Archive for April 2018
A new bill introduced in the House seeks to bring greater transparency to the controversial 340B prescription drug discount program. Under H.R.5598, proposed by Rep. Earl “Buddy” Carter (R-GA), hospitals would be required to report the outpatient care they provide to low-income patients in both their main hospital and at pediatric care sites. Hospitals already separately report the inpatient care they provide to such patients. According to Representative Carter, I introduced this legislation today because I believe the 340B program is very important, but it needs to be improved. 340B is an outpatient program and currently hospitals do not have to report low-income utilization in outpatient settings. This legislation adds an additional layer of transparency to allow us to better … Read More
The short-term health insurance plans that the administration proposes making more available to consumers as an alternative to comprehensive health insurance that meets Affordable Care Act coverage requirements may leave consumers with greater out-of-pocket costs and less coverage for some critical services. According to a Kaiser Family Foundation review of available short-term, limited duration plans in 10 markets across the country, those plans: often do not cover mental health and substance abuse services and outpatient prescription drugs may turn down individuals or charge them higher premiums based on age, gender, or health status, including pre-existing conditions require greater cost-sharing by their purchasers do not cover maternity services at all Such plans are not required to comply with the Affordable Care … Read More
A new study found that the increase in the number of insured Americans as a result of the Affordable Care Act has resulted in increased utilization of primary health care services. According to a study by the National Bureau of Economic Research, primary care utilization rose 3.8 percent, mammograms 1.5 percent, HIV tests 2.1 percent, and flu shots 1.9 percent over a three-year period. The study suggests that preventive care increased between 17 and 50 percent. The study attributes all of the gains to improved access to private insurance and none to Medicaid expansion. These results are based on self-reported information gathered from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. Learn more about these and … Read More
Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims. While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. This can pose a special challenge to Pennsylvania safety-net hospitals because they care for so many more Medicaid patients than the typical hospital. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity … Read More
Hospitals that serve large numbers of minority patients are reducing their Medicare readmissions rates more than other hospitals but are still more likely to be penalized under Medicare readmissions reduction program. This is one of the findings in a new study published in the journal Health Affairs. According to the study, hospitals that serve larger numbers of minority patients – typically, safety-net hospitals – are more likely to be penalized for readmissions than other hospitals because even though they are reducing their readmissions rates faster than other hospitals, their performance is compared, unfavorably, to hospitals that had fewer Medicare readmissions prior to the launch of the readmissions reduction program. This situation may change beginning in FY 2019 when a new … Read More
The Pennsylvania Health Law Project has just published the March 2018 edition of its monthly newsletter. Included in this edition are articles about: new procedures that will make it easier for Medicaid recipients to be treated for opioid abuse the continued implementation of the Community HealthChoices program of managed long-term services and supports for nursing home-eligible seniors, including its introduction in southeastern Pennsylvania beginning next year the work of special needs units in the HealthChoices managed care plans the confirmation of Teresa Miller as Secretary of the Pennsylvania Department of Human Services Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.