Pennsylvania safety-net hospitals Archives - Page 19 of 20 - Safety-Net Association of Pennsylvania

Greater Cost-Sharing in Medicaid’s Future?

States would be permitted to require greater cost-sharing from Medicaid recipients under a new regulation proposed by the federal Centers for Medicare & Medicaid Services (CMS).
The proposed regulation, which also addresses matters involving state Children’s Health Insurance Programs (CHIP) and health insurance exchanges, would permit states to impose increased co-pays for non-emergency use of hospital emergency rooms and for non-preferred prescription drugs. The cost-sharing for non-emergency use of emergency rooms would be limited to eight dollars for Medicaid recipients with incomes between 100 percent to 150 percent of the federal poverty level but would have no limit for those whose income is beyond 150 percent of the federal poverty level.
Cost-sharing requirements of low-income patients pose a particular challenge for Pennsylvania’s safety-net hospitals. Many of their Medicaid patients cannot afford larger co-payments and often leave the hospital without paying them, thereby increasing hospitals’ bad debt.
Interested parties have until February 13 to submit comments to CMS about the proposed regulation.
Read a CMS fact sheet on the proposed regulation and find a link to the regulation itself here , on the CMS web site.

PA Safety Net Admin2013-01-15T12:25:35+00:00January 15th, 2013|Uncategorized|Comments Off

Western PA Hospitals Worry About Fiscal Cliff, Part 2

No sooner did hospitals in western Pennsylvania breathe a sigh of relief over escaping the worst possible scenarios in the fiscal cliff crisis than they looked ahead and saw the fiscal cliff sequel: March 1, when all Medicare payments will be cut two percent unless Congress acts to prevent that reduction.
With Medicare accounting for 40 percent, 50 percent, and even 60 percent of revenue in some western Pennsylvania hospitals, providers are concerned about the impact the two percent sequester could have on their overall financial health.
Such a loss would be especially hard to bear for the area’s safety-net hospitals, which typically have fewer insured patients than other hospitals and therefore are more dependent on their Medicare revenue.
Learn more about why western Pennsylvania hospitals are concerned about March 1 in this Pittsburgh Business Times article .

PA Safety Net Admin2013-01-09T06:00:09+00:00January 9th, 2013|Uncategorized|Comments Off

Will Fiscal Cliff Deal Make Medicaid, Medicare More Vulnerable?

The relative lack of spending cuts included in the fiscal cliff/Medicare doc fix deal passed by Congress last week could increase the pressure to reduce costs in key safety-net programs like Medicare, Medicaid, and Social Security.
Or so some policy analysts believe.
Many members of Congress supported the fiscal cliff bill only reluctantly because of it lacked the bigger spending cuts they sought, the thinking goes. Now, with another fiscal cliff deadline looming on March 1, when the previously passed sequestration law takes effect, many who compromised last week will be demanding bigger cuts in exchange for their vote.
As a result, Medicare and Medicaid, two of the federal government’s fastest-growing expenses, are expected to be targets for those in search of cuts. In addition, Medicare has proven to be among the first places many officials look in their search for savings.
Any attempt to implement additional reductions in Medicaid and Medicare, beyond those already scheduled to take effect through the Affordable Care Act and last week’s fiscal cliff bill, would be especially damaging to Pennsylvania’s private safety-net hospitals.
Read more about how last week’s budget solution is far from the end of the threat to Medicare and Medicaid in this Boston Globe article .

PA Safety Net Admin2013-01-08T06:00:47+00:00January 8th, 2013|Uncategorized|Comments Off

GAO Finds Problems With Medicaid DSH Payments

The U.S. Government Accountability Office (GAO) is now reviewing audits of states’ Medicaid disproportionate share payments (Medicaid DSH) to hospitals and is raising questions about states’ compliance with federal requirements for those payments.
Based on its analysis of state Medicaid DSH audits, GAO found that states are making Medicaid DSH payments to hospitals that exceed those hospitals’ uncompensated care costs and are inaccurately calculating those hospital uncompensated care costs. The GAO also found that states are not always targeting their Medicaid DSH payments to the hospitals that provide the most uncompensated care.
States are required to submit audits and data as a condition of receiving Medicaid DSH funds from the federal government. Currently, the Centers for Medicare & Medicaid Services (CMS) is not acting on the information it receives but will begin doing so after a transition period that ends when 2014 audits are completed. In anticipation of that time, GAO is reviewing the information CMS receives for state compliance with six federal standards for Medicaid DSH payments.
This data also may eventually be used to help implement the Medicaid DSH payment reduction mandated under the Affordable Care Act.
According to the report, Pennsylvania did not provide some of the required data, so in several instances in which the document provides specific information about individual state performance, it has nothing about Pennsylvania. It does note, however, that in FY 2007, six hospitals in the state received Medicaid payments greater than their Medicaid costs.
Because Pennsylvania’s safety-net hospitals care for so many uninsured and low-income patients and receive higher Medicaid DSH payments than other hospitals, they are far more dependent on these payments than other hospitals and will need to watch this situation closely in the future.
Learn more about GAO’s examination of Medicaid DSH payments – why it is undertaking this review, what it found, and how its findings may be used in the future – in the report More Transparency of and Accountability for Supplemental Payments are Needed, which can be found here , on GAO’s web site.

PA Safety Net Admin2012-12-28T06:00:33+00:00December 28th, 2012|Health care reform, Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

Medicaid at Risk in Fiscal Cliff Talks

If Medicaid is a health care program for at-risk low-income people, it appears that Medicaid itself is at risk during the current fiscal cliff talks in Washington, D.C.
While Medicaid was left untouched by last year’s sequestration bill, it is now viewed by growing numbers of policy-makers as a potential source of savings to help stave off the fiscal cliff.
Several aspects of Medicaid, in particular, appear to be vulnerable in the coming weeks. They include Medicaid provider taxes, which are incurring growing opposition in Washington and which, if ratcheted back, could save more than $25 billion; supplemental payments for Medicaid primary care providers, scheduled to take effect on January 1, which if eliminated would save $13 billion; better management of dual eligibles, which could save $12 billion; and medical equipment spending, where a competitive bidding program similar to that currently being introduced for Medicare could save $5 billion.
While all of these cuts would hurt Pennsylvania’s safety-net hospitals, those hospitals would particularly be affected by any reduction in either the rate at which the federal government matches the state’s Medicaid expenditures or in its ability to levy provider taxes, which are a key contributor to the financial foundation of the state’s Medicaid program.
Learn more about how Medicaid figures in the current fiscal cliff talks and how policy-makers are increasingly looking to Medicaid for savings in this Politico article .

PA Safety Net Admin2012-12-17T06:00:28+00:00December 17th, 2012|Uncategorized|Comments Off

Sneak Peek: PA Medicaid Costs to Rise $650 Million in FY 2014

In its mid-year budget briefing, the Corbett administration projects that Pennsylvania’s Medical Assistance costs will rise $650 million in the state’s 2014 fiscal year, which will begin on July 1, 2013.
The budget briefing also noted that the governor has directed state agencies to maintain level funding in their proposed FY 2014 budgets, that level funding essentially means a cut of seven to eight percent because of rising personnel costs, and that the governor “has reiterated that no new taxes will be part of the 2013-14 budget.”
Although the governor does not present his proposed FY 2014 budget for another two months, this raises the question of how the state might pay these increased Medicaid costs – or if next year’s budget might include payment cuts for the state’s Medicaid providers.
Cut would be particularly burdensome to Pennsylvania’s safety-net hospitals because of the especially high numbers of Medicaid patients they serve and their unusual dependence on Medicaid revenue.
Read about the mid-year budget briefing in this PA Independent article and find the budget briefing itself here .

PA Safety Net Admin2012-12-10T06:00:27+00:00December 10th, 2012|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

Will PA Expand Medicaid Program?

With President Obama re-elected and Congress unlikely to repeal the Affordable Care Act, Pennsylvania officials now face a major decision: will they expand the state’s Medicaid programs as the law originally intended?
The original health care reform law made that expansion mandatory, but earlier this year, the Supreme Court left the expansion decision to individual states. While some governors have already declared their intention to expand their Medicaid programs and others have announced that they will not, Pennsylvania Governor Tom Corbett has not yet announced a decision.
Why would the state choose to expand its Medicaid program, considering that it will end up costing taxpayers more money? On the other hand, why would it choose to leave billions of federal dollars on the table?
Because they serve so many low-income, uninsured patients who might benefit from an easing of Medicaid eligibility criteria, Pennsylvania’s private safety-net hospitals have a major stake in this decision.
Read more about the decision now facing the Corbett administration in this CQ HealthBeat article presented by the Commonwealth Fund. For a closer look at the Pennsylvania perspective, read this PA Independent article .

PA Safety Net Admin2012-11-15T06:00:12+00:00November 15th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Post-Election Diagnosis for Health Care

While President Obama’s re-election probably spells the end of talk of repealing the Affordable Care Act, many questions remain about how – and how completely – the health care reform law passed in 2010 will be implemented.
In the days following the election, observers are asking these and other questions.
In the article “Federal Deficit Talks Could Impact Obama’s Moves on Health Law,” Kaiser Health News speculates about the future of some of the more controversial and expensive aspects of the Affordable Care Act, including creation of the Independent Payment Advisory Board; the extensive insurance subsidies for which many Americans will be eligible; the future of the medical device tax; and the law’s provisions that limit the degree to which insurers can charge higher rates for older people.
The Stateline web site looks at the decisions ahead for state governments in the article “Obama Win Means Big Health Care Decisions for States.” Many governors still have not declared whether their state will expand their Medicaid programs – a move required by the Affordable Care Act but made optional by the Supreme Court in a June 2012 decision.
The first issue that will be addressed, though, is state decisions on whether to create their own health insurance exchanges, a key part of the reform law, or let the federal government create those exchanges for them. States are required to inform the federal government of their intentions by November 16, although it now appears they will be given more time. Pennsylvania is among the states that have not yet declared their intentions.
Meanwhile, looming over the health care industry is the prospect of sequestration, part of last year’s deficit reduction compromise, that leaves Medicaid untouched but will require a cut of two percent in all Medicare payments beginning on January 1 unless Congress acts to prevent these cuts. Read more about this in an article from The Hill titled “Sequester Would Cut $11 Billion from Medicare.”
These and other issues are of particular importance to Pennsylvania’s safety-net hospitals because of the especially large numbers of low-income and publicly insured patients they serve.

PA Safety Net Admin2012-11-09T10:42:28+00:00November 9th, 2012|Health care reform|Comments Off

Shift to HealthChoices Hits Bumps in the Road

Pennsylvania’s switch to HealthChoices to serve nearly the entire state Medicaid population is running into short-term obstacles in parts of the state.
Some recipients, for example, failed to choose a participating managed care plan, were assigned to plans, and now are confused about where to go and how to obtain care. In other instances, physicians are still negotiating with those plans or waiting to be credentialed for participation.
Some Pennsylvania safety-net hospitals, because of where they are located and their especially large numbers of Medicaid patients, may experience these problems more than the average hospital.
Read more about the challenges Medicaid recipients are encountering during this transition in this Erie-Times News article .

PA Safety Net Admin2012-11-08T06:00:02+00:00November 8th, 2012|Pennsylvania Medicaid policy|Comments Off

Medicaid Primary Care Pay Raise Set; OB/GYNs, ER Docs Excluded

When the Affordable Care Act’s mandatory rate increase for primary care services provided to Medicaid patients takes effect on January 1, ob/gyns and emergency room physicians will not be among the beneficiaries of the temporary raise in pay.
Under a new regulation issued last week, only family doctors, internists, and pediatricians will receive the pay increase, which was established as a short-term (two years) incentive to attract more physicians to serve Medicaid patients in anticipation of the significant increase in enrollment expected when many states expand their Medicaid eligibility criteria in 2014.
When working under the supervision of eligible primary care physicians, nurse practitioners and physician assistants also will receive the enhanced Medicaid payments.
State Medicaid payments for primary medical care typically fall well below comparable Medicare rates. Under the reform law, Medicaid payments for such services will be raised to Medicare levels for two years, with the federal government footing the bill for the difference.
Because they serve so many Medicaid patients and the state’s outpatient fees are so much lower than those paid by Medicare, Pennsylvania’s safety-net hospitals and the primary care physicians they employ should benefit greatly from this new policy.
Read more about who will and won’t benefit from the primary care fee increase and how it will be implemented in this Kaiser Health News article .