Pennsylvania safety-net hospitals Archives - Page 12 of 21 - Safety-Net Association of Pennsylvania

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures. It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
With virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here; and see this CMS fact sheet on the draft regulation.

PA Safety Net Admin2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments.
That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources. Pennsylvania is not among the states that continued paying the enhanced rates.
The question of whether the fee increase accomplished its objective and is worth re-establishing remains unanswered. The brief nature of the experiment – only two years – and the delays many states experienced before they started paying the enhanced rates left little time for meaningful research. One quantitative analysis suggests the rate increase helped, there have been several more qualitative approaches to research, and some studies remain under way.
Because they care for so many more Medicaid patients than the typical hospital, the adequacy of Medicaid payments has long been of special concern to Pennsylvania safety-net hospitals.
For a closer look at the Affordable Care Act’s Medicaid primary care fee bump, how it worked, its impact, and its future, see the new health policy brief “Medicaid Primary Care Parity” here, on the web site of the journal Health Affairs.

PA Safety Net Admin2015-05-15T06:00:54+00:00May 15th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

New 340B Rules Expected Soon

The federal Health Resources and Services Administration (HRSA) is expected to release new rules governing its section 340B prescription drug discount pricing program in the near future.
The new rules have long been in development and were in the verge of being published late last year when the agency decided to try another approach to addressing some of the program’s problems, but now, new draft guidelines are being reviewed by the White House Office of Management and Budget (OMB) in anticipation of being published soon in the Federal Register.
The 340B program, which provides discounts on prescription drugs to hospitals and others that serve large numbers of low-income patients, has encountered controversy in recent years with providers complaining about the lack of transparency in drug manufacturers’ prices and the manufacturers claiming that the program’s benefits are being extended to some patients who do not qualify for the assistance.
The 340B program is a vital resource for most Pennsylvania safety-net hospitals.
To learn more about the program and what might be expected when the new rules are proposed, see this CQ HealthBeat article presented by the Commonwealth Fund.

PA Safety Net Admin2015-05-13T06:00:39+00:00May 13th, 2015|Pennsylvania safety-net hospitals|Comments Off

Looking at Payment and Delivery System Reform

Last fall the Robert Wood Johnson Foundation brought together grant recipients and national experts to talk about health care payment and delivery system reform design and implementation issues.
Now, the foundation has released a brief paper that addresses what the experts consider to be the three greatest challenges in the pursuit of such reform:

Aligning alternative payments with clinician compensation
Considering social determinants of health in payment reform models
Repurposing hospital resources

The paper also takes a look at whether health care payments should be subject to risk adjustment to reflect the social and economic barriers to better health and care that some patients face. This is an important issue for Pennsylvania’s safety-net hospitals because of the significant numbers of low-income patients they serve.
These issues and more are addressed in greater detail in the new paper “Three Emerging Challenges for Sustained Payment and Delivery System Reform,” which can be found here.

PA Safety Net Admin2015-04-14T06:00:13+00:00April 14th, 2015|Uncategorized|Comments Off

Medicare-Medicaid Coordination Office Reports to Congress

The federal agency created by the Affordable Care Act to facilitate better coordination of federal benefits for those eligible for both Medicare and Medicaid has issued its annual report on its activities to Congress along with a number of recommendations for future policy changes.
In addition to reporting on its work over the past year, the Medicare-Medicaid Coordination Office recommended that Congress consider legislation to:

Create a pilot to expand the PACE program (Programs of All-Inclusive Care for the Elderly) to people between the ages of 21 and 55.
Ensure retroactive Medicare Part D coverage for newly eligible low-income beneficiaries.
Establish an integrated appeals process for dually eligible (Medicare and Medicaid) enrollees.
Allow for federal/state coordinated review of duals special need plan marketing materials.

The report also identified three areas the agency intends to explore further in the coming year:

Coverage standards for overlapping Medicare and Medicaid benefits.
Cost-sharing rules for qualified Medicare beneficiaries.
Quality measures and Medicare-Medicaid enrollees.

Because they serve so many low-income, dually eligible patients, Pennsylvania’s safety-net hospitals often have a considerable stake in this office’s efforts.
Find the Medicare-Medicaid Coordination Office’s complete report to Congress here.

PA Safety Net Admin2015-04-10T06:00:12+00:00April 10th, 2015|Uncategorized|Comments Off

MACPAC Looks at Value-Based Purchasing in Medicaid

At a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), the agency’s staff made a presentation on how different states are pursuing value-based purchasing in their Medicaid programs.
The presentation focused on current efforts in three states: Connecticut, Maryland, and Oklahoma, describing the policy approach those states have taken, the models they employ, the implementation challenges they have faced, and how they evaluate the effectiveness of their efforts.
Because they care for so many Medicaid patients, Pennsylvania’s safety-net hospitals have a special interest in new approaches to paying for Medicaid services.
Find the MACPAC presentation here.

PA Safety Net Admin2015-04-09T06:00:12+00:00April 9th, 2015|Pennsylvania safety-net hospitals|Comments Off

340B Program Faces Challenges, Change

A federal program that helps selected health care providers obtain discounted drugs for low-income patients they are serving on an outpatient basis may soon face major changes.
The 340B prescription drug pricing program, created more than 20 years ago to help serve low-income individuals, has come under fire in recent years in both the House and the Senate over how qualified, participating providers – disproportionate share hospitals, Federally Qualified Health Centers and their look-alikes, children’s hospitals, critical access hospitals, rural referral centers, and others – use the savings they derive from the program. While there is a general expectation that providers will use those savings to provide additional services to low-income patients, they are required neither to do that nor to discloses how they do use their savings.
The House Energy and Commerce Committee held a hearing about the program last week and Congress has asked the Medicare Payment Advisory Commission (MedPAC) to look into the program as well.
In addition, the U.S. Government Accountability Office (GAO) recently published an update on the status of its 2011 recommendations for improving the program, which it found suffered from inadequate oversight by Health Resources and Services Administration (HRSA), lacked adequate criteria for determining patient and provider eligibility, and lacked controls for preventing drugs acquired through the program from being diverted to ineligible patients.
The administration has long been thought to be preparing new guidelines for the 340B program.
Most Pennsylvania safety-net hospitals qualify for the 340B program because of the many low-income patients they serve, so any changes in the program will be of special interest to them.
For a closer look at the issues surrounding the 340B program, see this Roll Call blog report. Find a summary of the GAO report Drug Discount Program: Status of GAO Recommendations to Improve 340B Drug Pricing Program Oversight and a link to the study itself here and a report on some of the testimony provided at the congressional hearing here.

PA Safety Net Admin2015-03-30T06:00:39+00:00March 30th, 2015|Pennsylvania safety-net hospitals|Comments Off

Numbers Link Medicaid Expansion, Diabetes Diagnoses

One of the primary arguments made by the Safety-Net Association of Pennsylvania in favor of state Medicaid reimbursement policies that support the work of safety-net hospitals is that many of the low-income patients they serve have had sporadic contact with the health care system over the years and often present with medical problems that go well beyond the immediate reason that brings them to hospitals.
Now comes new information that supports that argument.
The medical testing company Quest Diagnostics has found that the number of Medicaid patients its testing has found to have diabetes has risen more than 24 percent during two recent six-month review periods in states that have expanded their Medicaid programs while the number of such patients found to have diabetes in states that did not expand their Medicaid programs saw only a 0.4 percent increase in diabetes diagnoses.
Pennsylvania did not expand access to Medicaid during the review periods covered by the Quest analysis but now that it has done so, the problem seems likely to arise in the state.
Because of where they are located, Pennsylvania’s safety-net hospitals serve higher proportions of low-income patients than the typical community hospital and are therefore more likely to be caring for these more challenging patients newly diagnosed with diabetes in the near future.
For more information about the Quest findings and their implications, see this New York Times article. In addition, the latest edition of the journal Diabetes Care presents a study on the subject. See that article here.

PA Safety Net Admin2015-03-26T06:00:08+00:00March 26th, 2015|Pennsylvania safety-net hospitals|Comments Off

States Turning More to Providers to Fund Medicaid

States are relying more on provider taxes and other sources to raise their share of Medicaid funding, a new study by the U.S. Government Accountability Office (GAO) has found.
According to the GAO, state use of such funding rose 21 percent from 2008 to 2012. Most of the money came from health care provider taxes, provider donations, intergovernmental transfers, and Medicaid certified public expenditures.
While the study examined the issue nation-wide it focused on Medicaid financing in three states: California, Illinois, and New York.
Use of provider taxes is of special interest to Pennsylvania safety-net hospitals because it appears the state’s proposed FY 2016 budget may call for funding more of the state’s Medicaid program with proceeds from hospital provider taxes.
To learn more about how states are financing their share of their Medicaid programs and why this is of interest to policy-makers, see the recently re-released GAO report States’ Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection and a newly published companion to the report titled Questionnaire Data on States’ Methods for Financing Medicaid Payments from 2008 through 2012.

PA Safety Net Admin2015-03-19T06:00:57+00:00March 19th, 2015|Pennsylvania safety-net hospitals, Proposed FY 2016 Pennsylvania state budget|Comments Off

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face. See its report here.

PA Safety Net Admin2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off

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