New Public Charge Rule Could Affect Immigrants, Providers

Legal immigrants may become reluctant to seek government-sponsored health care and providers may find themselves delivering more uncompensated care in the wake of the adoption of a new federal “public charge” regulation that seeks to define more narrowly the kinds of individuals who should be granted entry to the U.S. in the future.

The new Department of Homeland Security regulation, while focused on applicants for entry into the U.S., could have the unintended effect of discouraging legal immigrants from enrolling in Medicaid, CHIP, and other government programs and even lead them to disenroll from such programs out of a mistaken concern that participating in such programs could jeopardize their status as legal immigrants.  The Kaiser Family Foundation, in fact, estimates that two to three million people will leave Medicaid and CHIP because of the new regulation.

More than a quarter of a million interested parties responded to the proposed regulation, which was published last October, and since its release last week a wide variety of groups, ranging from the American Hospital Association and America’s Essential Hospitals to the American Council of Pediatrics, have noted the new regulation’s potential impact with alarm.  Hospitals, in particular, are concerned that if people disenroll from Medicaid and CHIP, they will end up providing more uncompensated care to patients who previously had health insurance through those two public programs.

This could be especially challenging for Pennsylvania safety-net hospitals that are located in communities with large numbers of low-income legal immigrants.

Learn more about the new public charge regulation and health care providers’ reaction to it in the Fierce Healthcare article “Healthcare industry groups warn final ‘public charge’ rule could impact immigrant health, drive up costs.”

Filed under: Federal Medicaid issues, Pennsylvania safety-net hospitals

Overdose Deaths Down in PA

Overdose deaths in Pennsylvania fell 18 percent from 2017 to 2018, according to a news release issued by Governor Wolf’s office.

The decline results, according to the news release, from a combination of prevention, rescue, and treatment.  These and efforts, including the distribution of free naloxone, a drug that helps rescue those who have overdosed on some drugs, have been funded in part by a grant from the U.S. Substance Abuse and Mental Health Services Administration and Pennsylvania’s own Substance Use Disorder Loan Repayment Program, which assists health care professionals who work in the behavioral health field with the cost of their education.

At the same time, however, overdose deaths in Pennsylvania from stimulants such as cocaine and methamphetamines continue to rise.

Learn more about the decline in overdose deaths in Pennsylvania and how it has come about from a news release from the governor’s office and the Johnstown Tribune-Democrat article “State OD deaths dropped 18 percent in 2018; stimulant deaths rose.”

Filed under: Uncategorized

PHC4 Reports on Common Procedures

The Pennsylvania Health Care Cost Containment Council has published a new report detailing hospital performance on four common surgical procedures:  knee replacement, hip replacement, spinal fusion, and coronary artery bypass graft.

The report details individual hospital performance on these procedures, including in-hospital mortality, complications, and extended post-operative length of stay.  In addition, it breaks down hospital performance for all of these measures and all of these procedures based on patient age, income, gender, geographic location, and race and ethnicity.

The PHC4 report also reveals how many of these procedures individual hospitals performed and how much they charged for their services.

Learn more in the new PHC4 publication Common Procedures Report.

Filed under: Uncategorized

CMS Introduces New Medicaid Opioid Management Guidelines

States must do more to monitor the prescription and use of opioids within their Medicaid programs, the Centers for Medicare & Medicaid Services told them this week.

In a formal guidance letter to state Medicaid programs issued as part of implementation of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018, CMS called on states to update their drug utilization programs, revise relevant portions of their state Medicaid plan, and introduce stronger practices for setting limits on the prescription of opioids and monitoring the use of opioids among patients for whom such drugs are prescribed.  These changes must include both prospective and retrospective drug utilization review.

The new requirements apply both to Medicaid fee for service and managed care programs and all of these steps must be completed by the end of calendar year 2019.

Learn more from the CMS guidance letter “State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act.”

Filed under: Federal Medicaid issues

PA Slams Brakes on Medicaid Transportation Program Overhaul

The plan to introduce major changes in Pennsylvania’s free medical transportation program for the Medicaid population has temporarily been halted.

As envisioned by the state, the current program, in which individual counties contract independently with transportation providers to serve their residents on Medicaid, was to be replaced by a regional approach in which the state contracts with three vendors to serve all of Pennsylvania.  Objections by members of the state legislature and county officials, however, led to legislation that requires the Department of Human Services, Department of Transportation, and Department of Aging to study the implications of such a change for patients and taxpayers and to report their preliminary findings to the legislature in September.

Learn more about Pennsylvania’s Medical Assistance Transportation Program, how it works now, how the state sought to change it, and what to expect in the near future in the Philadelphia Inquirer article “Overhaul of PA’s medical transport program on hold after counties raise concerns.”


Filed under: Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

New Bill Would Address Social Determinants of Health

The federal government would provide funding to help address social determinants of health within Medicaid populations under a new bill introduced in the House of Representatives last week.

According to a legislative summary prepared by one of the bipartisan bill’s sponsors,

Economic and social conditions have a powerful impact on our health and wellness. Stable housing, reliable transportation and access to healthy foods are all factors that can make a difference in the prevention and management of many health conditions like diabetes, asthma and heart disease. Known as social determinants of health, a focus on these non-medical factors can improve health outcomes and wellbeing. States are increasingly looking to deploy social determinants of health interventions to manage costs and improve health outcomes within their Medicaid programs. However, one of the greatest challenges to high-impact interventions is the difficulty in navigating and coordinating fragmented and complex programs aimed at addressing healthcare needs, food insecurity, housing instability, workforce supports, and transportation reliability, among others.

To address these challenges, the bill would

help states and communities devise strategies to better leverage existing programs and authorities to improve the health and well-being of those participating in Medicaid. The legislation will provide planning grants and technical assistance to state, local and Tribal governments to help them devise innovative, evidence-based approaches to coordinate services and improve outcomes and cost-effectiveness.

Such legislation could be especially beneficial to the communities served by Pennsylvania safety-net hospitals, which generally can be found in low-income communities whose residents’ health is often shaped in large part by social determinants of health.

Learn more about the Social Determinants Accelerator Act by reading a summary of the bill’s key provisions and an FAQ on the bill.

Filed under: Federal Medicaid issues, social determinants of health

ACA’s Medicaid Pay Bump Helped But Benefits Now Lost, Study Says

Health status and access to care improved for Medicaid patients when the Affordable Care Act mandated a temporary rate increase for physicians serving newly insured patients covered through that law’s Medicaid expansion.

But when the mandate for increased physician payments ended and state Medicaid programs reverted to their previous, lower payments, many of those benefits were lost.

Or so reports a new study from the National Bureau of Economic Research.

According to the study, even a $10 rate increase improved access to care enough to reduce by 13 percent Medicaid recipients’ complaints about not being about to find a doctor.  Utilization also increased.  The temporary Medicaid pay increase has even been credited with improving school attendance and reducing chronic absenteeism.

Despite the benefits of the temporary increase in Medicaid payments to physicians, most states returned to lower payments when the mandated ended, most of the gains resulting from the better pay for treating Medicaid patients disappeared, and the disparities between privately insured individuals and Medicaid patients returned to their pre-Affordable Care Act levels.

Researchers estimate that increasing Medicaid payments to physicians by an average of $26 a visit would eliminate disparities in access to care.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve have so many more Medicaid patients than the typical American community.

Learn more from the National Bureau of Economic Resarch study “The Impacts of Physician Payments on Patient Access, Use, and Health” and from the Healthcare Dive report “Even $10 increase in Medicaid payments helps erase disparities in care access, study says.”

Filed under: Affordable Care Act

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals.  Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries.  CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that the current requirement applies only to Medicaid fee-for-service payments even though most Medicaid beneficiaries now receive care through managed care plans, the payments for which are not subject to the same process.

The agency adds that it intends to

…replace the ongoing access reviews required by current regulations with a more comprehensive and outcomes-driven approach to monitoring access across delivery systems, developed through workgroups and technical expert panels that include key State and federal stakeholders.

Because they care for so many Medicaid patients, the adequacy of the rates states pay for Medicaid services is especially important to Pennsylvania safety-net hospitals.

Learn more about CMS’s proposal in its news release on the subject or see the proposed regulation itself.  Learn about the process CMS intends to employ to replace its current approach to monitoring access to Medicaid services in this CMS informational bulletin.


Filed under: Federal Medicaid issues

Medicaid DSH Delay Advances in Energy and Commerce Committee

Medicaid disproportionate share cuts would be delayed for two years under a proposal advanced last week by the Health Subcommittee of the House Energy and Commerce Committee.

The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.

The Safety-Net Association of Pennsylvania supports this delay of Medicaid DSH cuts.  Earlier this year, SNAP asked members of the state’s congressional delegation to join a campaign in the House of Representatives to delay this cut.

Learn more about the possibility of another delay of Medicaid DSH cuts in the HealthLeaders article “House Panel Advances Surprise Bill Package.”


Filed under: DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments

The Role of Medicaid in Addressing Social Determinants of Health

Medicaid can play a major role in addressing the social determinants of health.

Or so argues a recent post on the Health Affairs Blog.

According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care.  Medicaid, the post maintains, can play a major role in addressing social determinants of health.

The post outlines the role state Medicaid programs can play in addressing social determinants of health; describes tools for such action such as section 1115 Medicaid demonstration waivers; offers examples of efforts currently under way in some states; and presents suggestions for steps the federal government can take to facilitate such efforts.

Addressing social determinants of health is an especially important issue for Pennsylvania safety-net hospitals because they care for so many more Medicaid-covered low-income patients than the typical hospital in the state.

Learn more from the Health Affairs Blog post “For An Option To Address Social Determinants Of Health, Look To Medicaid.”


Filed under: Federal Medicaid issues, Pennsylvania safety-net hospitals, social determinants of health

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2012 Safety-Net Association of Pennsylvania