Archive for Pennsylvania Medicaid policy
The Pennsylvania Health Law Project has published its May newsletter. Included in this edition are articles on new criteria for Medicaid coverage of high-cost hepatitis C drugs and the release of a draft of the state’s proposed Medicaid quality strategy; an update on Community HealthChoices, Pennsylvania’s new program of Medicaid managed long-term services and supports; an overview of Medicaid-covered behavioral health services; a summary of recent federal proposals with implications for the state’s Medicaid program; and a report on the nomination of Teresa Miller to lead the new Department of Health and Human Services that Governor Wolf has proposed establishing. Find the newsletter here.
Pennsylvania’s Medicaid program will make treatment for hepatitis C more readily available to Medicaid beneficiaries beginning on July 1, state officials have announced. In recent years, new drugs have become available that effectively cure hepatitis C but their exceptionally high costs led many insurers, including most state Medicaid programs, to limit access to those drugs until patients show more advanced signs of the disease. A year ago the Pennsylvania Department of Human Services’ pharmacy and therapeutics committee recommended expanding access to these drugs for Pennsylvania Medicaid beneficiaries and now, that recommendation has been adopted and that expansion will begin with the new state fiscal year on July 1. Under the new criteria, patients with lower scores of severity of hepatitis … Read More
The Pennsylvania Health Law Project has published its April 2017 newsletter. Included in this edition are articles about: the budget bill passed by the state House and its potential impact on Medicaid in Pennsylvania; the potential impact on Medicaid of the American Health Care Act under consideration by Congress; an update on Community HealthChoices, the state’s new program of managed long-term services and supports for seniors struggling to continue living in the community; information on the income verification process for those seeking to apply for or renew Medicaid eligibility; and the process of shifting prescriptions from Medicaid to Medicare. Find the latest edition of PA Health Law News here.
Medicaid payments to hospitals are comparable to or even higher than Medicare payments. Or at least they are once supplemental Medicaid payments are included. So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues. In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is … Read More
The Pennsylvania Health Law Project has published its March 2017 newsletter. Included in this edition are stories about: new starting dates for the beginning of new HealthChoices physical health contracts an update on Community HealthChoices, the state’s planned program of managed long-term services and supports for those who qualify for nursing home care but wish to continue living independently in the community the launch of the state’s ABLE Savings Program through which children and adults with significant disabilities can open special state-sponsored investment accounts the introduction of a new assessment tool for people in need of substance disorder treatment Find the latest edition of PA Health Law News here.
Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs. This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit. According to CMS, This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients. The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party … Read More
Pennsylvania’s Medicaid program is moving toward greater use of value-based purchasing in its Medicaid behavioral health programs. Last week, the state’s Office of Mental Health and Substance Abuse Services held a webinar to offer information about the state’s plan for employing value-based purchasing in Medicaid and how it will do so for behavioral health services in particular. Go here to see the presentation delivered at that webinar.
The manner in which Pennsylvania operates its county assistance offices would change under a new proposal from the Department of Human Services that was included in Governor Wolf’s proposed FY 2018 budget. Under the plan, the state would consolidate county assistance office back-office operations in five new regional processing centers. While every county will have what DHS is calling a county assistance office “presence,” the new approach would lead to the lay-off of 70 of the county assistance office program’s nearly 7000 employees. The process of determining Medicaid eligibility in Pennsylvania either begins or works its way through the state’s county assistance offices. Learn more about the proposal to change some aspects of county assistance office operations in this DHS … Read More
The Pennsylvania Department of Human Services has announced new steps designed to combat opioid abuse within the state’s Medicaid population. Among those steps are ensuring that only providers registered with the state’s Medicaid program can prescribe opioids and fill opioid prescriptions for Medicaid patients; monitoring the opioid-prescribing practices of participating Medicaid providers and taking actions when those practices are inappropriate; introducing new opioid prescribing guidelines; improving access to naloxone to fight opioid overdoses; expanding drug treatment programs; and more. To learn more, see this news release from the office of Pennsylvania Governor Tom Wolf.