Archive for December 2019

PA Introduces Medicaid PDL on January 1

Beginning tomorrow, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients. And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs. The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services. While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon:  the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new … Read More

Posted in Pennsylvania Medicaid policy

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November-December 2019 newsletter. Included in this month’s edition are articles about: Changes in care coordination in the Community HealthChoices program in southeastern Pennsylvania beginning on January 1. Changes in the delivery of Medicaid-covered intensive behavioral health services in homes, schools, and the community for children and adolescents. The switch from Medicaid to Medicare as primary payer for medication-assisted treatment for opioid use disorder for dually eligible (Medicare and Medicaid) patients. Pennsylvania’s request for a delay in implementation of electronic visit verification for Medicaid-covered personal assistance services and home health aides. The delay in implementation of the new public charge rule and its implications for taking advantage of Medicaid benefits among potentially affected … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do. At last count, various parts of Congress were considering four major surprise medical bill proposals:  one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees.  Some have been around for some time while one emerged only in the past week. The Commonwealth Fund has prepared a summary of the four proposals that includes a chart that compares … Read More

Posted in Uncategorized

Medicaid DSH Cut Delayed

Scheduled cuts in Medicaid DSH payments to hospitals will be delayed until at least late May under new federal spending legislation. The cuts in Medicaid disproportionate share allotments to the states, mandated by the Affordable Care Act and delayed several times by Congress – including twice in FY 2020 alone under continuing resolutions to fund the federal government – are among a number of so-called “extenders” included in spending bills passed by Congress this week and sent to the president for his signature. Authorization for delaying the cut in allotments to the states, which would have resulted in reduced Medicaid DSH payments for many hospitals – including private safety-net hospitals – would expire on May 22.  Congress is expected to … Read More

Posted in Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid


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 Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources. Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session … Read More

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

Prescription Drug Bill Would Kill Two Years of Medicaid DSH Cuts

Two years of Medicaid DSH cuts would be eliminated under a new prescription drug bill released last week by the Senate Finance Committee. The Prescription Drug Pricing Reduction Act includes a provision that would eliminate two years of Affordable Care Act-mandated cuts in the allocation of federal money to the states for Medicaid disproportionate share hospital payments (Medicaid DSH).  Those cuts have been delayed several times by Congress but were scheduled to begin in October of 2019 and run through federal FY 2025, only to be delayed again twice by continuing resolutions adopted by Congress to fund the federal government in the absence of enacted appropriations bills. Under this proposal, the first two years of Medicaid DSH cuts would be … Read More

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

PA Rural Hospitals to Get Boost From State

A new law seeks to stabilize the financial condition of Pennsylvania’s rural hospitals. Senate Bill 314, passed by the legislature and signed by Governor Wolf, establishes a new Rural Health Redesign Center Authority and Pennsylvania Rural Health Redesign Center fund that will seek to support the delivery of health care by rural hospitals in the state by, as a legislative co-sponsorship memo explained, creating an annual, prospective budget with regular, predictable payments; improving the ability to develop and carry out expanded and innovative community health services; and providing the capacity to pursue programs addressing key needs such as behavioral health and substance abuse and cooperative EMS. The new approach will shift participating hospitals from fee-for-service to global payments.  Eligible hospitals … Read More

Posted in Uncategorized

Progress Continues Toward Launch of PA Health Insurance Exchange

Pennsylvania remains on target to launch its own health insurance exchange in time for the 2021 open enrollment season. The shift away from using the federal exchange and developing a state-based exchange was approved by the state legislature earlier this year.  That shift took a major step forward recently when the state hired a contractor to create the site’s platform. State officials estimate that once the state’s site is up and running it will costs $25 million a year to operate; currently, Pennsylvania pays $95 million a year to participate in the federal exchange.  In addition, the state will be able to collect the three percent of premiums that insurers pay to appear on the federal site.  Those seeking insurance … Read More

Posted in Uncategorized

High-Deductible Plans Driving Rise in Hospital Bad Debt

Hospital bad debt rose in 2018 after several years of decline, and according to Moody’s, high-deductible health insurance is one of the major drivers of that increase. According to the bond rating agency, non-profit hospitals are seeing growing amounts of bad debt as they struggle, often unsuccessfully, to collect from patients whose high deductibles leave them on the hook for meaningful amounts of care. Kaiser Health News reports that 28 percent of covered workers, nearly half of them working for companies with fewer than 200 employees, now have health plan deductibles of at least $2000.  That proportion of individuals with such high deductibles has nearly quadrupled in the last decade. Bad debt can be an especially challenging problem for Pennsylvania … Read More

Posted in Pennsylvania safety-net hospitals
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