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Archive for August 2016

PA Launches Prescription Drug Monitoring Program

Pennsylvania’s Department of Health has launched its much-anticipated prescription drug monitoring program. Previously operated by the state’s office of the attorney general but assigned to the state’s Health Department through 2014 legislation, the program requires those authorized to prescribe controlled substance prescription drugs to collect and submit information to the PDMP each time they do so within 72 hours. That information is then stored in a database that is available to health care professionals to help them identify patients who may have problems with controlled substances or may even be going from provider to provider to gain additional prescriptions. The state Health Department has created a web site for the program that includes FAQs about how the PDMP works for … Read More

Posted in Uncategorized

PA Ratchets Up Battle Against Opioid Abuse

The Commonwealth of Pennsylvania will create 25 new Opioid Use Disorder Centers of Excellence, joining 20 similar centers established last year. According to a news release from the office of Pennsylania Governor Tom Wolf, The additional COEs announced today will serve at least 5,600 additional individuals.  The COEs are a central, efficient hub around which treatment revolves. These centers will have navigators to assist people with opioid-related substance use disorders through the medical system, and ensure they receive behavioral and physical health care, as well as any evidence-based medication-assisted treatment needed. The centers are funded in part by state behavioral health funds, in part by state Medicaid funds, and in part by federal Medicaid matching funds. Learn more about the Centers … Read More

Posted in Uncategorized

Who’s Still Uninsured?

Hispanics. Young people between the ages of 19 and 34. Men. Low-income people, especially those living in states that have not expanded their Medicaid programs. People in the South – again, especially those living in states that have not expanded their Medicaid programs. Those who work for small companies. The uninsured rate in the U.S., 20 percent before the Affordable Care Act took effect, is now 13 percent. Learn more about how the Affordable Care Act has changed the rate at which different groups of Americans are insured in this Commonwealth Fund survey.

Posted in Affordable Care Act

CMS Proposes Medicaid DSH Rule

The Centers for Medicare & Medicaid Services has proposed a new rule that would clarify the basis for eligible hospitals’ Medicaid disproportionate share hospital payments (Medicaid DSH). Individual hospitals’ Medicaid DSH payments are based on their uncompensated care costs and the rule clarifies that only uncompensated costs for Medicaid patients for whom hospitals receive no other payments, such as from Medicare, state or local governments, or third-party payers, would count toward their hospital-specific Medicaid DSH limit. See the rule here. Interested parties have until September 15, 2016 to submit formal comments to CMS about its proposal. Representatives of Pennsylvania safety-net hospitals who would like to know more about how this proposal might affect their hospital can use the “contact us” link on … Read More

Posted in Medicaid supplemental payments, Pennsylvania safety-net hospitals

Price Transparency Report Released by PA Department of Health

The Pennsylvania Department of Health has published a report it commissioned on the state of health care price transparency in the commonwealth. The report, prepared by the organization Catalyst for Payment Reform, seeks to … evaluate the level and robustness of health care price transparency in the Commonwealth of Pennsylvania today and the opportunities to enhance it going forward. The report reviews and assesses the legal and regulatory landscape related to price transparency; identifies and compares the best practices of other states that are leading the country in enhancing price transparency; summarizes results from a CPR-conducted evaluation of consumer-facing transparency tools offered by health insurance plans; identifies gaps in price and quality transparency in the state; and lastly, provides actionable … Read More

Posted in Uncategorized

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations. If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities.  If this trend holds true in Pennsylvania, it could be harmful to many of the communities served by the state’s safety-net hospitals. To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

Posted in Pennsylvania safety-net hospitals, Uncategorized

PA Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance. The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment. HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements … Read More

Posted in HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

CMS Urges Improvements in Care for Physically, Mentally Disabled

New guidance issued by the Centers for Medicaid Services outlines how states can make better use of home care in serving physically and mentally disabled Medicaid beneficiaries. Those steps include establishing open registries of home care workers; establishing qualifications for such workers; and paying wages that will help foster continuity of care for the clients of those home care workers. In making these recommendations, CMS seeks to make greater use of managed long-term services and supports and home- and community-based services when serving individuals who might otherwise need costly nursing home care. Pennsylvania is in the process of launching a new such program, called Community HealthChoices, that will offer dually eligible Medicare/Medicaid seniors the option of receiving managed long-term services … Read More

Posted in Pennsylvania Medicaid policy

Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital. The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016. Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and the average penalty in FY 2017 will be 0.73 percent – up from 0.61 percent in FY 2016. The program … Read More

Posted in Uncategorized

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations.   Such payments are often used to distribute the proceeds from state hospital taxes. The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely. In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals
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2012 Safety-Net Association of Pennsylvania