Archive for June 2015
Immediately after the Supreme Court verdict in the case of King v. Burwell was handed down, the Wolf administration announced that it will no longer seek to create a Pennsylvania health insurance exchange. In a news release, Governor Wolf explained that I took steps to protect Pennsylvania’s consumers by putting in place a contingency in the event the Supreme Court ruled people are not eligible for subsidies, but I am pleased to say that we will no longer need to rely on this plan. See the news release here.
The Safety-Net Association of Pennsylvania has urged Pennsylvania’s Department of Human Services to pursue transformative innovation in the state’s HealthChoices Medicaid managed care program. In particular, SNAP has called on DHS to create regional health collaboratives consisting of both insurers and providers to work together to deliver better, more coordinated care to Pennsylvania’s Medicaid population. SNAP also recommended that the state finance innovation by implementing a Delivery System Reform Incentive Payments program, better known as DSRIP, to fund innovation in the state’s Medicaid program. SNAP’s suggestions came in response to a request for information issued by the state seeking recommendations for how to improve the HealthChoices program in anticipation of the state’s plan to rebid HealthChoices managed care contracts later … Read More
The federal government has provided new guidance to states concerning how to ensure that the rates they pay Medicaid managed care organizations are adequate. While federal law has long required that such rates be “actuarially sound,” the Centers for Medicare & Medicaid Services (CMS), which issued the draft guidance, has released new guidance to advise states about the information it seeks to ensure that proposed rates are truly actuarially sound. The guidance notes that CMS will follow three principles when evaluating proposed rates to be paid to Medicaid managed care organizations. The capitation rates are reasonable and comply with all applicable laws (statutes and regulations) for Medicaid managed care; the rate development process complies with all applicable laws (statutes and … Read More
The Pennsylvania Health Law Project has published the June edition of Health Law News, its monthly newsletter. Included in this edition are articles about access to drug and alcohol treatment services for Pennsylvania Medicaid beneficiaries; the lack of habilitative services made available to people with disabilities or significant health problems by health insurance plans offered by insurers serving Pennsylvanians through the federal health insurance exchange; and the state’s recent proposal for managed long-term services and supports (MLTSS). Find the latest edition of Health Law News here.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP). In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers. Find a summary of the MACPAC report and a link to the complete report here.
The U.S. Department of Health and Human Services (HHS) has approved a request by Pennsylvania Governor Tom Wolf for permission for his state to develop a state-based marketplace through which to offer health insurance to Pennsylvanians as provided for in the Affordable Care Act. Currently, Pennsylvanians seeking health insurance use the federal exchange. The constitutionality of the use of that exchange is currently being weighed by the Supreme Court and the Wolf administration’s desire to create a state exchange is widely considered an attempt to avoid a crisis should the court rule against the federal government in the case of King v. Burwell. A ruling in that case is expected in the very near future. Go here to see the … Read More
While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways. Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more. In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 … Read More
A new report from a non-partisan bioethics institute suggests that the patient satisfaction surveys that Medicare uses as part of its value-based purchasing program may not be providing the kind of information on which Medicare payments should be based. According to the Hastings Center report “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?” the surveys appear to blend patient satisfaction with their experience while hospitalized with the quality of care they received during that hospitalization and that “Good ratings depend more on manipulable patient perceptions than on good medicine.” Currently, patient satisfaction is a major component of Medicare’s value-based purchasing program and hospitals can be rewarded or penalized based on their patients’ … Read More
While the Affordable Care Act’s Medicaid expansion has helped millions of Americans gain health insurance, it has not translated (so far) into improved financial health for the hospitals providing those Medicaid services. This is the conclusion drawn recently by Moody’s Investor Services, the credit-rating company. According to Moody’s, hospital financial performance has improved across the board since implementation of the Affordable Care Act but has not improved more in states that expanded their Medicaid programs than it has in states that chose not to expand Medicaid eligibility. As a result, hospital operating margins in states that have expanded their Medicaid programs have not improved more than those in states that did not expand. What hospitals in expansion states have experienced … Read More
The Pennsylvania Health Law Project has published the May edition of Health Law News, its monthly newsletter. Included in this edition are articles about the Wolf administration’s newly released Medicaid managed long-term supports and services proposal; the increase in Medicaid enrollment since the state’s Medicaid expansion began on January 1; the Medical Assistance Transportation Program; and the state’s application to the federal government to establish Pennsylvania’s own health insurance marketplace. Go here to see the latest edition of PA Health Law News.