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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

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs.

Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs.

This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations.

As a Medicaid expansion state, Pennsylvania and the safety-net hospitals that serve its low-income communities have contributed to this encouraging trend.

Learn more about how Medicaid expansion is improving the health of low-income people with diabetes and lowering health care spending in this California Healthline report or go here to see the Health Affairs study “Medicaid Eligibility Expansions May Address Gaps in Access to Diabetes Medications” on which that report is based.

Filed under: Affordable Care Act, Pennsylvania safety-net hospitals

PA Outlines Implementation of Association Health Plans

In a letter to the U.S. Secretary of Health and Human Services and Secretary of Labor, the Pennsylvania Insurance Department has outlined how it plans to implement at the state level the recent federal regulation governing association health plans.

In the letter, state Insurance Commissioner Jessica Altman notes ambiguities in the federal regulation and describes how the state Insurance Department intends to address those ambiguities and other aspects of the federal regulation that she believes are unclear.

See the Insurance Department’s news release on this issue here and read Commissioner Altman’s letter here.

Filed under: Uncategorized

PA Looking at Social Determinants of Health

One of the emerging trends in health care is a greater focus on what are called the “social determinants of health” – factors and conditions  in individuals’ lives that may affect both their health and their ability to obtain the medical services they need to stay healthy or recover when they are sick or injured.

Pennsylvania’s Department of Human Services, which runs the state’s Medicaid program, has increased its focus on the social determinants of health as it looks to Medicaid providers and Medicaid managed care plans to do more than provide medical services:  it wants them to join with others in addressing the social determinants of health of the communities they serve.

Recently, Pennsylvania Department of Human Services deputy executive secretary Leesa Allen, former director of the state’s Medicaid program, participated in a panel discussion to talk about the social determinants of health and how the state is approaching this issue.  Go here to listen to that conversation, which was broadcast by WITF, a Harrisburg-based public radio station.

Filed under: Pennsylvania Medicaid

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements.

Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries.

Azar told a Heritage Foundation audience that

We suffered one blow in district court in litigation, but we are undeterred.  We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states.  We are moving forward.

Twice in the past two years, proposals to impose a work requirement on Pennsylvania Medicaid recipients failed in the state legislature.  The issue is likely to arise again.

Learn more about the ruling against Kentucky’s Medicaid work requirement, which was approved by HHS, and the federal government’s determination to enable states to impose such requirements in this Washington Post article.

Filed under: Federal Medicaid issues, Pennsylvania Medicaid

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers.

This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs.

The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers.  The two biggest risks, the GAO concluded, were:

  1. incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for services not provided; and
  2. inaccurate state payments to MCOs resulting from using data that are not accurate or including costs that should be excluded in setting payment rates.

The GAO traces some of these problems to a delay in the Centers for Medicare & Medicaid Services’ planned Medicaid managed care guidance to states; limited implementation of new auditing practices CMS introduced in 2016; and CMS’s failure to account for overpayments to providers when it reviews state capitation rates for Medicaid managed care plans.

To address these shortcomings, the GAO report recommends that CMS:

  1. expedite issuing planned guidance on Medicaid managed care program integrity;
  2. address impediments to managed care audits; and
  3. ensure states account for overpayments in setting future MCO payments.

The vast majority of Pennsylvania’s non-long-term care Medicaid spending is through Medicaid managed care.

Learn more about the study – why it was undertaken, how it was conducted, what it found, and what it recommended – by going here to see the GAO report Medicaid Managed Care:  Improvements Needed to Better Oversee Payment Risks.

 

Filed under: Federal Medicaid issues, Pennsylvania Medicaid

Former PA Gubernatorial Candidate Lands at CMS

Paul Mango, who earlier this year ran unsuccessfully for the Republican nomination for governor of Pennsylvania, has joined the Centers for Medicare & Medicaid Services as chief principal deputy administrator and chief of staff.

Mango previously worked as a health care consultant for more than 25 years, including for the McKinsey & Company consulting firm.  Among his past Pennsylvania clients were hospitals and insurers.

Filed under: Uncategorized

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs.

According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible.

Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it.

Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion.

Learn more about the studies, their results, and their significance by going here to see the Health Affairs report “No Association Found Between The Medicaid Primary Care Fee Bump And Physician-Reported Participation In Medicaid and here for the study “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion.”

Filed under: Affordable Care Act, Federal Medicaid issues

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2012 Safety-Net Association of Pennsylvania