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Archive for March 2014

2.5 Million Uninsured, Underinsured in PA

1.4 million Pennsylvanians were uninsured and another 1.1 million were underinsured in 2012, according to a new report. The report, America’s Uninsured:  A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions, was produced by the Commonwealth Fund. According to the Central Penn Business Journal, the report defines “underinsured” as those whose households spent a high share of annual income on medical care — 10 percent or more of income on medical care, excluding premiums, or 5 percent or more if income was under 200 percent of the federal poverty level.  It did not include insured people who needed care but went without it because of the out-of-pocket costs they would incur or the insured who stayed … Read More

Posted in Uncategorized

MACPAC Recommends Steps to Ensure Continuity of Care

Citing income volatility among low-income Americans, the federal agency charged with analyzing Medicaid and the Children’s Health Insurance Program (CHIP) has recommended that Congress adopt measures to ensure that low-income Americans retain health insurance as their income fluctuates above and below the federal poverty level. In its March report to Congress, MACPAC (the Medicaid and CHIP Payment and Access Commission) recommends that Congress empower states to extend coverage to eligible adults for an entire year to ensure that as those adults become eligible for Medicaid, lose Medicaid eligibility as their income rises, and then become eligible again because of unemployment or illness, they can maintain continuity of coverage and care. MACPAC also recommends that Congress extend the current transitional medical … Read More

Posted in Uncategorized

PA Examining Long-Term-Care Issues

With a fast-growing elderly population, Pennsylvania currently has two advisory committees looking at how to help that population tend to its medical and social needs as it ages. The state legislature’s bipartisan Joint State Government Commission is working with an advisory group to the state House and is expected to complete its work and issue a report this summer. Meanwhile, Governor Corbett’s recently created Pennsylvania Long-Term Care Commission held its first meeting this month and is expected to work through the end of the year. For a closer look at the issues these two groups are addressing and how they are going about their work, see this article in the Pittsburgh Post-Gazette.

Posted in long-term care, Pennsylvania Medicaid policy

Bill in Congress Would Benefit PA Safety-Net Hospitals

New legislation introduced in Congress would add a risk adjustment component to Medicare’s hospital readmissions reduction program. Such a measure would benefit Pennsylvania’s safety-net hospitals. H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, proposes modifying Medicare’s hospital readmissions reduction program.  Under the bill, hospitals’ performance in preventing Medicare readmissions would be risk-adjusted for patients who are dually eligible for Medicare and Medicaid; for patients who are considered non-compliant; for patients whose readmission has been classified as based on psychosis or substance abuse; and for patients who have specific medical conditions. Hospitals found to have too many Medicare readmissions suffer financial penalties under Medicare’s hospital readmissions reduction program.  Recent studies suggest that in its current form, the … Read More

Posted in Uncategorized

Providers Must Re-enroll to Serve PA Medicaid Population

All health care providers that serve Pennsylvania’s Medicaid population must re-enroll with the state if they wish to continue doing so. The requirement, established under the Affordable Care Act, applies to providers that participate in both the state’s Medicaid managed care and fee-for-service programs. Additional information can be found about the requirement and how to re-enroll in this Medical Assistance Bulletin notice.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

How Did Healthy PA Change?

In December, the Corbett administration released a draft of its application to the federal government for a waiver from aspects of existing Medicaid law so it could implement its “Healthy Pennsylvania” Medicaid reform and health insurance expansion program. The public was then invited to comment on the draft application, and in late February, the administration submitted its official Medicaid waiver application to the federal government.  That official application included a number of changes from the December draft, reflecting comment submitted to state officials. What were those changes? The state has published a brief document, “Healthy Pennsylvania Demonstration Adjustments,” that summarizes those changes.  Find that document here.  

Posted in Health care reform, Healthy PA, Pennsylvania Medicaid policy

PA Learns of 43,000 New Medicaid Applicants

The federal government has sent to Pennsylvania state officials data on 43,000 people whose applications for Medicaid eligibility have been tied up for months in the federal government’s computers as part of the troubled launch of the healthcare.gov web site. Most of the applicants will be contacted by Department of Public Welfare caseworkers while applications for the Children’s Health Insurance Program (CHIP) will be handled by the state Insurance Department. Learn more about this situation in this article on the web site of KYW radio.

Posted in Affordable Care Act

Increase Use of Value-Based Purchasing, HHS Told

A study performed for the U.S. Department of Health and Human Services calls for greater use of value-based purchasing in federal health care reimbursement policy. The study, performed by the RAND Corporation, recommends developing a national value-based purchasing strategy; developing a more deliberate approach to evaluating the effectiveness of value-based purchasing efforts; and developing performance measures that support value-based purchasing approaches. Such an approach could be a major challenge for Pennsylvania’s safety-net hospitals, according to a Harvard School of Public Health analysis that found that in the first year of Medicare’s value-based purchasing program, hospitals that served the largest numbers of low-income patients suffered the largest financial penalties from that program. Read more about the RAND study in this Fierce … Read More

Posted in Uncategorized

State Seeks Restoration of Tobacco Money

Pennsylvania has gone to court to seek the restoration of more than $200 million in tobacco funds that it lost as a result of an arbitration ruling last year. The money, from the national master tobacco settlement agreement, is used to make Tobacco Uncompensated Care Fund payments that are vital to the state’s safety-net hospitals.  The purpose of the tobacco money is to help underwrite the cost of uncompensated care provided by hospitals that serve especially large numbers of uninsured patients. Last year an arbitration panel ruled that the state had failed to collect the tobacco taxes owed to it as part of the national tobacco settlement agreement.  In its suit attempting to overturn the arbitration decision, the state maintains … Read More

Posted in Uncategorized

PA Relents on Medicaid Work-Search Requirement

One of the most controversial aspects of the Corbett administration’s proposal to expand the state’s Medicaid program was that every able-bodied adult of working age be required to demonstrate that they were pursuing employment. On Thursday, the administration agreed to drop that proposal in the face of opposition from the Obama administration. Instead, the Corbett administration will propose a one-year, voluntary, incentive-based pilot program requiring participants to document their work-search efforts.  Like the original work-search requirement, this proposal will be subject to federal review. Read more about this development in Pennsylvania’s pursuit of federal approval to expand its Medicaid program in this Lancaster Online article.  Find a copy of Governor Corbett’s letter dropping the controversial component and proposing an alternative … Read More

Posted in Healthy PA, Pennsylvania Medicaid policy
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