Pennsylvania Medical Assistance Archives - Page 4 of 7 - Safety-Net Association of Pennsylvania

Medicaid Expansion Glitch Hits Drug and Alcohol Patients, Providers

A flaw in the implementation of Pennsylvania’s Medicaid expansion has left many of the state’s Medicaid beneficiaries with no coverage for the treatment of their drug and alcohol problems – and some providers without payment for some care they have delivered.
Under the Healthy Pennsylvania Medicaid expansion program, beneficiaries with extensive health problems, like drug and alcohol issues, were supposed to be directed into the state’s “Healthy Plus” Medicaid benefits package, which covers services that address such problems. Instead, many were places in private, state-approved insurance plans for Medicaid beneficiaries, which do not cover those services.
State officials are aware of the problem and say they will soon have a plan to fix it.
Learn more about this glitch in Pennsylvania’s Medicaid expansion and how state officials hope to address it in this Philadelphia Inquirer article.

PA Safety Net Admin2015-01-30T06:00:14+00:00January 30th, 2015|Healthy PA, Pennsylvania Medicaid policy|Comments Off

SNAP Principles for Changing Course on Medicaid Expansion in Pennsylvania

With the inauguration of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The third of those four papers presents eight principles SNAP believes state officials should follow if they choose to abandon the Healthy Pennsylvania model of Medicaid expansion in favor of a more traditional approach to expanding the state’s Medicaid expansion.
Those eight principles are:

communicate changes effectively to the provider community
ensure beneficiaries’ continuity of coverage and continuity of care
ensure the adequacy of provider networks
simplify beneficiary and provider enrollment
preserve vital supplemental payments to safety-net hospitals
continue pursuing Medical Assistance payment reforms
ensure the long-term financing of Medical Assistance in response to current and future threats to that financing
invest in innovative, population-based infrastructure and programmatic improvements

The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
The second paper, “The Challenges Pennsylvania Safety-Net Hospitals Face,” describes the special role safety-net hospitals play in serving low-income and medically vulnerable Pennsylvanians and the emerging challenges they face in fulfilling this vital role.
Find all three SNAP papers here.

PA Safety Net Admin2015-01-28T06:00:12+00:00January 28th, 2015|Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

The Challenges Facing Pennsylvania’s Safety-Net Hospitals

With the arrival of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The second of those four papers describes the major health care and health policy challenges safety-net hospitals face. Those challenges include:

the distinct patients safety-net hospitals serve
inadequate payments for Medicaid services
the large numbers of uninsured and underinsured patients safety-net hospitals serve
threats to vital state Medicaid supplemental payments, such as Medicaid disproportionate share payments (Medicaid DSH
continuing change and reform in the health care system, including the delivery of care and how safety-net hospitals are paid for their services

The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
Find both SNAP papers here.

PA Safety Net Admin2015-01-23T06:00:07+00:00January 23rd, 2015|Safety-Net Association of Pennsylvania|Comments Off

PA Closing in on Classification Criteria for New Medicaid Recipients

Among the features of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program is the consolidation of 14 current adult benefits packages into just two packages: the “Healthy” package for new recipients considered low-risk patients and the “Healthy Plus” package for those who are considered high-risk patients, or medically frail.
But ever since the Corbett administration unveiled its Medicaid expansion plan last fall, the question of how new recipients would be evaluated to determine which benefit package they will receive has remained unanswered.
Now, the Pennsylvania Department of Public Welfare (DPW) appears to be getting closer to providing a clear answer.
Recently, DPW’s Medical Assistance Advisory Committee (MAAC) circulated three working documents that present the state’s latest thinking on the classification process.
The first document presents an overview of the latest version of state’s screening tool, including what the tool is, how it defines “medically frail,” and how it will be used. It also notes that use of the tool is not mandatory.
This next document offers additional information about how the state envisions defining “medically frail.”
And this third document is a draft of the screening tool itself, the health care needs questionnaire.
Pennsylvania’s Medicaid expansion is scheduled to take effect on January 1, 2015, but people who think they may be eligible may begin enrolling on December 1 through the state’s enrollment web site or at any state county assistance office.

PA Safety Net Admin2014-10-31T06:00:57+00:00October 31st, 2014|Healthy PA|Comments Off

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs.
In a paper entitled “Medicaid Managed Care Modernization: Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome.
The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans.
The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many Medicaid patients and managed care has become the primary means through which the state’s Medicaid program serves those patients.
Learn more about Medicaid directors’ recommendations for improving and regulating state Medicaid managed care programs in this National Association of Medicaid Directors correspondence with the Center for Medicaid and CHIP Services.

PA Safety Net Admin2014-10-27T06:00:19+00:00October 27th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Introducing…The Pennsylvania Department of Human Services

The Pennsylvania Department of Public Welfare is no more.
The state executive branch agency whose Office of Medical Assistance Programs has overseen Pennsylvania’s Medicaid program since its inception has officially been renamed the Department of Human Services.
The legislation requiring the name change takes effect in November and the department will phase-in its new name over time.
Read the press release from the governor’s office announcing the name change here.

PA Safety Net Admin2014-09-25T06:00:40+00:00September 25th, 2014|Uncategorized|Comments Off

PA Aging Waiver Program Struggles With Backlog

A Pennsylvania program to help the elderly remain in their own homes instead of moving into nursing homes is struggling with backlogs.
The state’s Aging Waiver Program is a Medicaid program that enables those who meet certain medical and financial criteria to receive assistance in their own homes from nurses and home health aides rather than go into a nursing home.
Currently the program serves more than 32,000 people – nearly twice as many as it did six years ago – but applications are taking as long as two months to process. The biggest challenge is verifying financial eligibility, but the state recently added staff to help address the backlog.
Learn more about Pennsylvania’s Aging Waiver Program in this Pittsburgh Tribune-Review article.

PA Safety Net Admin2014-08-11T06:00:49+00:00August 11th, 2014|Pennsylvania Medicaid policy|Comments Off

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”
So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.
The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education. It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.
In the report, the IOM proposes six goals for improving GME financing.

Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. 
Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1. 
Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals. 
Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds. 
Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment. 
Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods.

To fulfill these goals, the report offers three specific recommendations:

Investing strategically: Maintain Medicare GME funding at its current level, but modernize payment methods to reward performance, ensure accountability, and incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out. 
Building an infrastructure to facilitate strategic investment: Establish a two-part governance infrastructure for federal GME financing. A GME Policy Council in the Office of the Secretary of the Department of Health and Human Services should oversee policy development and decision making. A GME Center within the Centers for Medicare & Medicaid Services should function as an operations center with the capacity to administer payment reforms and manage demonstrations of new payment models. 
Establishing a two-part Medicare GME fund: Allocate Medicare GME funds to two distinct subsidiary funds—a GME Operational Fund to finance ongoing residency training activities and a Transformation Fund to finance development of new programs, infrastructure, performance methods, payment demonstrations, and other priorities identified by the GME Policy Council.

Graduate medical education is an important issue for the Pennsylvania safety-net hospitals that also are teaching hospitals. The state’s Medicaid program is an important source of medical education funding for these hospitals as well.
To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.

PA Safety Net Admin2014-08-01T06:00:22+00:00August 1st, 2014|Pennsylvania Medicaid policy|Comments Off

GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.

PA Safety Net Admin2014-07-31T06:00:42+00:00July 31st, 2014|Pennsylvania Medicaid policy|Comments Off

PA Reverses “MAWD” Elimination

The Corbett administration has reversed an earlier decision and decided to retain Pennsylvania’s Medical Assistance for Workers With Disabilities program, frequently referred to as “MAWD.”
MAWD provides low-cost health insurance to Pennsylvanians with disabilities who do not otherwise qualify for Medical Assistance because they work and have earnings.
The program, which serves about 34,000 people, costs the state $7 million a year. A Department of Public Welfare spokesman said preserving the program is consistent with the Corbett administration’s Healthy Pennsylvania initiative.
Learn more about MAWD here and about the decision to retain it in this Insurance Net News article.

PA Safety Net Admin2014-07-29T06:00:28+00:00July 29th, 2014|Healthy PA, Pennsylvania Medicaid laws and regulations|Comments Off

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