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Archive for December 2017

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients. Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs. Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH.  The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients. The Affordable Care Act calls for reducing Medicaid DSH payments … Read More

Posted in Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News. Included in this edition are articles about: The January 1 introduction of Community HealthChoices, a mandatory program of managed long-term services and supports, in southwestern Pennsylvania the January 1 implementation of the federal ordering, referring, or prescribing rule that requires that all such actions involving Pennsylvania Medicaid patients be undertaken by providers enrolled with the state to serve Medicaid patients various Medicare issues Find these stories here in the latest edition of Health Law News.

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

Medicaid Directors Meet

The National Association of Medicaid Directors held its fall conference recently outside Washington, D.C. This is an important event at which policy-makers and policy experts meet to discuss Medicaid programs, trends, challenges, and opportunities. Many of the materials used during that conference are now publicly available, including video clips from speeches by CMS Administrator Seema Verma and others and presentations on a number of subjects, including: Medicaid’s role in supporting community engagement and economic mobility busting the silos of physical and behavioral health care alternative payment models and addressing the social determinants of health early intervention in behavioral health the opioid epidemic pediatric innovations in Medicaid Go here for links to the speeches and presentations offered at the conference.

Posted in Federal Medicaid issues

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C. The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting. The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s … Read More

Posted in Federal Medicaid issues

House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program. That means Medicare, Medicaid, and possibly even Social Security. Ryan said that We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking. Medicare and Medicaid cuts would be very harmful to Pennsylvania safety-net hospitals. Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying about entitlement cuts in this Washington Post story.

Posted in Federal Medicaid issues, Medicare

ED Myths Exposed

The uninsured do not use emergency rooms more than the insured. And the expansion of health insurance coverage increases rather than decreases ER use. So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.”  Find the study here.

Posted in Uncategorized

Senators Seek 340B Reprieve

A bipartisan group of senators has written to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer expressing concern about cuts in Medicare Medicare prescription drug payments to qualified providers as a result of new regulations governing the section 340B prescription drug discount program.  Those cuts have been adopted by regulation by the Centers for Medicare & Medicaid Services and will take effect beginning on January 1, 2018. Under the regulation adopted by CMS, Medicare payments for prescription drugs dispensed on an outpatient basis to low-income patients will be reduced to qualified providers by $1.6 billion in the coming year.  While acknowledging problems with how the 340B program has evolved over the years, the senators ask their leaders … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs. So concludes a new study in Annals of Internal Medicine. According to the report, Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.  This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce. Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance.  Medicaid, in particular, has not been a financial participant in such efforts. But that may be changing. The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios.  The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients. Because … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals
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