Archive for May 2014

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients. The initiative consists of two parts:  first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations. Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients. Learn more about this new undertaking in this Kaiser Health News report.

Posted in Pennsylvania Medicaid policy

Hospitals Reconsidering Charity Care Policies?

In the wake of Affordable Care Act policies that enhance access to health insurance, hospitals around the country are beginning to take a second look at their charity care policies. Some are charging co-pays to uninsured patients; others are moving the line at which they provide free or subsidized care. Such practices are not occurring in great numbers and do not yet constitute a trend, but they do reflect a growing concern among hospitals that some of their uninsured patients have options they are choosing not to exercise. The New York Times has taken a look at a few hospitals that have reconsidered their long-time charity care policies.  Read its report here.

Posted in Affordable Care Act

PHC4 Issues Report on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued its annual report on the financial performance of the state’s acute-care hospitals. Among the highlights: The state-wide average operating margin of hospitals fell from 5.73 percent in FY 2012 to 4.69 percent in FY 2013. Uncompensated care rose 5.41 percent, to more than $1 billion, and up from an average of 2.72 percent of hospital net patient revenue in FY 2012 to 2.81 percent in FY 2013. 35 percent of hospitals reported negative operating margins. 22 percent reported negative operating margins over the latest three-year period. Find the complete PHC4 report here.

Posted in Uncategorized

No Observation Rate Yet for PA Medicaid

The Pennsylvania Department of Public Welfare has published a notice in the Pennsylvania Bulletin continuing its current payment methodology under the state’s Medicaid program but noting that it still has not developed an observation rate for the program. Last year the state indicated that it wanted to establish such an observation rate, but it has not yet done so.  The new notice states that The Department also announced its intent to establish an observation rate for hospital cases for which an inpatient admission is not medically necessary, but medical observation of a patient is required. The Department received multiple public comments concerning an intended observation rate. At this time, the Department plans to develop a payment policy and rates for … Read More

Posted in Pennsylvania Bulletin, Pennsylvania Medicaid policy

Safety-Net Hospital Finances Falling Behind Other Hospitals

While most hospitals have recovered from the worst of the recession, safety-net hospitals that were already weak before the recession now find a growing financial gap between themselves and other hospitals. So reports the new study “Hospital Financial Performance in the Recent Recession and Implications for Institutions That Remain Financially Weak,” which was published in the May edition of Health Affairs. According to a news release about the study, About 28 percent of the safety-net hospitals were financially weak in 2006.  While their financial performance dipped in 2008, these institutions rebounded by 2011.  However, the financial gap between the safety-net hospitals and the non-safety-net hospitals continues to widen in terms of their total profit.  The release also notes the implications … Read More

Posted in Uncategorized

PA Seeks Insurer Bids for Medicaid Expansion

In anticipation of the possibility of receiving approval from the federal government to expand its Medicaid program, the Corbett administration is soliciting bids from insurers interested in serving the state’s Medicaid expansion population. The market for those insurers:  approximately 600,000 people who would become eligible for Medicaid and free to choose from among eligible insurers. The Corbett administration has taken a sometimes-controversial approach to Medicaid expansion, seeking to underwrite premiums to private insurers for those newly eligible for Medicaid coverage.  For months the administration has been negotiating the terms of its proposed Healthy Pennsylvania Medicaid expansion plan with the federal government, and the decision to seek bids in anticipation of a possible January 1, 2015 launch of Medicaid expansion is … Read More

Posted in Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy

Study Points to Risk of DSH Cuts

A new study suggests that future cuts in Medicare disproportionate share (Medicare DSH) and Medicaid DSH payments could pose problems for hospitals that serve large numbers of uninsured patients. According to a new report in the journal Health Affairs, Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly. Medicare DSH and Medicaid DSH payments help underwrite the uncompensated care hospitals provide to their uninsured patients.  These payments are a vital source of revenue for Pennsylvania’s safety-net hospitals and Pennsylvania is among the states that have not yet adopted Medicaid expansion. Even after Affordable Care Act … Read More

Posted in Affordable Care Act, Health care reform, Pennsylvania Medicaid policy
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