Archive for June 2018

Proposed Federal Reorganization Could Affect Health Care

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs. In its 132-page Delivering Government Solutions in the 21st Century:  Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare.  This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP). In addition, the proposal would: consolidate all health research programs in the National Institutes of Health, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute … Read More

Posted in Federal Medicaid issues, Medicare

CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.” The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability. The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medical Assistance

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress. Among the findings included in the report by the Medicare Payment Advisory Commission are: Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays. Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted. MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities. MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities. MedPAC’s recommendations include: Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care. Reducing … Read More

Posted in Medicare

Amid Budget Woes, States May Look to Medicaid for Savings

Budget challenges may lead some states to seek changes in their Medicaid programs aimed at saving money. Or so reports Fitch Ratings, the bond rating company. According to Fitch, health care was the biggest driver in rising state spending between 2005 and 2015 and the portion of state spending on health and social services will increase from 30.7 percent in 2015 to 38.3 percent in 2025. Among the measures states will turn to in an effort to manage rising health care costs, according to Fitch, are Medicaid work requirements, reductions in Medicaid retroactive coverage, new Medicaid premiums, and lifetime limits on Medicaid benefits. The report specifically cites Pennsylvania as a state that is expected to face the kind of budget … Read More

Posted in Pennsylvania Medicaid

Mixed Results for PA Overdose Admissions in 2017

2017 hospital admissions for heroin overdoses in Pennsylvania rose nearly 13 percent but admissions for overdoses of pain medication fell more than two percent that year, according to the Pennsylvania Health Care Cost Containment Commission. Nearly ten percent of those heroin patients died in the hospital, as did half that proportion of pain medication overdose patients. The average age of the heroin overdose patients admitted was 33 and nearly two-thirds of them were insured by Medicaid.  Of the pain medication patients admitted, the average age was 53 and 42 percent were insured by Medicare, 34 percent by Medicaid, and 19 percent by commercial insurers. Learn more about trends in hospital admissions for heroin and pain medication overdoses in the Pennsylvania … Read More

Posted in Uncategorized

Verdict: Medicaid Expansion Improved Care and Access

A new review of studies published since the Affordable Care Act’s Medicaid expansion has concluded that expansion improved care, access to care, and coverage in states that expanded their Medicaid programs. Among the improvements cited by studies are: greater use of primary care more preventive health visits more behavioral health care shorter hospital stays fewer avoidable hospital admissions reduced access problems reduced reliance on hospital ERs as a primary source of care improved monitoring and compliance rates for patients with diabetes and hypertension higher rates of screening for prostate cancer and Pap smears In addition, hospitals provided less uncompensated care and had better margins. Learn more in the Health Affairs study “The Effects Of Medicaid Expansion Under The ACA:  A … Read More

Posted in Affordable Care Act, Federal Medicaid issues

Do “Narrow Networks” Jeopardize Care?

They may if they serve Medicaid patients. Or so suggests a new Health Affairs report. As growing numbers of Medicaid managed care plans reduce their provider networks as a means of managing costs, provider turnover appears to be growing.  According to the report, narrow networks tracked during a five-year period experienced a 20 percentage point greater rate of physician turnover than non-narrow plans. Such turnover is thought to be a potential problem for Medicaid patients who are socially or clinically vulnerable and present complex medical needs.  The loss of a physician can disrupt and complicate the care of such patients – and disrupt it in ways that may not necessarily be detected by current quality measures. This could pose a … Read More

Posted in Uncategorized

PA Awards Grants to Improve Coordination of Care for Medicaid Patients

The Pennsylvania Department of Human Services has awarded $8 million in grant money “…to increase efficiency in the delivery of health care services to Medicaid patients.” According to a DHS news release announcing the grants, The grants will help connect hospitals, nursing homes, and ambulatory practices to the Pennsylvania Patient & Provider Network, or P3N, which enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N. Dividing the $8 million are the Clinical/Connect Health Information Exchange, the HealthShare Exchange, the Keystone Health Information Exchange, and the  Mount Nittany Exchange. To learn more, see this DHS news release.

Posted in Uncategorized

S&P: 340B Cuts Will Hurt

Payment cuts in the 340B prescription drug program will most likely hurt hospital financial performance, and among those most likely to be hurt are DSH hospitals, small hospitals, and rural hospitals. These are among the conclusions in a report recently issued by S&P Global Ratings. The report concludes that …the impact of the cuts to the 340B Drug Pricing Program on not-for-profit hospitals that rely on 340B drug savings will likely weaken their operating performance at a time of already tightening margins. Effective the beginning of 2018, the Centers for Medicare & Medicaid Services cut the 340B program 16 percent, or $1.6 billion, reducing the reimbursement 340B-eligible hospitals receive for dispensing prescription drugs on an outpatient basis to eligible patients. … Read More

Posted in 340b, DSH hospitals, Medicare, Pennsylvania safety-net hospitals

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its May 2018 newsletter. Included in this month’s edition are stories about: The continued implementation of Community HealthChoices, the state’s new program of managed long-term services and supports for dually eligible Medicaid and Medicare beneficiaries. The introduction of a new tool for determining whether Medicaid beneficiaries shall be deemed eligible for Medicaid long-term-care services. State legislation that, if adopted, would establish presumptive eligibility for older adults applying for in-home care. A new framework for participants in state Medicaid managed care programs to appeal denials of services. New processes to streamline the determination of eligibility for Medicaid of individuals recently released from prison. Pending legislation that would permit selected mental health facilities to deem … Read More

Posted in HealthChoices, long-term care, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy
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