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Archive for December 2018

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform. CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details. See a brief notice about the new office here.

Posted in Uncategorized

Feds Urge States to Do More for Dually Eligible

In a formal guidance letter to state Medicaid directors, the Centers for Medicare & Medicaid Services has outlined ten ways that states can better serve individuals who are enrolled in both Medicare and Medicaid. Noting that such dually eligible individuals represent 20 percent of Medicare enrollees but 34 percent of Medicare spending while also constituting 15 percent of Medicaid beneficiaries but 33 percent of Medicaid spending, the letter from CMS administrator Seema Verma to state Medicaid directors explains that This letter describes ten opportunities – none of which require complex demonstrations or Medicare waivers – to better serve individuals dually eligible for Medicare and Medicaid, including through new developments in managed care, using Medicare data to inform care coordination and … Read More

Posted in Federal Medicaid issues, Medicare

Bill Would Overhaul Medicaid DSH

A new Senate proposal would change how the federal government allocates Medicaid disproportionate share money (Medicaid DSH) to the states. The State Accountability, Flexibility, and Equity (SAFE) for Hospitals Act, introduced by Senator Marco Rubio (R-FL), seeks to …create equity for all states by updating a metric used to determine how much each state is allotted, which has not been reformed since the early 1990s. A news release issued by Senator Rubio explains that the bill Gradually changes the DSH allocation formula so states’ allocations are based on the number of low-income earners living in the state, as a percentage, of the total U.S. population earning less than 100% of the Federal Poverty Level (FPL). Prioritizes DSH funding to hospitals … Read More

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

MACPAC Looks at Medicaid DSH

Last week the federal Medicaid and CHIP Payment and Access Commission met in Washington, D.C. and one of the subjects on its agenda was Medicaid DSH. The Affordable Care Act mandated major reductions of Medicaid disproportionate share (Medicaid DSH) allotments to states and those reductions have been delayed by Congress several times but are now scheduled to begin in FY 2020. At the MACPAC meeting the commission’s staff presented three proposed recommendations that address Medicaid DSH allotments; these recommendations were based on a consensus reached by MACPAC commissioners at their October meeting.  Those recommendations are: Phase in Medicaid DSH reductions more gradually over a longer period of time. Apply reductions to unspent DSH funds first. Distribute reductions in a way … Read More

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

PA Making In-roads in Opioids Fight

Pennsylvania is making progress in the fight against opioids, according to a new report. At the heart of this progress has been improved access to medication-assisted treatment, enforcement of parity laws, enhanced access to naloxone, and better oversight of the care of Medicaid patients, including enhanced coverage of alternatives to opioids for pain management. The report also cites several areas where Pennsylvania can improve its efforts, including removing more barriers to care for patients with substance use disorders, improving access to alternative pain therapies, further expanding access to naloxone, and evaluating current policies and programs to ensure that they contribute to fighting the opioid challenge. Learn more in the report Spotlight on Pennsylvania:  Leading-Edge Practices and Next Steps in Ending … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

PA Auditor General Issues Blistering Report on PBMs

Pennsylvania Auditor General Eugene DePasquale has released a report highly critical of pharmacy benefit managers and called for greater oversight of such companies. Citing PBMs’ lack of transparency, lack of oversight, and reimbursement disparity, DePasquale’s report, compiled after research and public hearings throughout the state that relied heavily on the testimony of independent pharmacies, includes 10 recommendations, among them several that directly address Medicaid in Pennsylvania.  Those Medicaid-related recommendations are: To better control costs, Pennsylvania should consider directly managing its Medicaid prescription drug benefits instead of contracting with managed care organizations to do so. The General Assembly should pass legislation to use the federal Centers for Medicare & Medicaid Services’ National Average drug Acquisition Cost (NADAC) for pricing prescription drugs … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

Ambulances Respond Slower to Low-Income Communities

People living in low-income communities wait about four minutes longer for ambulances to respond to their call for help when they are having a heart attack, a new study has found. In communities with annual median incomes between $57,000 and $113,000, the study found that ambulances arrive in an average of 37.5 minutes – faster than in communities where the annual median income is between $20,250 and $42,642, where the typical wait time is 43 minutes. Neither result is anywhere near industry benchmarks of 4, 8, and 15 minutes for delivering specific services in response to heart attack symptoms. Among the possible reasons for the difference in response times, the study’s authors suggest, are hospital closures in and around low-income … Read More

Posted in Pennsylvania safety-net hospitals

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the November 2018 edition of its newsletter. Included in this edition are articles about: Community HealthChoices, the state’s program of managed long-term services and supports for eligible Medicaid/Medicare beneficiaries; the return of General Assistance cash grants to Pennsylvania; Governor Wolf’s veto of legislation that would impose a work requirement on many Pennsylvania Medicaid recipients; an increase in the income limits for eligibility for PACENET, the state’s prescription drug assistance program; and a federal proposal to change “public charge” regulations. Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

CMS Introduces New Waivers

The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care. Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses. “State-specific premium assistance” waivers enable states to create their own subsidy programs. “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health insurance policies that do not meet Affordable Care Act benefits and coverage requirements. “Risk stabilization strategies” waivers give states greater … Read More

Posted in Affordable Care Act, Health care reform
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