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Archive for May 2012

HealthChoices Expands, ACCESS Plus Contracts

Effective July 1, the Pennsylvania Medical Assistance program’s HealthChoices mandatory managed care program will expand to seven new counties:  Bedford, Blair, Cambria, Franklin, Fulton, Huntingdon, and Somerset.  At the same time, the state’s ACCESS Plus Medicaid managed care program will cease operations in those same counties. Further information can be found in a May 25 Department of Public Welfare (DPW) Medical Assistance Bulletin, which can be found here.

Posted in Meetings and notices

Medical Assistance Primary Care Rates to Rise

Rates for primary care services covered by Pennsylvania’s Medical Assistance program will rise upon implementation next year of a new federal regulation recently published in draft form by the Centers for Medicare & Medicaid Services (CMS). Under the proposed regulation, Pennsylvania must pay Medicare-level rates for Medicaid-covered primary care services in 2013 and 2014.  Medicare rates are higher for such services than Pennsylvania’s Medical Assistance rates, and under the proposed regulation the federal government, not the state, will pay for the difference between Medicare and Medicaid rates. This new policy was mandated by the Affordable Care Act.  In addition to raising fee-for-service rates, Pennsylvania will be expected to revise agreements with its contracted HealthChoices plans to ensure that they, too, … Read More

Posted in Health care reform, Pennsylvania Medicaid policy

PA Sets Terms of New Telemedicine Expansion

The Pennsylvania Department of Public Welfare (DPW) has announced that it is expanding its use of telemedicine to serve the state’s Medical Assistance population.  Telemedicine is widely considered an especially useful tool for serving rural patients. Under the new approach, the program will expand the types of medical specialists who may engage in telemedicine, remove the requirement that referring physicians participate in telemedicine consultations, and establish specific technologies for use in such consultations. DPW has issued a new Medical Assistance Bulletin presenting more information about its new approach. Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30 describes the new program and outlines procedures for engaging in telemedicine consultations.  This bulletin can be found here.  A fee schedule and provider codes can be … Read More

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

Medical Assistance Expands Use of Telemedicine

Pennsylvania’s Medical Assistance program has unveiled plans to make greater use of telemedicine in the future. According to a news release from the governor’s office, the program will expand the types of medical specialists who may engage in telemedicine, remove the requirement that referring physicians participate in telemedicine consultations, and establish specific technologies for use in such consultations. Learn more about this Medical Assistance initiative by going here and reading the governor’s news release.

Posted in Pennsylvania Medicaid policy

Medical Malpractices Cases, Verdicts Down in PA

Ten years after the state Supreme Court instituted changes in how and where medical malpractice cases could be filed, the number of cases filed and the number of verdicts issued has declined. Currently, cases must be certified as having potential merit before they are filed.  Also, plaintiffs must file in the county where the alleged malpractice occurred.  Previously, those with weaker cases often filed in counties where juries are considered more lenient. Read more about how and why in this Pittsburgh Post-Gazette article.

Posted in Pennsylvania Medicaid laws and regulations

PA Hospitals Doing Better, PHC4 Reports

The financial performance of Pennsylvania’s acute-care hospitals improved in 2011, according to the Pennsylvania Health Care Cost Containment Council. While hospitals’ uncompensated care rose 11.2 percent, to $990 million, the state-wide average operating margin rose from 4.37 percent to 5.58 percent, according to Financial Analysis 2011, Volume One, Acute Care Hospitals.  Hospitals’ net income rose $769 million, to $2.69 billion, with 72 percent of that improvement coming from operating income. Find PHC4’s news release and the report itself, which includes an industry-wide analysis as well as detailed information about the financial performance of every Pennsylvania acute-care hospital, here on PHC4’s web site.

Posted in Uncategorized

MAAC to Meet

The next meeting of Pennsylvania’s Medical Assistance Advisory Committee (MAAC) will be held on Thursday, May 24 in Harrisburg.  The MAAC advises the Pennsylvania Department of Public Welfare on Medicaid policy.  Its meetings are open to the public.

Posted in Meetings and notices

Readmissions and Poverty

At a time when Medicare and many state Medicaid programs are attempting to penalize hospitals when patients are readmitted shortly after they were discharged, researchers have found that some of those readmissions are linked to factors beyond hospitals’ control. According to research presented recently at the American Heart Association’s Quality of Care & Outcomes Research Scientific Sessions 2012, differences in regional readmission rates are more closely tied to socioeconomic factors and access to care than they are to hospitals’ performance. Researchers found that nine percent of regional variation in hospital readmission rates can be tied to patients’ poverty.  Access to care, based on the availability of doctors and hospital beds, can be tied to 17 percent of regional variation in … Read More

Posted in Safety-Net Association of Pennsylvania

Access to Care Declines

Non-elderly and uninsured adults have less access to health care than they did ten years ago, according to a new study released by the Urban Institute. The study, “Virtually Every State Experienced Deteriorating Access to Care for Adults Over the Past Decade,” also concluded that this deterioration of access can be found in almost every state, is even worse for the uninsured, and is especially great in states with the highest uninsured rates. Learn more about this erosion of the health care safety net and download the entire report here, on the Urban Institute’s web site.

Posted in Uncategorized

Medicaid Raises Doc Pay

Primary care physicians serving Medicaid patients will receive a raise in their fees for the next two years. The raises, a temporary measure mandated by the Affordable Care Act, will be in effect for calendar years 2013 and 2014 and will raise Medicaid’s primary care physician fees to the same level paid by Medicare for comparable services. The $11 billion needed to pay for this raise will come from the federal government.  States will not be required to provide matching funds. Read a news release from the Centers for Medicare & Medicaid Services (CMS) about the new Medicaid primary care fee here, a CMS fact sheet here, and the newly proposed regulation here.

Posted in Pennsylvania Medicaid policy
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2012 Safety-Net Association of Pennsylvania