsylvania Health Access Network.

2013-02-22T10:25:57+00:00February 22nd, 2013|Health care reform, Pennsylvania Medicaid policy|Comments Off on Report Says PA Medicaid Expansion Would Create Jobs, Foster Economic Activity

The Proposed FY 2014 Pennsylvania State Budget: Part 1 of 7

The Big Picture

Last Tuesday, Pennsylvania Governor Tom Corbett unveiled his proposed state FY 2014 budget.  Later that day, members of the Safety-Net Association of Pennsylvania (SNAP) received a comprehensive memo outlining the governor’s budget proposal with an emphasis on the issues that matter most to the state’s 61 private safety-net hospitals.
Over the next seven business days, SNAP will present the highlights of the governor’s budget, again with an emphasis on Medical Assistance and other matters of special interest to Pennsylvania’s safety-net hospitals.
The following is a schedule of the remaining six parts of this overview:
Safety-Net Association of Pennsylvania logo
Today:  the big picture underlying the proposed budget.
In this proposed budget, the Department of Public Welfare (DPW) projects a three percent increase in Medical Assistance enrollment and caseload in FY 2014.  Overall, the DPW budget calls for $14.2 billion in total spending on Medical Assistance – a decrease of less than half a percent from the current fiscal year’s available funding.
While some of the proposed changes in the budget are spending decisions, others reflect a reduction in the state’s federal medical assistance percentage, or FMAP (the rate at which the federal government matches state Medicaid spending), which will fall from its current 54.28 percent to an estimated 53.52 percent during FY 2014.  Consequently, in some cases, lower payments would reflect a reduced federal contribution rather than a state decision to reduce those payments.
The major themes of next year’s proposed Medical Assistance budget appear to be a continued state-wide expansion of the HealthChoices Medical Assistance managed care program and expanded access to community-based services for individuals with intellectual disabilities and the elderly.
The budget does not provide for the Medicaid expansion envisioned in the Affordable Care Act.  Governor Corbett has conveyed to the federal government that he will not expand Medicaid eligibility at this time but his document states that such expansion will be the subject of further analysis and public discussion.
Tomorrow:  The Major Medical Assistance Spending Categories
 

Path to FY 2013 EHR Payments Set

The Pennsylvania Department of Public Welfare has published Medical Assistance Bulletins that explain to providers how to pursue their Medicaid electronic health record (EHR) incentive payments for FY 2013.
The bulletin for eligible hospitals can be found here and the bulletin for eligible physicians and other providers can be found hereBookshelf with law books.

2013-02-11T06:00:17+00:00February 11th, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on Path to FY 2013 EHR Payments Set
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