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Archive for November 2019

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20. A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress.  If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025. Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals. Medicaid DSH payments are a vital tool for helping safety-net hospitals care for the low-income residents of their communities.  … Read More

Posted in Affordable Care Act, DSH hospitals, Federal Medicaid issues

Administration Shares Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” The statement, an annual OMB document, organizes the priorities as follows: Facilitating patient-centered markets Fixing health care financing through protecting private insurance and Medicare Fixing health care financing through reforming the individual market Fixing health care financing through making the ACA and Medicaid fiscally sustainable Bringing value to health care through price and quality transparency Bringing value to health care through patient-centered health IT Bringing value to health care through deregulation, especially for coordinated care Bringing value to health care through tackling the high cost of prescription drugs Bringing … Read More

Posted in Affordable Care Act, Federal Medicaid issues, Medicare

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019. According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments.  The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments.  Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion. CMS maintains that the improper Medicaid payment rate will decline in future years because it has introduced more rigorous enforcement of Affordable Care Act requirements … Read More

Posted in Federal Medicaid issues

DHS Unveils Strategic Plan

Pennsylvania’s Department of Human Services has a new strategic plan for 2019 through 2022. While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas: Provide every child with a strong foundation for physical and behavioral well-being Bend the health care cost curve Drive innovative whole-person care Holistically assess needs and connect to resources Address the social determinants of health Expand health care beyond the doctor’s office and into the places people live, work, and play Coordinate physical health care, behavioral health care, and long-term services and supports Promote health equity Lead the … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2019 newsletter. Included in this month’s edition are articles about: the state’s release of a request for applications for insurers to serve participants in Pennsylvania’s HealthChoices physical health care program Pennsylvania’s new Medicaid preferred drug list legislation to expand the state’s Medical Assistance for Workers Program the expansion of the state’s Living Independence for the Elderly (LIFE) program to 14 new counties over the next 18 months. Read about these subjects and more in the Pennsylvania Health Law Project’s October newsletter.

Posted in HealthChoices, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

PHC4 Reports on Hospital Mortality, Admission Rates, and Performance

Mortality rates, admission rates, and other aspects of hospital performance are the subject of a new report by the Pennsylvania Health Care Cost Containment Commission. The report presents information on hospital volume and outcomes for 17 different medical conditions and surgical procedures from October 2017 through September 2018.  It also compares hospital performance over the five-year period from 2013 through 2018 on an aggregate state-wide basis and for individual hospitals. Overall, the report found decreases in hospital mortality for most of the 17 conditions, with respiratory failure, sepsis, colorectal procedures, and intestinal obstructions experiencing the biggest decreases (by percentage).  Hospital admissions for chest pain, chronic obstructive pulmonary disease, and pneumonia experienced the biggest declines while admissions for respiratory failure and … Read More

Posted in Uncategorized

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states. The report includes: data about changes in the uninsured rate demographic information about the uninsured information about the cost of hospital uncompensated care perspectives on hospital Medicaid shortfalls a comparison of hospital uncompensated care costs when calculated using different methodologies data about hospitals that provide “essential community services” information about scheduled Medicaid DSH allotment reductions All Pennsylvania safety-net hospitals receive Medicaid DSH … Read More

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

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed. After lunch, MACPAC staff briefed the Commission on challenges states face as they prepare for mandatory reporting of quality measures for children enrolled in Medicaid and the State … Read More

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

Medicaid Expansion Brings Improvements to Expansion States

States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study. Specifically, they experienced: a 3.1 percent decline in inpatient days a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia a reduction of nearly three percent in hospital costs. Pennsylvania is one of those expansion states, and Medicaid expansion has greatly enhanced the ability of Pennsylvania safety-net hospitals to serve their communities. Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study … Read More

Posted in Affordable Care Act, Federal Medicaid issues, Pennsylvania safety-net hospitals

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act. And hospitals that receive these payments are now preparing for the worst. The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money.  The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise … Read More

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