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Archive for December 2014

Access to Medicaid Services

A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients. Find that commentary here.

Posted in Uncategorized

PA Addresses Healthy PA Transition Issues

The Pennsylvania Department of Human Services (DHS – formerly the Department of Public Welfare) has issued a memo to Medical Assistance stakeholders addressing two issues involving implementation of the state’s Healthy Pennsylvania Medicaid expansion that have been brought to its attention. The first issue is that individuals who enrolled in Medicaid in December were not assigned to a behavioral health managed care organization. The second addresses screening of individuals who currently qualify for Medicaid under the General Assistance category who have behavioral health needs and who likely qualify for the “Healthy Plus” Medicaid benefits plan beginning in 2015. See the state’s message to stakeholders outlining what these issues are about and how it plans to address them in this memo … Read More

Posted in Healthy PA, Pennsylvania Medicaid policy

PA Officially Ends Enhanced Medicaid Payments

The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31. While some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1. See the Medical Assistance Bulletin notice here.

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

Medical Assistance Eligibility Manual Released

The Pennsylvania Health Law Project has updated its Medical Assistance eligibility manual. Written in plain English for a general readership, the manual describes the various ways individuals may qualify for Medical Assistance (Medicaid) in Pennsylvania and how they can go about applying for benefits. Find the updated manual here.

Posted in Pennsylvania Medicaid policy

PA Wins Innovation Planning Grant

Pennsylvania is among 21 states that will receive State Innovation Models Initiative Model Design Awards from the federal Center for Medicare and Medicaid Innovation. The award of $3 million will be used to …engage a diverse group of stakeholders, including public and commercial payers, providers and consumers, to develop a State Health Care Innovation Plan. The purpose of the state innovation models program is to support …states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation. The Innovation Center is interested in testing innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the … Read More

Posted in Health care reform, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year. At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington. During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016.   They will vote on their recommendation at their next meeting. A presentation to MedPAC members by their staff also offered a number of observations about Medicare services: Demand for hospital services is stable. With hospital occupancy down to 60 percent, it appears hospitals have excess capacity. The quality of care hospitals provide is improving according … Read More

Posted in Uncategorized

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services. In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments:  a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies. The program, the benefits, and the new guidelines take effect on January 1. Find this Medical Assistance Bulletin here.

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

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia. Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index:  elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English.  Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions for the three conditions studied, with employment status more than three times as powerful an indicator as lack of high … Read More

Posted in Uncategorized

Governor-Elect Sets Transition Teams

Pennsylvania Governor-elect Tom Wolf has announced the membership of his transition committees for human services (including Medicaid), health, and insurance. Those committees and their members are: Human Services Chair Michael Rashid – Former CEO, AmeriHealth Caritas Deb Beck – President, DASPOP Joan Benso – President & CEO, PA Partnership for Children Jeff Brown – President and CEO, Brown’s Super Stores, Inc. Mark Bullock – Senior VP, Mercy Health System Adam Devlin – Co-Founder, New Vitae Wellness and Recovery John Elliott – Chairman and Senior Shareholder, Elliott Greenleaf Liz Healey – Member, Pittsburgh School Board; Executive Director, The PEAL Center Dorothy Mann – Former CEO, The Family Planning Council of SEPA Sam Milkes – Executive Director, PLAN, Inc. Ross Nese – … Read More

Posted in Uncategorized

PA Medicaid Primary Care Fees to Plummet

Payments to Pennsylvania primary care physicians who serve Medicaid patients will fall 52.4 percent after the first of the year, when the Affordable Care Act’s two-year increase in those payments ends. The temporary fee increase was included in the Affordable Care Act to encourage more primary care physicians to serve Medicaid patients in anticipation of the significant growth of Medicaid as a result of the reform law’s Medicaid expansion.  Under that law, Medicaid primary care fees were raised to the level of Medicare primary care rates for two years.  Nation-wide, the average Medicaid primary care fee will fall 42.8 percent. So far, 15 states plan to use their own money to prevent the dramatic reduction of Medicaid primary care payments.  … Read More

Posted in Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals
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