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CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients.

Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C.

The Washington Examiner reports that at that event, Verma said that

We are looking at what the court said.  We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals.

CMS currently has applications from eight states to establish new Medicaid work requirements.  While Pennsylvania is not among them, some members of the state’s General Assembly unsuccessful advocated such a requirement last year and continue calling for the introduction of a work requirement in the state’s Medicaid program.

Learn more about the legal obstacles Medicaid work requirements have encountered and how CMS views those obstacles in this Washington Examiner article.

 

Filed under: Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the June 2018 edition of its monthly newsletter.

Included in this edition are articles about:

  • Changes in Pennsylvania Medicaid’s medical transportation program governing non-emergency transportation.
  • The renewal of the state’s hospital tax and an increase in that tax.
  • Challenges surrounding the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports, in southwestern Pennsylvania.
  • Information about the launch of Community HealthChoices in southeastern Pennsylvania.
  • A provision in a recent bill modifying the state’s human services code that calls for the Department of Human Services to develop a new, outcomes-based program for hospitals and Medicaid managed care plans that will be oriented toward preventing potentially avoidable medical events.

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

 

Filed under: long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

HHS Chief Says 340B Changes are Coming

Health care providers and drug manufacturers should expect changes in the section 340B prescription drug discount program in the near future.

That was the message conveyed by Health and Human Services Secretary Alex Azar during a recent conference held by the 340B Coalition.

The 340B program, which provides discounts on the prescription drugs dispensed on an outpatient basis by eligible providers to their low-income patients, has become increasing controversial in recent years as it has expanded and pharmaceutical companies have objected to the discounts they must provide.

Among the changes Azar suggested are coming are greater accountability among participating hospitals for how they use the savings they derive from the discounts and a narrowing of the difference between the prices hospitals pay for the drugs and their average sales price, which Azar said is currently too great.  CMS recently imposed a 28 percent reduction of Medicare payments to participating providers for drugs dispensed to 340B-qualified patients.

To qualify for participation in the program, providers must serve especially high proportions of low-income patients.  All Pennsylvania safety-net hospitals participate in the program.

Learn more about Secretary Azar’s comments from this Healthcare Dive article.

Filed under: 340b, Uncategorized

Energy and Commerce to Look at 340B Today

The Health Subcommittee of the House Energy and Commerce Committee will hold a hearing today to review various proposals to alter the 340B prescription drug discount program.

That program enables hospitals that care for especially large numbers of low-income patients to receive discounts on prescription drugs that they dispense on an outpatient basis to low-income patients.

Among the issues the Health Subcommittee is expected to consider are whether hospitals are using these discounts to benefit their low-income patients and whether the extent of the discounts the pharmaceutical industry is required to provide result in increased prescription drug costs for others.

The subcommittee has already held two hearings on the 340B program this year and is currently considering more than a dozen proposals to change the program in some way.

All Pennsylvania safety-net hospitals participate in the 340B program and consider it an essential tool in their efforts to serve the residents of the low-income communities in which they are located.

Learn more about the 340B program and the various proposals to change it currently before Congress in this Roll Call article.

Filed under: 340b

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members.

While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans:  three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks.

Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015.

Learn more about physician turnover in Medicaid managed care plans in the Health Affairs study “Network Optimization And The Continuity Of Physicians In Medicaid Managed Care,” which can be found here.

 

Filed under: Uncategorized

Proposed Federal Reorganization Could Affect Health Care

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs.

In its 132-page Delivering Government Solutions in the 21st Century:  Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare.  This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP).

In addition, the proposal would:

  • consolidate all health research programs in the National Institutes of Health, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute on Disability, Independent Living, and Rehabilitation Research;
  • reduce the U.S. Public Health Service Commissioned Corps from 6500 to no more than 4000 officers; and
  • remove food safety responsibilities from the Food and Drug Administration, change that agency’s name to the Federal Drug Administration, and shift food safety responsibilities to the Department of Agriculture.

Also part of this Department of Health and Public Welfare would be a new Council on Public Assistance that would ostensibly become the executive branch’s welfare policy-making body.  Serving on this council would be the heads or representatives of the heads of the Department of Agriculture, Department of Housing and Urban Development, the new Department of Education and the Workforce, and the Office of Management and Budget, with the council to be headed by the secretary or secretary’s designee from the Department of Health and Public Welfare.

While some of the White House’s recommendations can be implemented via executive action, others require congressional action.

Find the White House’s brief summary of its recommendations here and find the full report here.

 

Filed under: Federal Medicaid issues, Medicare

CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.”

The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability.

The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state and comparative state performance based on a variety of metrics while also reporting on federal turnaround time on matters such as waiver requests and rate reviews.  CMS envisions the scorecard evolving from year to year by offering more and different information.

Go here to see a CMS fact sheet on the new Medicaid scorecard and go here to visit the scorecard’s home page.  See the Pennsylvania Medicaid scorecard here.

Filed under: Pennsylvania Medicaid, Pennsylvania Medical Assistance

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress.

Among the findings included in the report by the Medicare Payment Advisory Commission are:

  • Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays.
  • Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted.
  • MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities.
  • MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities.

MedPAC’s recommendations include:

  • Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care.
  • Reducing payments to off-campus emergency departments in certain urban areas.
  • Rebalancing Medicare’s physician fee schedule to increase payments for ambulatory evaluation and management services while reducing payments for procedures, imaging, and tests.
  • Paying for sequential stays in a unified prospective payment system for post-acute care.
  • Establishing new ways to help patients, families, and hospitals identify higher-quality post-acute care providers for their patients.
  • Establishing new principles for measuring quality that address both population-based measures and quality incentives.
  • Encouraging the development of managed care plans that better meet the needs of the dually eligible (Medicare and Medicaid) population.
  • Eliminating Medicare payment increases for skilled nursing facilities in FY 2019 and FY 2020 because of the healthy financial condition of those facilities.
  • Urging Medicare to use a uniform set of population-based measures for different health care settings and different populations.
  • Moving forward with a unified post-acute-care payment system as quickly as possible.

Learn more about MedPAC’s thinking, research, conclusions, and recommendations by consulting the following materials:   the news release that accompanied MedPAC’s transmission of its report to Congress; a fact sheet that accompanied the report’s release; and the 407-page report itself.

Filed under: Medicare

Amid Budget Woes, States May Look to Medicaid for Savings

Budget challenges may lead some states to seek changes in their Medicaid programs aimed at saving money.

Or so reports Fitch Ratings, the bond rating company.

According to Fitch, health care was the biggest driver in rising state spending between 2005 and 2015 and the portion of state spending on health and social services will increase from 30.7 percent in 2015 to 38.3 percent in 2025.

Among the measures states will turn to in an effort to manage rising health care costs, according to Fitch, are Medicaid work requirements, reductions in Medicaid retroactive coverage, new Medicaid premiums, and lifetime limits on Medicaid benefits.

The report specifically cites Pennsylvania as a state that is expected to face the kind of budget pressures that could lead to such Medicaid cuts.

Learn more about the challenges facing state governments in the coming years in this Fitch news release and this summary on the Healthcare Dive web site.

 

Filed under: Pennsylvania Medicaid

Mixed Results for PA Overdose Admissions in 2017

2017 hospital admissions for heroin overdoses in Pennsylvania rose nearly 13 percent but admissions for overdoses of pain medication fell more than two percent that year, according to the Pennsylvania Health Care Cost Containment Commission.

Nearly ten percent of those heroin patients died in the hospital, as did half that proportion of pain medication overdose patients.

The average age of the heroin overdose patients admitted was 33 and nearly two-thirds of them were insured by Medicaid.  Of the pain medication patients admitted, the average age was 53 and 42 percent were insured by Medicare, 34 percent by Medicaid, and 19 percent by commercial insurers.

Learn more about trends in hospital admissions for heroin and pain medication overdoses in the Pennsylvania Health Care Cost Containment Commission report “Hospitalizations for Opioid Overdose – 2016 to 2017,” which can be found here.

Filed under: Uncategorized

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2012 Safety-Net Association of Pennsylvania