Archive for April 2017

Medicaid Work Requirements

Both Congress and a number of states have discussed introducing work requirements into their Medicaid programs.  Such a proposal was part of the American Health Care Act, a number of governors and state legislators have discussed work requirements as a condition of Medicaid eligibility, and some states are reportedly considering including such requirements in section 1115 Medicaid waiver applications. In a new report, the Congressional Research Service examines the U.S. Department of Health and Human Services’ authority to grant such waivers and how courts might look at such requirements if they were be contested. Go here to see the Congressional Research Service report “Judicial Review of Medicaid Work Requirements Under Section 1115 Demonstrations.”

Posted in Federal Medicaid issues

New MACPAC Reports

The Medicaid and CHIP Payment and Access Commission has released several new reports, including: a look at how states exercise flexibility in their individual Medicaid programs; methodologies for setting Medicaid per capita caps; a review of how states are addressing high-cost hepatitis C drugs in their Medicaid programs; an analysis of Medicaid disproportionate share hospital payment (Medicaid DSH) allotments and payments; and an analysis of when states will exhaust their CHIP allotments. MACPAC is a non-partisan legislative branch agency that advises Congress, the states, and the administration on Medicaid and CHIP payment and access issues. Find links to these and other MACPAC reports here, on the MACPAC web site.

Posted in Federal Medicaid issues

Medicaid Per Capita Caps Explained

In a new report, the Commonwealth Fund looks at Medicaid per capita caps, an idea that has been discussed for years, that was part of the as-yet unsuccessful American Health Care Act, and a proposal that is almost certain to resurface in the near future. Among other things, the article explains what per capita caps are and how they would work describes how per capita caps differ from current Medicaid policy considers how the implementation of per capita caps might affect low-income people, providers, and insurers Learn more in the Commonwealth Fund article “Essential Facts About Health Reform Alternatives: Medicaid Per Capita Caps,” which can be found here.

Posted in Federal Medicaid issues, Uncategorized

New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments. Or at least they are once supplemental Medicaid payments are included. So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues. In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is … Read More

Posted in Medicaid supplemental payments, Pennsylvania Medicaid policy, Uncategorized

Medical Homes and High-Need Patients

With five percent of patients accounting for 50 percent of health care costs, such high-need patients are the subject of increasing attention as health care providers search for better ways to serve them at less cost.  Such patients are especially challenging when they lack the financial resources and personal support systems needed to address their considerable medical needs. One of those ways is through the concept of the medical home:  an approach to primary care, also often referred to as a patient-centered medical home, that is a team-based approach to delivering patient-specific, coordinated, accessible care that focuses on quality and safety and that features as one of its defining characteristics closer contact between patients and their caregivers. Pennsylvania safety-net hospitals … Read More

Posted in Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its March 2017 newsletter. Included in this edition are stories about: new starting dates for the beginning of new HealthChoices physical health contracts an update on Community HealthChoices, the state’s planned program of managed long-term services and supports for those who qualify for nursing home care but wish to continue living independently in the community the launch of the state’s ABLE Savings Program through which children and adults with significant disabilities can open special state-sponsored investment accounts the introduction of a new assessment tool for people in need of substance disorder treatment Find the latest edition of PA Health Law News here.

Posted in HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid policy

To Require Work or Not to Require Work

That is the question policy-makers are asking as they consider imposing work requirements on healthy Medicaid participants. In recent years a number of states have attempted to establish such a requirement, only to have their requests to do so rejected by regulators in Washington, and a clause permitting states to establish such a requirement was included last month in the eventually sidetracked American Health Care Act.  Even now, a Kentucky Medicaid waiver application under consideration by the Centers for Medicare & Medicaid Services includes a work requirement. Does the lack of a work requirement encourage people in Medicaid expansion states to withdraw from the workforce? Is a work requirement a way to raise the income of beneficiaries just enough to … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

CMS Clarifies Medicaid DSH Rule

Last week the Centers for Medicare & Medicaid Services announced a final rule addressing the treatment of third-party payers in calculating Medicaid uncompensated care costs.  This calculation affects individual hospitals’ Medicaid disproportionate share (Medicaid DSH) limit. According to CMS, This rule clarifies federal requirements regarding the treatment of third party payers in determining the hospital-specific Medicaid DSH payment limit, which is set by statute as a hospital’s “uncompensated costs” incurred in providing hospital services to Medicaid and uninsured patients. The final rule makes clearer our existing policy that uncompensated costs include only those costs for Medicaid eligible individuals that remain after accounting for all payments received by or on behalf of Medicaid eligible individuals, including Medicare and other third party … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals

Presentation on Value-Based Purchasing in PA Medicaid

Pennsylvania’s Medicaid program is moving toward greater use of value-based purchasing in its Medicaid behavioral health programs. Last week, the state’s Office of Mental Health and Substance Abuse Services held a webinar to offer information about the state’s plan for employing value-based purchasing in Medicaid and how it will do so for behavioral health services in particular.  Go here to see the presentation delivered at that webinar.  

Posted in HealthChoices, Pennsylvania Medicaid policy
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