Archive for October 2014

PA Closing in on Classification Criteria for New Medicaid Recipients

Among the features of Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program is the consolidation of 14 current adult benefits packages into just two packages:  the “Healthy” package for new recipients considered low-risk patients and the “Healthy Plus” package for those who are considered high-risk patients, or medically frail. But ever since the Corbett administration unveiled its Medicaid expansion plan last fall, the question of how new recipients would be evaluated to determine which benefit package they will receive has remained unanswered. Now, the Pennsylvania Department of Public Welfare (DPW) appears to be getting closer to providing a clear answer. Recently, DPW’s Medical Assistance Advisory Committee (MAAC) circulated three working documents that present the state’s latest thinking on the classification process. The … Read More

Posted in Healthy PA

Some PA Women Could Lose State Medical Benefits

The expiration of a state health program could leave about 90,000 low-income Pennsylvania women without the free family planning and women’s health benefits they currently receive. A program called SelectPlan for Women offers limited health benefits to low-income women between the ages of 18 and 44 who are otherwise ineligible for Medicaid.  While there has been no formal announcement of the program’s termination, women’s health advocates have informally been told that such a termination is possible at the end of the year. If the program expires, some of the women it currently covers will be eligible for Medicaid under the state’s Medicaid expansion to take effect on January 1 while others should be eligible for at least some subsidization of insurance … Read More

Posted in Healthy PA, Pennsylvania Medicaid policy

State Releases Information on Primary Care Loan Repayment Program

Part of Governor Corbett’s Healthy Pennsylvania health care reform plan, introduced in the fall of 2013, was a program to help primary care providers pay off their education loans in exchange for a commitment to provide care in facilities that serve predominantly underserved communities and low-income patients. Now, the state has released further information about the program, including what kinds of providers are eligible for assistance, how they may apply to participate, and how the facilities in which they work can be certified for eligibility.  Also available are application materials. The deadline for primary care providers to apply is December 4. Find a fact sheet about the program here and more information about the application process here.

Posted in Healthy PA

The Candidates Talk Health Care

One of the issues in almost any major election is health care, and this year’s gubernatorial race in Pennsylvania is no exception. With this in mind, the Central Penn Business Journal has published excerpts of Pennsylvania Physician magazine interviews with the candidates in next month’s election, Republican Governor Tom Corbett and his Democratic challenger, Tom Wolf.  In the article, the candidates share their views on some of this year’s more important health care issues, including Medicaid expansion, emergency care, the challenge of attracting more doctors to Pennsylvania, and more. Find the article here.

Posted in Uncategorized

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs. In a paper entitled “Medicaid Managed Care Modernization:  Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome. The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans. The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many … Read More

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

New Video Explains PA Medicaid Expansion

The Pennsylvania Department of Public Welfare has posted a new presentation video on its Healthy Pennsylvania Medicaid expansion program.  The video outlines how the program works, who is eligible to participate, what the benefits are, and more.  It offers useful information for hospital employees and other Pennsylvania health care providers who will soon see an influx of as many as 600,000 new Medicaid recipients in the state. Find the video here, on the state’s Healthy PA web site.

Posted in Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy

Corbett Signs Observation Status Notification Bill

Pennsylvania Governor Tom Corbett has signed into law a bill that requires hospitals to inform patients when their stay in a hospital has been classified as observation status and not an inpatient admission. The new law calls for hospitals to provide such notification when patients are under a hospital’s care for more than 23 consecutive hours; when they are in a bed and receiving meals outside of the emergency room; and when they have not formally been admitted. Observation status poses considerable financial challenges to patients, leaving them vulnerable for charges for tests, medicine, and post-discharge nursing and rehabilitation care that would be covered by their insurance if they were inpatients but are not covered to the same degree if … Read More

Posted in Uncategorized

Congressman Calls for Helping Safety-Net Hospitals by Improving Medicare Readmissions Program

Congressman James Renacci (R-OH) is again asking his House colleagues to support his proposal to adjust Medicare’s hospital readmissions reduction program – a program he maintains is especially harmful to safety-net hospitals. Noting that in its current form the program penalizes hospitals that care for larger numbers of poorer, sicker patients and that this “jeopardizes the viability of hospitals that service this vulnerable population,” the congressman urges his colleagues to support his bill, H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program Act. This bill calls for adjusting the program’s approach “to account for certain disparities in patient population…” See Representative Renacci’s letter to House colleagues here.

Posted in Uncategorized

Increased Utilization by New Medicaid Patients Levels Off, Study Finds

Spikes in hospital emergency room and inpatient admissions attributed to patients who have recently obtained Medicaid coverage eventually taper off, according to a new study. According to the study Increased Service Use Following Medicaid Expansion is Mostly Temporary:  Evidence From California’s Low Income Health Program, dramatic increases in ER use and hospitalizations among those newly insured by Medicaid eventually level off and should not especially tax either hospital capacity or state Medicaid budgets. The study, performed by the UCLA Center for Health Policy Research, found that after pent-up demand for care among those who previously had limited access to services was satisfied, utilization dropped by more than two-thirds and then remained relatively constant.  Outpatient utilization remains generally stable, the study … Read More

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

Insurers Struggle to Find Providers to Participate in Healthy PA Medicaid Expansion

The insurers selected to participate in Pennsylvania’s Healthy PA Medicaid expansion program are having a hard time persuading hospitals and doctors to join their provider networks. Citing low Medicaid reimbursement rates, providers have been reluctant to work with the chosen insurers. The state selected nine insurers to offer Medicaid coverage to approximately 600,000 new recipients beginning on January 1, but now, one of those insurers has withdrawn from the program and another is considering reducing the geographic region it intends to serve. Originally, the Corbett administration said it hoped to have at least three insurance options in each of the nine regions created for the Medicaid expansion program.  Now, it appears that two carriers per region is a more realistic … Read More

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