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Confluence of State, Federal Activity Prompts Medicaid Talk in Harrisburg

The combination of Congress attempting either to repeal and replace or repair the Affordable Care Act and Pennsylvania facing a multi-billion budget shortfall has led some policy-makers in Harrisburg to begin talking about ways to better manage or reduce the state’s Medicaid costs. Those costs climbed from $3.9 billion in 2004 to $6 billion in 2014. Among the possibilities state lawmakers are discussing:  tighter rules for participation, greater efficiency, work and work search requirements for able-bodied Medicaid recipients, charging premiums for high-income families for which Medicaid provides coverage for their profoundly disabled children, and a pilot program to test whether a recipient care management program might eliminate medical errors, improve recipient health, and reduce health care costs. Learn more about … Read More

Posted in Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News. Included in the June/July edition are articles about the status of Pennsylvania’s FY 2018 budget, including possible changes in the state human services code; a delay in awarding new HealthChoices contracts; new quality initiatives in the state’s contracts with HealthChoices managed care organizations; an update on the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports; and more. Find the newsletter here.

Posted in Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

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.

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

PA Medicaid to Expand Access to Hep C Drugs

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

Posted in Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

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.

Posted in Pennsylvania Medicaid policy, Pennsylvania proposed FY 2018 budget

New MACPAC Study Evaluates Medicaid, Medicare Payments

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

Posted in Medicaid supplemental payments, Pennsylvania Medicaid policy, Uncategorized

Pennsylvania Health Law Project Newsletter

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.

Posted in HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid policy

CMS Clarifies Medicaid DSH Rule

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

Posted in Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals

Presentation on Value-Based Purchasing in PA Medicaid

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.  

Posted in HealthChoices, Pennsylvania Medicaid policy

PA Proposes Changes in County Assistance Office Operations

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

Posted in Pennsylvania Medicaid policy
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2012 Safety-Net Association of Pennsylvania