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Proposed “Public Charge” Regulation Could Hit Medicaid, Hospitals

If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S.

The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time.

A new analysis published by the Kaiser Family Foundation concluded that

Under the proposed rule, individuals with lower incomes, a health condition, less education, and/or who are enrolled or likely to enroll in certain health, nutrition, and housing programs would face increased barriers to obtaining LPR [legal permanent residency] status.

The study notes that

Nearly all (94%) noncitizens who originally entered the U.S. without LPR status have at least one characteristic that DHS could potentially weigh negatively in a public charge determination.

To avoid losing eligibility for legal permanent residency status, the analysis suggests,

 The proposed rule would likely lead to disenrollment from Medicaid and other programs among noncitizens who intend to seek LPR status as well as among a broader group of individuals in immigrant families, including their primarily U.S. born children.

How many people might disenroll from Medicaid, CHIP, and other programs is difficult to project but the study notes that

If the proposed rule leads to Medicaid disenrollment rates ranging from 15% to 35% among Medicaid and CHIP enrollees living in a household with a noncitizen, between 2.1 to 4.9 million Medicaid/CHIP enrollees would disenroll.

And

Reduced participation in Medicaid and other programs would negatively affect the health and financial stability of immigrant families and the growth and healthy development of their children, who are predominantly U.S.-born.

This, in turn, could lead to financial challenges for health care providers serving communities with large numbers of low-income patients, many of whom could be individuals who do not have permanent residency status.  Some could seek to disenroll from Medicaid, or not to enroll if they qualify, leaving them uninsured if and when they need and seek medical care.  This could prove especially challenging for Pennsylvania safety-net hospitals located in areas with large numbers of immigrant residents.

Learn more about the proposed regulation and its implications for those it might affect and their health status in the Kaiser Family Foundation report “Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid,” which can be found here.

Filed under: Federal Medicaid issues

PA Insurers Drop Pre-Authorization Requirement for Medication-Assisted Opioid Treatment

Seven of the largest health insurers serving Pennsylvanians have agreed to end pre-authorization requirements for patients needing medication-assisted treatmen for opioid addictions.

As explained in a news release issued by the governor’s office,

These guidelines apply to individual, small group, and large group fully insured plans. Self-funded plans, where employers provide health care coverage administered by a third party, are regulated by the federal government and are not included in this agreement.

In addition,

The guidelines implement thresholds for prior authorization for long- and short-acting opioids, morphine milligram equivalents (MME) and exceptions for active cancer, sickle cell crisis, and palliative care/hospice patients. Generally, commercial insurers are requiring prior authorization for all long-acting opioid prescriptions and short-acting opioid prescriptions after seven days. Some insurers are phasing in their alignment with many of the guidelines.

To learn more about the new approach by health insurers, including how the agreement was reached and to which medication-assisted treatments this new policy will apply, see this news release from the governor’s office.

Filed under: Uncategorized

CMS Promises Enhanced Use of Medicaid Data to Improve Program Results

Centers for Medicare & Medicaid Services administrator Seema Verma intends to increase federal use of data reported by the states to improve the performance of state Medicaid programs.

In an article published on the CMS blog, Verma wrote that

Through strong data and systems, CMS and states can drive toward better health outcomes and improve program integrity, performance, and financial management in Medicaid and CHIP.

Verma pointed to two core sets of data she considers vital:  Medicaid and CHIP child and adult core sets, which are reported only voluntarily by states, and administrative data submitted through the relatively new Transformed-MIS system.  The latter, according to Verma.

…modernizes and enhances the way states submit operational data about beneficiaries, providers, claims and encounters.  It is the foundation of a national analytic data infrastructure to support programmatic and policy improvements and program integrity efforts and will help advance reporting on outcomes.  It also enhances the ability to identify potential fraud and improve program efficiency.

All states now use Transformed-MIS.

Learn more about how CMS uses data now and how it envisions using it in the future to improve the performance of state Medicaid programs in the CMS blog entry “CMS Promises Enhanced Use of Medicaid Data to Improve Program Results,” which can be found here.

Filed under: Federal Medicaid issues

Verma Speaks at Medicaid Managed Care Summit

Centers for Medicare & Medicaid Services administrator Seema Verma recently addressed the Medicaid Managed Care Summit, which was held in Washington, D.C.

Ms. Verma’s speech focused on four major areas:

  • Empowering states to function as laboratories for innovation by giving them the flexibility to introduce changes that work best for their own citizens.
  • Developing Medicaid and CHIP scorecards that present data on health outcomes, quality metrics, and CMS’s administrative performance.
  • Improving Medicaid program integrity, including through “…targeted audits to ensure that provider claims for actual health care spending match what the [Medicaid managed care] health plans are reporting financially.”
  • Strengthening CMS’s use of data in Medicaid oversight.

See Ms. Verma’s complete remarks here.

Filed under: Federal Medicaid issues

Bill Would Advance Telemedicine in PA

A bill proposed in the Pennsylvania state legislature would require private insurers to cover telemedicine services under selected circumstances.

House Chamber of the State HouseSenate Bill 780, currently under consideration by the House Professional Licensure Committee, was the subject of a recent committee hearing during which hospital officials from across the state spoke in support of fostering greater use of telemedicine in the delivery of health care services.

Learn more about the bill and why hospital executives traveled to Harrisburg to express their support for it in this article in the publication Lehigh Valley Business or go here to see the bill itself.

Filed under: Uncategorized

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals.

The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve.  The readmissions performance of hospitals is then compared only to other hospitals within each peer group.

As a result of this new approach, readmissions penalties against safety-net hospitals are expected to decline 25 percent in FY 2019 while the average penalty for hospitals serving the fewest low-income patients will rise.

Kaiser Health News has published a detailed story describing the policy change and its implications for hospitals, which face penalties of up to three percent of their Medicare revenue for what is considered “excessive” readmissions of Medicare patients within 30 days of their discharge from the hospital.  Included in the article is a searchable database of every hospital in the country that lists the peer group for each hospital, its FY 2018 and FY 2019 readmissions penalties by percentage of Medicare revenue, and the change in readmissions penalty expected from FY 2018 to FY 2019.  Go here to see the article “Medicare Eases Readmission Penalties Against Safety-Net Hospital.”

Filed under: Medicare

PA Uninsured Rate Hits All-Time Low

Pennsylvania’s uninsured rate in 2017 was 5.5 percent – the lowest on record, according to the Wolf administration.

Pennsylvania State MapAccording to the Wolf administration, more than one million Pennsylvanians have obtained health insurance in recent years through the expansion of the state’s Medicaid program or improved access to insurance made possible through the Affordable Care Act.

The national uninsured rate is 8.8 percent.

Learn more about the decline in the number of uninsured Pennsylvanians from this news release from the governor’s office.

Filed under: Affordable Care Act

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C. to review a number of Medicaid- and CHIP-related issues.

MACPAC members heard presentations on and discussed the following issues:

Find outlines of these subjects and additional materials by clicking the links above and go here for a transcript of the two days of public meetings.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program.  While its recommendations are binding on neither the administration nor Congress, MACPAC’s work is highly influential and often finds its way into future Medicaid and CHIP policy.  Because Pennsylvania safety-net hospitals serve so many Medicaid and CHIP patients, they have an especially major stake in MACPAC deliberations and recommendations.

 

Filed under: Federal Medicaid issues

Low-Acuity Use of Emergency Departments Declines

People are using hospital emergency departments less frequently for low-acuity medical problems, turning instead to retail clinics and urgent care.

According to a new study of a limited patient population published in JAMA Internal Medicine,

Visits to the ED for the treatment of low-acuity conditions decreased by 36% (from 89 visits per 1000 members in 2008 to 57 visits per 1000 members in 2015), whereas use of non-ED venues increased by 140% (from 54 visits per 1000 members in 2008 to 131 visits per 1000 members in 2015). There was an increase in visits to all non-ED venues: urgent care centers (119% increase, from 47 visits per 1000 members in 2008 to 103 visits per 1000 members in 2015), retail clinics (214% increase, from 7 visits per 1000 members in 2008 to 22 visits per 1000 members in 2015), and telemedicine (from 0 visits in 2008 to 6 visits per 1000 members in 2015). Utilization and spending per person per year for low-acuity conditions had net increases of 31% (from 143 visits per 1000 members in 2008 to 188 visits per 1000 members in 2015) and 14% ($70 per member in 2008 to $80 per member in 2015), respectively. The increase in spending was primarily driven by a 79% increase in price per ED visit for treatment of low-acuity conditions (from $914 per visit in 2008 to $1637 per visit in 2015).

Despite the emergency these ED alternatives, ED utilization continues to rise.

Learn more from the report “Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015,” which can be found here, on the JAMA Internal Medicine web site.

Filed under: Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the July/August 2018 edition of its newsletter.

Included in this edition are articles about:

  • proposed changes in Medicaid-covered behavioral health services for children;
  • the launch in southeastern Pennsylvania of Community HealthChoices, the state’s program of managed long-term services and supports for the dually eligible Medicare/Medicaid population;
  • Community HealthChoices’ person-centered services plans; and
  • changes in how individuals will seek health insurance for 2019 through the federal health insurance marketplace.

Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.

Filed under: Pennsylvania Medicaid, Pennsylvania Medicaid policy

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2012 Safety-Net Association of Pennsylvania