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PA Considering Medicaid Observation Rate

The Pennsylvania Department of Public Welfare is considering instituting a Medicaid observation rate for some hospital services.
According to a recently published Pennsylvania Bulletin,

The Department is considering the establishment of an observation rate for hospital cases for which an inpatient admission is not medically necessary but medical observation of a patient is required. The Department is currently considering developing criteria under which observation services provided by a hospital may be compensable under the MA Program. The Department intends to establish a comprehensive rate to cover observation services determined to be compensable under the Program.

DPW will accept written comments about this proposal for the next 30 days.
Read the Pennsylvania Bulletin notice here.

2013-07-02T06:00:31+00:00July 2nd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid policy, Proposed FY 2014 Pennsylvania state budget|Comments Off on PA Considering Medicaid Observation Rate

DPW Seeks to Renew Philadelphia Assessment

The Pennsylvania Department of Public Welfare has announced its intention to seek renewal of the Philadelphia hospital assessment first authorized in 2008.
The purpose of the assessment is to generate additional revenue to fund state Medicaid expenditures for hospital outpatient and emergency department services in Philadelphia and to provide additional funding to support the city’s public health clinics.
Read the Pennsylvania Bulletin announcement of DPW’s intention here.

2013-07-02T06:00:20+00:00July 2nd, 2013|Pennsylvania Bulletin, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off on DPW Seeks to Renew Philadelphia Assessment

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
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