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Archive for November 2013

Enrolling Homeless in Medicaid Poses Challenges, Offers Hope

Enrolling the homeless in Medicaid poses numerous logistical challenges for government, providers, and caregivers but also offers the prospect of improving the lives of those who gain access to care. Many low-income, homeless adults will be eligible for Medicaid for the first time in states that expand Medicaid eligibility under the Affordable Care Act, but enrolling them in the program can be difficult:  they can be hard to find, hard to convince to apply, and hard to enroll because they lack such basics as a mailing address and telephone number. Yet bringing health care to such individuals could greatly improve their lives and perhaps help address their homelessness by ending the financial stresses that resulted in homelessness or improving their … Read More

Posted in Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy

Safety-Net Hospitals Bear Brunt of Medicare Penalties

Hospitals that serve the largest proportion of low-income patients are suffering the greatest financial penalties under Medicare’s value-based purchasing program. Collectively, hospitals that serve the most low-income patients are seeing their Medicare payments reduced 0.09 percent during year two of the Medicare program while hospitals that serve the fewest low-income patients have seen their Medicare payments rise 0.06 percent, according to a new study by a Harvard School of Public Health professor. Medicare’s value-based purchasing program, mandated by the Affordable Care Act, bases penalties and bonuses on 24 quality measures. In Pennsylvania, 45 percent of the state’s hospitals received bonuses while 53 percent were penalized; both figures are the same as the national averages.  The average bonus for Pennsylvania hospitals … Read More

Posted in Affordable Care Act, Health care reform

400,000 Fall Into PA Insurance Gap

400,000 Pennsylvanians currently fall into a gap between eligibility for the state’s Medicaid program and qualifying for health insurance subsidies through the state’s health insurance marketplace. Under the Affordable Care Act, states were to expand eligibility for their Medicaid programs while the federal government would provide partial subsidies for low-income people who remained ineligible for Medicaid but were unlikely to be able to afford health insurance without such assistance. But when the Supreme Court made Medicaid expansion optional for states, many people fell into a new insurance gap that was not anticipated when the 2010 reform law was written.  Approximately half of the 50 states have expanded their Medicaid programs as the law expected, but in the half that did … Read More

Posted in Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy, Uncategorized

Some States Face Double Loss: No Medicaid Expansion Plus DSH Cut

When passed in 2010, the Affordable Care Act called for significant cuts in future Medicare disproportionate share hospital payments (Medicare DSH) based on the expectation that hospitals would have far fewer of the uninsured patients such payments helped subsidize.  They would have fewer uninsured patients because of the reform law’s Medicaid expansion provisions and enhanced access to affordable health insurance. But then the Supreme Court made Medicaid expansion optional instead of mandatory for states. Today, 25 states have chosen either not to expand their Medicaid programs or have not decided what to do, but their hospitals still face the prospect of a future loss of Medicare DSH revenue without the full expected decline in the number of uninsured patients they … Read More

Posted in Uncategorized

PA Facing Loss of Federal Medicaid Funds

Pennsylvania stands to lose $325 million in federal Medicaid matching funds next year. The reduction comes as a result of a decline in the state’s federal medical assistance percentage (FMAP) of 1.7 percentage points that takes effect as of October 1, 2014. Department of Public Welfare Secretary Beverly Mackereth is asking federal officials to review their calculation of the state’s matching rate. Read about the anticipated loss of federal Medicaid funds and how it might affect recipient benefits and provider payments in this Philadelphia Inquirer article.

Posted in Uncategorized

ACA Drives Rise in Medicaid Enrollment

While some aspects of implementation of the Affordable Care Act continue to struggle with technical problems, one aspect is moving ahead effectively:  enrollment in Medicaid is on the rise. More than 400,000 newly eligible people in just ten states have enrolled in Medicaid since October 1.  The ten states are among the 25 that have decided to expand their Medicaid programs in accordance with provisions of the federal health care reform law.  Other states either have chosen not to expand their programs or are still undecided about expansion. Pennsylvania is one of the states that has not expanded its Medicaid program but state officials are currently negotiating a possible expansion with the federal government.  The Safety-Net Association of Pennsylvania supports … Read More

Posted in Affordable Care Act, Health care reform, Pennsylvania Medicaid policy

CMS Offers Guidance on Medicare “Two-Midnight Rule”

The Centers for Medicare & Medicaid Services (CMS) has published an FAQ to give providers guidance on the application of its so-called two-midnight rule governing when certain medical situations qualify for patient admission and when they should be classified as Medicare outpatient observation status.  See that FAQ here.

Posted in Uncategorized

PA Ambulatory Surgery Centers Grow in Numbers, Profitability

The number of ambulatory surgery centers in Pennsylvania grew in FY 2012, and along with that growth in numbers came a growth in profitability. According to a new report by the Pennsylvania Health Care Cost Containment Council (PHC4), providers added 10 new facilities in FY 2012, raising the number to 281, and the average operating margin of the facilities rose from 24.94 percent to 25.83 percent. For the latest data on ambulatory surgery centers in Pennsylvania, where they are, who they serve, how many procedures they perform, and who is paying for those procedures, find a PHC4 news release and the agency’s latest report here.

Posted in Uncategorized

Psych Bed Shortage Taxing Hospital ERs

The lack of psychiatric beds in Pennsylvania has contributed to a rise in the number of behavioral health patients turning to hospital emergency rooms for care. Or so says the Pennsylvania Medical Society. Patients with nowhere else to turn often visit hospital ERs in search of help. In response, the medical society hopes to create a tracking system to identify behavioral health and detoxification beds. Learn more about this problem and physicians’ proposed response to it in this Central Penn Business Journal article.

Posted in Uncategorized
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