Archive for October 2012

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented. Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab. At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will … Read More

Posted in Health care reform, Pennsylvania Medicaid policy

Lawsuit Challenges Social Services Block Grants and the End of General Assistance Payments

A lawsuit has been filed in Pennsylvania’s Commonwealth Court challenging the state’s termination of General Assistance payments to low-income Pennsylvanians and the redirection of some state social services funding into block grants for selected counties. General Assistance grants are small sums of money that were paid monthly to low-income Pennsylvanians.  Many were thought to use this money for food, medicine, and other necessities. Pennsylvania’s counties have long received social services funding from the state.  Now, some counties have voluntarily agreed to accept less money in exchange for greater flexibility in how they spend it.  Some of the services provided with this money are delivered by hospitals, including the state’s private safety-net hospitals. The legal challenge is on procedural rather than … Read More

Posted in Pennsylvania Medicaid policy, Pennsylvania state budget issues

Pennsylvanians Who Lost Medicaid Eligibility Given Path to Restoration

More than 100,000 Pennsylvanians who were dropped from the state’s Medical Assistance rolls in the latter part of 2011 will receive a new opportunity to regain eligibility. Under an agreement between the Pennsylvania Department of Public Welfare and lawyers for advocacy groups, 100,000 people who lost their eligibility will receive a letter describing their right of appeal.  Those who appeal successfully will be restored to the state’s Medicaid rolls and could have their medical bills resolved for the period during which they were off those rolls. Read more about why these 100,000 people lost their eligibility and how advocates won this opportunity for restoration in this Philadelphia Inquirer article.

Posted in Pennsylvania Medicaid policy

Philadelphia Hospitals Hoping for Medicaid Expansion

Hospitals in the greater Philadelphia want the state to expand its Medicaid program as envisioned in the Affordable Care Act, the Philadelphia Business Journal reports. According to a spokesman for the Delaware Valley Healthcare Council, Philadelphia-area hospitals are concerned that the state might not expand Medicaid eligibility.  That expansion, mandated by the 2010 health care reform law, was made optional earlier this year by a Supreme Court decision. Read more about why Philadelphia-area hospitals – many of which are safety-net hospitals – are eager for the state to embrace the reform law’s Medicaid eligibility expansion in this Philadelphia Business Journal article.

Posted in Health care reform, Pennsylvania Medicaid policy

Medicare DSH Cuts Loom for PA Safety-Net Hospitals

Safety-net hospitals across the country will soon lose important funding that helps them care for many of their low-income and uninsured patients:  their Medicare disproportionate share hospital payments (Medicare DSH). Come 2014, the Affordable Care Act mandates a significant cut in hospitals’ Medicare DSH payments.  The underlying rationale for this cut is that once the health care reform law’s individual insurance mandate takes effect and states begin greatly expanding Medicaid eligibility (a reform law mandate made optional by this year’s Supreme Court decision), hospitals will have fewer such patients and less need for supplemental DSH funding. But as a Kaiser Health News article points out, hospital officials are concerned that the funding will phase out before the expanded insurance phases … Read More

Posted in Health care reform

New Medicare Wrinkle May Hurt Safety-Net Hospitals

A new Medicare program that bases payments to hospitals in part on patient satisfaction with those hospitals could be especially harmful to the nation’s safety-net hospitals. The Medicare value-based purchasing program, which took effect on October 1, will withhold one percent of all hospitals’ Medicare payments and then redistribute that money based on hospitals’ compliance with selected standards-of-care requirements and on the results of surveys of hospitalized Medicare patients.  The withheld one percent will then be redistributed to hospitals that perform well based on these criteria.  Beginning in 2017, two percent of hospitals’ Medicare payments will be withheld and eventually redistributed in this manner. Learn more about the Medicare value-based purchasing program and how hospitals are preparing for the survey … Read More

Posted in Health care reform

PA Lags in Developing Health Insurance Exchange

Pennsylvania is unlikely to have a health insurance exchange (HIE) up and running when the individual insurance requirement mandated by the Affordable Care Act takes effect in 2014. According to state insurance commissioner Michael Consedine, while Pennsylvania has laid considerable groundwork for developing its own exchange, its efforts have been hampered by lack of direction from the federal government on a number of key exchange-related issues.  An August letter from Mr. Consedine to U.S. Health and Human Services Secretary Kathleen Sebelius has not yet been answered.  In addition, the state legislature has not passed necessary enabling legislation. If Pennsylvania does not establish its HIE by 2014, residents of the state will be served by an exchange established by the federal … Read More

Posted in Health care reform

PA Relents on New Co-Pays for Selected Medicaid Recipients

The Pennsylvania Department of Public Welfare (DPW) has announced that it will not require selected Medical Assistance recipients with incomes 200 percent above the federal poverty level to pay co-payments for Medicaid services. The new co-pay policy, implemented October 1, affected about 48,000 families and especially targeted children with autism and other disabilities. Instead of seeking co-payments, DPW intends to seek federal permission to charge insurance premiums to the same patients. Read more about the controversy and the decision that temporarily ends it in this Pittsburgh Post-Gazette article.

Posted in Pennsylvania Medicaid policy

DPW Announces Selected Co-Payments

The Department of Public Welfare (DPW) has issued a Medical Assistance Bulletin to announce that it “is implementing copayments for services provided to children with disabilities, under the age of 18, who are eligible for Medical Assistance (MA) under the PH95 category” – that is, with incomes greater than 200 percent of the federal poverty level.  Find that bulletin here.  The state further elaborates on why it has adopted this policy in this Pennsylvania Bulletin notice.

Posted in Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy
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2012 Safety-Net Association of Pennsylvania