Archive for May 2018
Hospital groups and other health care interest organizations have expressed strong opposition to a Centers for Medicare & Medicaid Services proposal to ease requirements that states ensure adequate access to care for their Medicaid population. Under current federal Medicaid law, states must periodically review their Medicaid provider networks to ensure that Medicaid recipients have adequate access to care. Under a March CMS proposal, that requirement would exempt states from performing such reviews if at least 85 percent of their Medicaid population is enrolled in a managed care plan and similarly exempt them from reviewing the impact on their provider networks of rate cuts of less than four percent during a single state fiscal year or six percent over two consecutive … Read More
The section 340B prescription drug discount program has grown increasingly controversial in recent years. The program, established in the 1990s to help hospitals with the cost of the prescription drugs they provide to low-income patients on an outpatient basis, has grown considerably since its inception. Pharmaceutical companies argue that it is too large, that it contributes to the growing cost of prescription drugs, and that hospitals are not using the savings they reap from the program to serve more low-income patients, as was envisioned when Congress created the program. Eligible providers, on the other hand, note that much of the program’s growth was mandated by Congress and that 340B continues to serve its original purpose of helping hospitals serve low-income … Read More
The Pennsylvania Department of Corrections and the state’s Department of Human Services have developed a new process to simplify the Medicaid application process for individuals newly released from state prisons. Under the new process, Medicaid application will be automated for those leaving prison who consent to participate in the application process. This process will ensure Medicaid eligibility immediately upon release from prison for about 2000 individuals a year. Learn more about this process from this joint news release from the two departments.
A new report published on the Health Affairs Blog describes the continuing challenges safety-net hospitals face and offers suggestions for helping them meet those challenges. The challenges, according to the report, are the virtual elimination of the Affordable Care Act’s individual health insurance mandate; the continued decline in the amount of Medicare disproportionate share hospital money (Medicare DSH) provided to safety-net hospitals; and hospital closures that shift more of the burden for caring for uninsured patients onto a smaller pool of safety-net hospitals. The result is under-served patients and new financial risks for the hospitals that remain after some safety-net hospitals close because of the large amounts of uncompensated care those hospitals continue to provide. To address these challenges, the … Read More
The Centers for Medicare & Medicaid Services has denied a request from the state of Kansas to impose a lifetime limit on the Medicaid benefits individuals may receive. In a move that the agency appeared to signal last week and that appears to have national implications, CMS administrator Seema Verma explained that We have determined that we will not approve Kansas’ recent request to place a lifetime limit on Medicaid benefits for some beneficiaries…We seek to create a pathway out of poverty, but we also understand that people’s circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them. Medicaid advocates feared that benefit limits would follow in the … Read More
General acute-care hospitals experienced up and downs in their financial performance in 2017, the Pennsylvania Health Care Cost Containment Council has reported. In 2017, net patient revenue rose 3.9 percent operating margins fell from 6.02 percent to 5.15 percent but total margins rose from 5.96 percent to 6.62 percent uncompensated care declined from $844 million to $761 million – the fourth consecutive year of decline For more on these and other measures of hospital financial performance, including data on individual hospitals, go here to see the new PHC4 report Financial Analysis 2017: General Acute Care Hospitals.
With 74 million people enrolled in Medicaid managed care plans – roughly 71 percent of the U.S. Medicaid population – the Health Affairs Blog has taken a broad look at Medicaid managed care, addressing the question of how it works, whether it’s working, and what its future may be. The two-part report notes that some Medicaid managed care companies are highly profitable and that this profitability has increased in recent years. It also notes that the manner in which these companies serve their members varies greatly, that their medical loss ratios vary considerably from state to state, and that the reserves managed care companies hold vary greatly as well. In addition, the two-part report seeks answers to a number of … Read More
The Pennsylvania Health Law Project has published its April 2016 newsletter. Included in this edition are stories about: the continued introduction in southwestern Pennsylvania of the Community HealthChoices program of managed long-term services and support for seniors and the planned implementation of the program in southeastern Pennsylvania; a court ruling invalidating the state’s selection of managed care plans to serve Medicaid recipients who participate in the HealthChoices physical health program; and legislative efforts to establish a work requirement for some Medicaid participants. Go here for the latest edition of PA Health Law News.