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Archive for July 2018

Former PA Gubernatorial Candidate Lands at CMS

Paul Mango, who earlier this year ran unsuccessfully for the Republican nomination for governor of Pennsylvania, has joined the Centers for Medicare & Medicaid Services as chief principal deputy administrator and chief of staff. Mango previously worked as a health care consultant for more than 25 years, including for the McKinsey & Company consulting firm.  Among his past Pennsylvania clients were hospitals and insurers.

Posted in Uncategorized

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs. According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible. Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it. Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion. Learn more about the studies, their results, … Read More

Posted in Affordable Care Act, Federal Medicaid issues

CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients. Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C. The Washington Examiner reports that at that event, Verma said that We are looking at what the court said.  We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals. CMS currently has applications from eight states to establish new Medicaid work requirements.  While Pennsylvania is not among them, some members of the state’s General … Read More

Posted in Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the June 2018 edition of its monthly newsletter. Included in this edition are articles about: Changes in Pennsylvania Medicaid’s medical transportation program governing non-emergency transportation. The renewal of the state’s hospital tax and an increase in that tax. Challenges surrounding the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports, in southwestern Pennsylvania. Information about the launch of Community HealthChoices in southeastern Pennsylvania. A provision in a recent bill modifying the state’s human services code that calls for the Department of Human Services to develop a new, outcomes-based program for hospitals and Medicaid managed care plans that will be oriented toward preventing potentially avoidable medical events. Find these … Read More

Posted in long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

HHS Chief Says 340B Changes are Coming

Health care providers and drug manufacturers should expect changes in the section 340B prescription drug discount program in the near future. That was the message conveyed by Health and Human Services Secretary Alex Azar during a recent conference held by the 340B Coalition. The 340B program, which provides discounts on the prescription drugs dispensed on an outpatient basis by eligible providers to their low-income patients, has become increasing controversial in recent years as it has expanded and pharmaceutical companies have objected to the discounts they must provide. Among the changes Azar suggested are coming are greater accountability among participating hospitals for how they use the savings they derive from the discounts and a narrowing of the difference between the prices … Read More

Posted in 340b, Uncategorized

Energy and Commerce to Look at 340B Today

The Health Subcommittee of the House Energy and Commerce Committee will hold a hearing today to review various proposals to alter the 340B prescription drug discount program. That program enables hospitals that care for especially large numbers of low-income patients to receive discounts on prescription drugs that they dispense on an outpatient basis to low-income patients. Among the issues the Health Subcommittee is expected to consider are whether hospitals are using these discounts to benefit their low-income patients and whether the extent of the discounts the pharmaceutical industry is required to provide result in increased prescription drug costs for others. The subcommittee has already held two hearings on the 340B program this year and is currently considering more than a … Read More

Posted in 340b

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans:  three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn more about physician turnover in Medicaid managed care plans in the Health Affairs study “Network Optimization And The Continuity Of … Read More

Posted in Uncategorized
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