Pennsylvania safety-net hospitals Archives - Page 6 of 22 - Safety-Net Association of Pennsylvania

MFAR is Dead

At least for now.

The controversial Medicaid Fiscal Accountability Regulation, slated for implementation this fall over the objections of many health care stakeholders, will not move forward at this time.

In a tweet earlier this week, Centers for Medicare & Medicaid Services Administrator Seema Verma wrote that

We’ve listened closely to concerns that have been raised by our state and provider partners about potential unintended consequences of the proposed rule, which require further study. Therefore, CMS is withdrawing the rule from the regulatory agenda.

If implemented, opponents maintained, the regulation would have:

Deprived states of important, established policy-making prerogatives.
Created major new administrative burdens for state governments and hospitals.
Inappropriately regulated financing of the state share of Medicaid spending.
Introduced new, unspecified standards for state Medicaid programs.

While CMS maintained that MFAR would have enhanced the transparency of state Medicaid programs, the rule’s opponents maintained that it could lead to a major reduction of resources for serving the Medicaid population.

SNAP was among those opponents, arguing that the regulation could have hurt Pennsylvania safety-net hospitals and others that serve low-income communities by inappropriately regulating how states can finance their Medicaid programs. CMS proposed the rule last November; SNAP submitted formal comments expressing its opposition in January; and SNAP rallied Pennsylvania’s congressional delegation to oppose the rule in February, March, and July.

It is worth noting that in “withdrawing the rule from the regulatory agenda,” Verma did not preclude the possibility of reintroducing MFAR at some point in the future.

Learn more from article “Trump administration backing off Medicaid rule that states warned would lead to cuts” in the online publication The Hill.

PA Safety Net Admin2020-09-17T06:00:46+00:00September 17th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Medicaid Enrollment on the Rise

More people are enrolling in Medicaid, and much of the increase is driven by the COVID-19 emergency.

Or so reports the organization Families USA in a new study.

Pennsylvania State Map According to the study,

Over half of the 38 states reporting monthly enrollment through May or later have seen greater than 7% growth in enrollment since February. For the eight states reporting August enrollment, their average enrollment growth since February is approximately 11%.

But the implications are even greater, according to the analysis, which found that in large part because of COVID-19 job loss,

Medicaid enrollment among the 38 states reporting has already increased by 4.3 million people and is poised to increase much more in the near future. Analysis by Health Management Associates projects that up to 27 million people will lose their job-based insurance this year and that Medicaid will see an increase in enrollment of up to 18 million people by the end of 2020, depending on the severity of the economic downturn.

The effects of COVID-19 job loss and accompanying loss of insurance already appears to be visible in Pennsylvania, where Medicaid enrollment rose from 2.84 million in March of 2020 to 2.89 million in April, 2.94 million in May, and 2.977 million in June. Growing Medicaid enrollment poses a challenge for Pennsylvania’s safety-net hospitals because they care for so many low-income patients and payments from the state’s Medicaid program often do not cover the cost of the care they provide.

Learn more about the nation-wide trend in the Families USA report “Rapid Increases in Medicaid Enrollment: A Review of Data from Six Months.”

PA Safety Net Admin2020-09-16T06:00:58+00:00September 16th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania safety-net hospitals|Comments Off

Eliminate Medicaid DSH Cut, SNAP Asks PA Delegation

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states, and the Safety-Net Association of Pennsylvania has written to the state’s congressional delegation asking its members to convey this message to congressional leaders.

The cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to the delegation, SNAP wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured, including nearly 700,000 Pennsylvanians – a number thought to be rising because of the job loss associated with COVID-19. When these people are sick or injured, most will turn to the state’s 41 private safety-net hospitals for care. These hospitals depend heavily on their Medicaid DSH payments to underwrite the cost of care for their uninsured patients, so they have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never permitted those cuts to go into effect. The most recent delay expires after November 30..

Because they serve so many uninsured and underinsured patients, Medicaid DSH payments from the state are especially important for Pennsylvania’s safety-net hospitals.

PA Safety Net Admin2020-09-15T06:00:16+00:00September 15th, 2020|Affordable Care Act, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

COVID-19 Update: June 4, 2020

Coronavirus update for Thursday, June 4 as of 2:30 p.m.

Pennsylvania Update

SNAP Advocacy

Safety-Net Association of Pennsylvania logo Today SNAP wrote to Pennsylvania senators Robert Casey and Pat Toomey to ask them to pursue legislation with five major COVID-19-related policy initiatives that Pennsylvania safety-net hospitals need:

A 14-point increase in the federal medical assistance percentage (FMAP).
An additional $100 billion for hospitals.
Another delay in implementation of Affordable Care Act-mandated cuts in Medicaid disproportionate share (Medicaid DSH) allotments.
Prevention of implementation of the Medicare fiscal accountability regulation (MFAR).
Reduced interest rates and a longer payback period for Medicare payments advanced to hospitals through the CARES Act’s Accelerated and Advance Payment Program.

See SNAP’s letter here.

Governor Wolf

Governor Wolf announced that the Office of State Fire Commissioner will be working to enact recent legislation to provide $50 million in direct financial relief to fire and emergency medical service (EMS) companies hurt by the ongoing COVID-19 outbreak. $6 million of this money is targeted for EMS companies.

Governor Wolf and Secretary of Health Levine signed amended yellow phase orders to include 10 counties (including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) moving to the yellow phase at 12:01 a.m. tomorrow, June 5 and signed amended green phase orders to include 16 counties moving to the green phase at 12:01 a.m. tomorrow. With these orders, there are no counties in the red phase. In total, on June 5, there will be 34 counties in the green phase and 33 in the yellow phase. See the announcement here.

Department of Health – by the numbers

Yesterday’s new case and death totals are very similar to those of the previous day.
The number of health care workers who have contracted COVID-19 now exceeds 5600.
1174 Pennsylvanians are currently hospitalized with COVID-19 and 257 of them are on ventilators.
45 percent of acute-care beds, 38 percent of ICU beds, and 24 percent of pediatric ICU beds are currently unoccupied, as are 53 percent of hospital isolation rooms.

Department of Human Services/Office of Long-Term Living

The Office of Long-Term Living has issued guidance for modification to nursing facility bed increase requests during the COVID-19 pandemic.
With many of its employees working at home, OLTL has introduced a temporary change in the processing of 180-day claims exception requests.
OLTL has posted a notice explaining that due to COVID-19, it cannot access information necessary to calculate the healthcare-associated payments for MA-11 cost reports with acceptance letters normally mailed in March.

Department of Aging

The Department of Aging has published guidance for the reopening and operation of adult daily living centers during the COVID-19 crisis in counties that have transitioned to the green phase.
The department has created an older adult daily living center reopening checklist for facilities reopening in green phase areas.
The department also has created a staff and participant COVID-19 wellness check screening tool for older adult daily living centers that are reopening.
The department also clarified that OLTL is requiring LIFE Centers to follow adult daily living center guidance for reopening.

Federal Update

Centers for Medicare & Medicaid Services

CMS has published a compendium of Medicare physician fee schedule changes implemented in recent months in response to the COVID-19 crisis.
CMS has posted a table that describes COVID-19 adjustments announced yesterday for CMMI model programs.
CMS announced that the Nursing Home Compare web site now provides data on COVID-19 cases and deaths in individual nursing homes. Accompanying this announcement is publication of an FAQ on this nursing home data and a memo to state Medicaid programs about the data.

Department of Health and Human Services

HHS has updated its CARES Act’s Provider Relief Fund FAQ with additions on pages 3, 20, and 21. Hospitals should review these changes carefully.
HHS announced new lab data reporting guidance that specifies what additional data must be reported to HHS by laboratories along with COVID-19 test results. This guidance standardizes reporting. See HHS’s announcement, the guidance itself, and an FAQ for the guidance.

Centers for Disease Control and Prevention

The CDC has updated its web page on COVID-19 in racial and ethnic minorities.

Food and Drug Administration

The FDA has introduced a new web-based resource, Testing Supply Substitution Strategies, that includes detailed information to help support labs performing authorized COVID-19 tests.
The FDA has updated the question-and-answer appendix in its guidance Conduct of Clinical Trials of Medical Products during COVID-19 Public Health Emergency with new information about compliance for electronic systems used to generate electronic signatures on clinical trial records.
The FDA has issued an alert to providers about the temporary absence of the “paralyzing agent” warning statement on the vial caps of the neuromuscular blocking agents vecuronium bromide and rocuronium bromide, both of which are often used for patients requiring medical ventilation.
The FDA has issued emergency use authorizations (EUAs) for five new commercial diagnostic tests for COVID-19. Find them here, here, here, here, and here.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

(To receive this daily update directly, sign up for our mailing list at info@pasafetynet.org.)

PA Safety Net Admin2020-09-01T18:36:23+00:00June 5th, 2020|Coronavirus, COVID-19, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

MFAR Backlash Continues

Diverse health care and government interests are rallying around their opposition to the proposed Medicaid fiscal accountability rule.

Bookshelf with law books The regulation, proposed by the Centers for Medicare & Medicaid Services in November would impose new limits on the ability of states to finance their share of their Medicaid spending, potentially jeopardizing provider payments and the ability of high-volume Medicaid providers to operate without suffering great losses.

In all, CMS received more than 4200 written comments in response to the proposed regulation, most of them expressing opposition. Among those doing so were state governments, the National Governors Association, hospitals and hospital associations, nursing home operators, and health advocacy organizations. Also among them was the Safety-Net Association of Pennsylvania. In summarizing its opposition, SNAP wrote in a formal comment letter to CMS on behalf of Pennsylvania safety-net hospitals that

SNAP is concerned that this proposed regulation would inappropriately restrict the state’s ability to finance the non-federal share of the Medicaid program, would impose significant additional regulatory burdens – the cost of which would far outstrip their benefit – would inappropriately introduce subjectivity into the application of previously clear and objective regulatory standards, and is beyond the scope of the statutory authority granted to CMS.

See SNAP’s entire letter here.

Learn more about the Medicaid fiscal accountability rule, what it seeks to do, and why so many oppose in the Stateline article “Medical Groups Slam Trump Medicaid Rule.”

PA Safety Net Admin2020-03-04T06:00:15+00:00March 4th, 2020|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

340B Déjà Vu: CMS Seeks to Collect Data From Hospitals

For the second time in four months, the federal government has announced its intention to collect data from hospitals and other providers on what they pay for the prescription drugs they purchase through the section 340B prescription drug discount program.

Last week the Centers for Medicare & Medicaid Services published a notice announcing its intention to collect this data. Previously, health care interests sued CMS when it attempted in 2018 to reduce payments to providers for drugs purchased through the 340B program and the court ruled against CMS, maintaining that the agency did not have enough data on hospitals’ acquisition costs for the drugs to justify the proposed payment reduction. The newly announced data collection effort seeks to rectify that shortcoming as the court considers CMS’s appeal of a similar decision in a lawsuit filed after CMS again proposed reducing 340B payments and was again rebuffed by the courts in 2019.

Under federal law, CMS must publish a notice declaring its intention to collect such data and seek input from stakeholders. For this particular notice, stakeholders have until March 9 to respond.

CMS published a similar notice in September of 2019 announcing its intention to collect similar data. That data collection never took place.

Most Pennsylvania safety-net hospitals participate in the 340B program and consider it a vital tool in serving the many low-income residents of the communities in which they are located.

To learn more about CMS’s 340B data collection effort, see the notice it published in the Federal Register and read the Becker’s Hospital Review article “CMS ready to survey 340B hospitals about drug acquisition costs.”

PA Safety Net Admin2020-02-13T06:00:33+00:00February 13th, 2020|340b, Pennsylvania safety-net hospitals|Comments Off

Wolf Administration Proposes New Human Services Initiatives for FY 2021

New human services efforts to support vulnerable populations are a major part of Governor Tom Wolf’s proposed $36.06 billion FY 2021 budget for Pennsylvania.

The proposed budget, presented to the state legislature earlier this week, includes the following new initiatives:

creating pathways to success in the workforce for low-income Pennsylvanians
increasing the minimum wage to $15
increasing Department of Human Services staffing to support licensing and oversight
supporting adults in long-term-care facilities
legal services for vulnerable populations
direct care worker comprehensive training
commitment to performance-based metrics, accountability, and transparency in services and licensing
supporting vulnerable populations through home- and community-based services and reducing waiting lists
prevention services to support at-risk families
improving food security while supporting agriculture

Go here to see DHS’s presentation of these initiatives.

In addition, the Safety-Net Association of Pennsylvania has prepared a detailed memo describing the proposed FY 2021 budget’s implications for Pennsylvania safety-net hospitals and the state’s Medicaid program. For a copy of this memo, use the “contact us” link in the upper right-hand corner of this page.

PA Safety Net Admin2020-02-07T06:00:38+00:00February 7th, 2020|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2021 budget, Pennsylvania safety-net hospitals, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

Medicaid DSH Cut Delayed

Scheduled cuts in Medicaid DSH payments to hospitals will be delayed until at least late May under new federal spending legislation.

The cuts in Medicaid disproportionate share allotments to the states, mandated by the Affordable Care Act and delayed several times by Congress – including twice in FY 2020 alone under continuing resolutions to fund the federal government – are among a number of so-called “extenders” included in spending bills passed by Congress this week and sent to the president for his signature.

Authorization for delaying the cut in allotments to the states, which would have resulted in reduced Medicaid DSH payments for many hospitals – including private safety-net hospitals – would expire on May 22. Congress is expected to address Medicaid DSH, along with surprise medical bills, the price of prescription drugs, and other health care matters, before that time.

SNAP has argued against Medicaid DSH cuts for a number of years, doing so most recently in an October 2019 message to members of Pennsylvania’s congressional delegation in which it wrote that

Should the Medicaid DSH cut take effect, Pennsylvania would lose 40 percent of its federal Medicaid DSH allotment in FY 2020 and 80 percent of its allotment each year from FY 2021 to FY 2025. Such devastating cuts could jeopardize access to care for the state’s uninsured and jeopardize the ability of the state’s safety-net hospitals to serve them. It is essential, for the sake of Pennsylvania’s health care safety net and the communities and patients that safety net serves, that the Medicaid DSH cut continue to be delayed.

Learn more about the delay in Medicaid DSH cuts and other aspects of this recent health care spending legislation in the Becker’s Hospital Review article “Congress unveils $1.3T spending deal: 5 healthcare takeaways.”

PA Safety Net Admin2019-12-19T06:00:58+00:00December 19th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid|Comments Off

Prescription Drug Bill Would Kill Two Years of Medicaid DSH Cuts

Two years of Medicaid DSH cuts would be eliminated under a new prescription drug bill released last week by the Senate Finance Committee.

The Prescription Drug Pricing Reduction Act includes a provision that would eliminate two years of Affordable Care Act-mandated cuts in the allocation of federal money to the states for Medicaid disproportionate share hospital payments (Medicaid DSH). Those cuts have been delayed several times by Congress but were scheduled to begin in October of 2019 and run through federal FY 2025, only to be delayed again twice by continuing resolutions adopted by Congress to fund the federal government in the absence of enacted appropriations bills.

Under this proposal, the first two years of Medicaid DSH cuts would be eliminated entirely and the cut then would take effect from FY 2022 through FY 2025 – only four of the six years worth of cuts anticipated by the Affordable Care Act.

The legislation also would bring other changes to the Medicaid DSH program, including new reporting requirements on the non-Medicaid DSH supplemental payments hospitals receive from their state governments; changes in Medicaid shortfall and third-party payment policies; and a GAO study and report on hospital uncompensated care costs.

All Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider them critical to serving the many Medicaid-covered and uninsured residents of the low-income communities in which they are located.

Go here to see the proposed legislation.

PA Safety Net Admin2019-12-10T12:24:38+00:00December 10th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

High-Deductible Plans Driving Rise in Hospital Bad Debt

Hospital bad debt rose in 2018 after several years of decline, and according to Moody’s, high-deductible health insurance is one of the major drivers of that increase.

According to the bond rating agency, non-profit hospitals are seeing growing amounts of bad debt as they struggle, often unsuccessfully, to collect from patients whose high deductibles leave them on the hook for meaningful amounts of care.

Kaiser Health News reports that 28 percent of covered workers, nearly half of them working for companies with fewer than 200 employees, now have health plan deductibles of at least $2000. That proportion of individuals with such high deductibles has nearly quadrupled in the last decade.

Bad debt can be an especially challenging problem for Pennsylvania safety-net hospitals because they care for so many low-income patients who, even when they have health insurance, often struggle to find the money to pay their share of the costs their plans do not cover.

Learn more about the bad debt challenge facing hospitals in the Healthcare Dive article “Nonprofit bad debt climbs again amid steeper deductibles, Moody’s says.”

PA Safety Net Admin2019-12-03T06:00:46+00:00December 3rd, 2019|Pennsylvania safety-net hospitals|Comments Off

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