Archive for April 2015
The Pennsylvania Department of Human Services (DHS) has issued a new Medical Assistance Bulletin on the state’s expansion of its Medicaid program via the HealthChoices managed care program. The bulletin notifies providers of the introduction of a new adult benefit package that applies to all adult Medicaid recipients in the state, highlighting some of the major changes in benefits from past packages. It also provides information about the state’s plan for a phased transition from the current private care option (PCO) insurance plans to HealthChoices plans over the coming months. See DHS Medical Assistance Bulletin 99-15-05 here.
Last weekend Pennsylvania’s Department of Human Services (DHS) formally moved more than 121,000 people from the Corbett administration’s Healthy Pennsylvania Medicaid expansion program to the Wolf administration’s expansion of the state’s long-time HealthChoices Medicaid managed care program. Those who were shifted had enrolled in Healthy Pennsylvania private coverage option (PCO) plans before the end of calendar year 2014. In the next few days they will receive written notification of the shift. All will receive the same Medicaid benefits: a basic adult benefit package. Individuals will no longer be able to enroll in PCO plans, and over the next few months more than 137,000 Pennsylvanians still in PCO plans will be shifted into HealthChoices plans in stages with completion expected by … Read More
With the state still struggling to enroll and revalidate Medicaid providers, the Pennsylvania Department of Human Services (DHS) presented an update on its efforts to improve that process at the April 23 meeting of its Medical Assistance Advisory Committee (MAAC). According to the presentation, DHS is focusing its improvements in three primary areas: introducing a new electronic enrollment web portal this fall; standardizing its processes and procedures; and adding staff next month to facilitate enrollments. DHS staff made a presentation on its latest efforts at the April 23 MAAC meeting. See that presentation here.
Pennsylvania will need 11 percent more primary care doctors by 2030, according to the Joint State Government Commission. The state already has 155 health professional shortage areas for primary care, and with 27 percent of Pennsylvania’s doctors 60 years of age or older and more than half older than 50, the commission believes the state needs to take steps to ensure the adequacy of its future supply of physicians. With this need in mind, the commission has offered a series of recommendations for increasing Pennsylvania’s supply of doctors, including encouraging medical schools to do more to train primary care providers, improving student loan repayment programs, and offering more residency positions in the hope that more residents will remain in the … Read More
In response to the challenges the state has encountered processing Medicaid provider enrollment applications, the Pennsylvania Department of Human Services (DHS) has unveiled what it believes will be an improved approach to tackling this problem. The improvements include electronic enrollment, standardization of policies and procedures, and additional provider enrollment staffing. At the heart of the backlog are Affordable Care Act requirements. Go here to see a message from DHS acting secretary Theodore Dallas on this subject.
Come 2017, states will have a new tool at their disposal through which to pursue health care reform. At that time, states will be able to seek new state innovation waivers from the federal government that will enable them to change covered benefits and insurance subsidies; replace health insurance exchanges; modify the individual or employer mandate; and do other things so long as their efforts ensure continued access to comprehensive and affordable health insurance. The waivers, created under the Affordable Care Act, are good for five years. The Commonwealth Fund has published an issue brief that explains the section of the Affordable Care Act that includes state innovation waivers and outlines how states might use innovation waivers to customize health … Read More
The state’s Commonwealth Court has upheld a lower court decision restoring more than $125 million in tobacco funding that an arbitration panel sought to deny the state. Under the terms of the Tobacco Master Settlement, states receive annual payments from tobacco companies to compensate them for the costs they incur caring for people sickened by cigarettes and smoking. In 2013, an arbitration panel ruled that the state had failed to fulfill all of the settlement agreement’s terms and reduced Pennsylvania’s proceeds from the agreement. A 2014 appeal of that decision restored much of that funding and the Commonwealth Court upheld that decision. The tobacco funding is used to support smoking cessation programs, cancer research, and health care services. It is … Read More
The independent agency that advises Congress on Medicare payment issues has recommended that Medicare eliminate its controversial two-midnight rule. At its recent meeting in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC) also recommended that Medicare focus RAC (Recovery Audit Contractor) audits on hospitals with the highest numbers of short inpatient stays, shorten the look-back period for audits, modify the three-day rule for skilled nursing facility coverage, and require hospitals to inform patients when their stay has been classified as observation status rather than inpatient status. Learn more about MedPAC’s recommendation in this Fierce Healthcare news report and go here to see the MedPAC presentation of the recommendations the agency’s board approved.
The Pennsylvania Health Law Project has published its March 2015 newsletter. Included in this edition are articles about the state’s changes in how it is expanding its Medicaid program; a look at Governor Wolf’s proposed FY 2016 Medicaid budget; and closer examinations of a proposed expansion of services for older adults and people with disabilities and the budget of the state’s Office of Mental Health and Substance Abuse Services. Find the Pennsylvania Health Law Project’s latest newsletter here.
Last fall the Robert Wood Johnson Foundation brought together grant recipients and national experts to talk about health care payment and delivery system reform design and implementation issues. Now, the foundation has released a brief paper that addresses what the experts consider to be the three greatest challenges in the pursuit of such reform: Aligning alternative payments with clinician compensation Considering social determinants of health in payment reform models Repurposing hospital resources The paper also takes a look at whether health care payments should be subject to risk adjustment to reflect the social and economic barriers to better health and care that some patients face. This is an important issue for Pennsylvania’s safety-net hospitals because of the significant numbers of … Read More