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Archive for May 2015

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade. In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace. In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures.  It also proposes better aligning the governance of CHIP with Medicaid, new requirements … Read More

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals

Underinsurance Remains a Problem

Twenty-three percent of American adults are uninsured, according to a new survey by the Commonwealth Fund. Among them, 14 million had deductibles that exceeded five percent of their income while another 24 million had deductibles that fell below that threshold but had out-of-pocket health care costs – deductibles, co-insurance, co-payments, and out-of-network payments – that exceeded ten percent of their income. The figures are for 2012 and reflected no change since 2010 but were nearly twice those found in 2003. In addition, the survey found that the proportion of the insured with high-deductible plans has more than tripled, from three percent to 11 percent, since 2003.  This is believed to reflect the proliferation of high-deductible plans in recent years – … Read More

Posted in Affordable Care Act

PHC4 Reports on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has released its annual report on the financial performance of the state’s acute-care hospitals. Among the highlights (changes in performance are from 2013 to 2014): The total margin of hospitals state-wide declined 0.36 percentage points, from 6.06 percent to 5.7 percent. The operating income of acute-care hospitals fell from $1.8 billion to $1.7 billion. Thirty-four percent of hospitals lose money on operations and 28 percent lost money overall. Uncompensated care rose 2.2 percent, or $22 million, to $1.07 billion. The number of hospital discharges and patient days declined. The number of outpatient visits fell 3.2 percent. Outpatient services accounted for 44.8 percent of net patient revenue. To learn more about what PHC4 … Read More

Posted in Uncategorized

Medical Malpractice Suits Fall in PA

Since new laws designed to reduce the number of medical malpractice suits in Pennsylvania were passed in 2003 and 2004, the number of such suits has been cut in half. Last year, 1463 medical malpractice suits were filed in Pennsylvania.  In 2002, 2904 such suits were initiated. And possibly related, the number of physicians practicing medicine in Pennsylvania has risen – a development that follows a nation-wide trend but is doing so at a rate that exceeds the growth in the number of doctors in other states. To learn more about what Pennsylvania did to reduce medical malpractice lawsuits, how those laws are working, and how this may or may not be affecting the state’s supply of practicing physicians, see … Read More

Posted in Uncategorized

GAO Examines Medicaid Section 1115 Waivers

The U.S. Department of Health and Human Services (HHS) frequently exercises the authority granted to it under section 1115 of the Social Security Act to authorize Medicaid expenditures for uses not strictly permitted under that law if those uses extend Medicaid coverage to populations not already served by Medicaid or promote Medicaid objectives. Pennsylvania’s Medicaid program has long taken advantage of section 1115 waivers. At the request of the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee, the U.S. Government Accountability Office (GAO) examined recently approved section 1115 waivers to evaluate whether those waivers met the criteria for the exemptions and whether the documents HHS issues when approving those waiver requests adequately convey what the … Read More

Posted in Pennsylvania Medicaid policy

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference.  The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments. That two-year Medicaid primary care fee bump ended on December 31, 2014.  Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources.  Pennsylvania is not … Read More

Posted in Affordable Care Act, Pennsylvania Medicaid policy

5% of Medicaid Recipients Account for 50% of Costs

Just five percent of all Medicaid recipients are responsible for nearly half of the program’s expenditures. Or so says a new report by the U.S. Government Accountability Office (GAO). Conversely, the 50 percent of Medicaid’s least costly recipients account for only eight percent of the program’s costs. Disabled Medicaid recipients, while fewer than 10 percent of the overall total, represent nearly two-thirds of the highest-cost group. These figures reflect spending from 2009 through 2011. The greatest Medicaid expenditures were invested in seven types of care:  for patients with asthma, diabetes, HIV/AIDS, mental health conditions, substance abuse, and delivery or childbirth along with those residing in long-term-care facilities. To learn more about the GAO’s findings, see a summary of the report … Read More

Posted in Uncategorized

New 340B Rules Expected Soon

The federal Health Resources and Services Administration (HRSA) is expected to release new rules governing its section 340B prescription drug discount pricing program in the near future. The new rules have long been in development and were in the verge of being published late last year when the agency decided to try another approach to addressing some of the program’s problems, but now, new draft guidelines are being reviewed by the White House Office of Management and Budget (OMB) in anticipation of being published soon in the Federal Register. The 340B program, which provides discounts on prescription drugs to hospitals and others that serve large numbers of low-income patients, has encountered controversy in recent years with providers complaining about the … Read More

Posted in Pennsylvania safety-net hospitals

PA Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the April edition of Health Law PA News, its monthly newsletter. Included in this edition are articles about the status of Pennsylvania’s latest Medicaid expansion effort; an explanation of state policy for calculating applicants’ income for the purpose of determining whether they are eligible for Medicaid; health insurance options for immigrants; and more. Find the latest edition of Health Law PA News here.

Posted in HealthChoices PA, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

Minutes of MAAC Fee-For-Service Subcommittee Meeting

The Fee for Service Subcommittee of Pennsylvania’s Medical Assistance Advisory Committee (MAAC) has approved the minutes of the subcommittee’s February 11 meeting. That meeting addressed the introduction of in-house radiology review in the state’s Medicaid fee-for-service program, Medicaid expansion in the state, provider enrollment and revalidation efforts as required by the Affordable Care Act, and more. See those minutes here.

Posted in Pennsylvania Medicaid policy
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