Archive for November 2014
The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program. The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients. While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned. A spokesman for the federal Health Resources and Services administration told Bloomberg BNA that the release has been delayed until next year and that the … Read More
When the federal government approved the Corbett administration’s Healthy Pennsylvania Medicaid proposal at a time when the governor trailed in the polls in his bid for re-election, observers wondered whether Mr. Corbett would continue to implement the program if he lost even if his opponent opposed that implementation. The answer, apparently, is yes. Department of Public Welfare Secretary Beverly Mackereth told the Pittsburgh Post-Gazette that the state continues to implement the Healthy Pennsylvania Medicaid expansion and will begin enrolling participants on December 1 in anticipation of the program’s official launch on January 1. It is doing so despite being asked not to do so by representatives of Governor-elect Tom Wolf, who does not take office until January 20. Learn more … Read More
The Centers for Medicare & Medicaid Services (CMS) has published data showing changes in the premiums for individual and small group health insurance plans offered in Pennsylvania for 2015. Including plans offered both within and outside the federal health insurance marketplace, the numbers show that individual plan premiums are up an average of 2.31 percent while small group plans have seen rates rise 3.19 percent. Learn more about the data release in this Central Penn Business Journal article or go here for the entire CMS database, where you can search for data by state.
Fifty American states have 50 different Medicaid programs. While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities. The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years. Among the areas the survey explored are: budgets Affordable Care Act implementation relationships with others in their state government, federal agencies, and regulators program integrity innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and challenges in the area of long-term services and supports Find out how the country’s 50 Medicaid directors view the challenges … Read More
Seventeen of the 18 members of Pennsylvania’s U.S. House delegation have sent a joint, bipartisan letter to House Speaker John Boehner and minority leader Nancy Pelosi asking them make a priority of repealing – before the current session of Congress ends – the sustainable growth rate formula (SGR) used to determine how doctors are paid to serve Medicare patients. See their letter here.
The independent federal agency that advises Congress on Medicare payment issues met last week in Washington and addressed a number of issues of importance to hospitals. Among the issues discussed by the Medicare Payment Advisory Commission (MedPAC) were: beneficiary access to hospital care and how service volume affects hospital costs hospital short stay policy issues per beneficiary payment for primary care the 340B drug pricing program site-neutral payments for selected conditions treated in inpatient rehabilitation facilities and skilled nursing homes payment policies to promote the use of services based on clinical evidence Find links to the presentations offered by MedPAC staff on these issues here, on MedPAC’s web site.
Pennsylvania Governor Tom Corbett’s Healthy Pennsylvania program calls for the state to expand its Medicaid program on January 1 through a private insurance market option in which people choose private insurance plans through which to receive the Medicaid benefits for which they are newly eligible. But Pennsylvania Governor-elect Tom Wolf wants to expand the state’s traditional Medicaid program and not employ the private insurance market coverage. Governor Corbett will still be in office when his program is set to take effect on January 1, 2015. Mr. Wolf will not take the oath of office until January 20. The Philadelphia Inquirer takes a look at how Pennsylvania’s private insurance market option came about and what may happen next. See its story … Read More
The Pennsylvania Health Law Project has released its October newsletter. It includes articles about Healthy Pennsylvania’s Medicaid expansion and its impact on behavioral health benefits; about letters the state is sending to current Medicaid recipients about changes in their benefits; and about letters from the federal government to those enrolled in federal marketplace plans reminding them that they need to renew their health insurance. The newsletter also features an article about how the state will address those currently enrolled in federal marketplace plans who will become eligible for Medicaid on January 1. Find the Pennsylvania Health Law Project’s newsletter here.
The Mcare assessments of Pennsylvania hospitals and doctors will decrease 48 percent in 2015. Pennsylvania’s Medicare Care Available and Reduction of Error Fund, or Mcare, provides supplemental medical malpractice liability insurance for Pennsylvania health care providers. Pennsylvania requires hospitals and doctors to have a minimum level of liability coverage and they obtain half of that minimum amount from the Mcare Fund. Next year’s assessment is smaller because of reduced claims against the Mcare Fund and leftover money from previous years that a court ordered to be used for this purpose. To learn more about the fund and the decrease, see this news release on the state Insurance Department’s web site.
Companies will no longer be able to provide their employees with group health insurance plans that do not cover inpatient hospitalization. This news came in a recent notice published by the Internal Revenue Service. Recently, many large employers with lower-wage workers were purchasing low-cost health insurance that does not cover hospitalization. The IRS, however, has ruled that such plans do not meet the Affordable Care Act’s minimum value threshold. Companies were only able to purchase such plans because they are not required meet the reform law’s essential health benefits package requirement, which applies only to plans offered to individuals on health insurance exchanges. The no-hospitalization policies were likely to leave many lower-income workers without the coverage they needed – and … Read More