Archive for HealthChoices PA
The Pennsylvania Health Law Project has published its January 2017 newsletter. Included in this edition are stories about: impending changes in the lineup of managed care providers that serve Medicaid participants in the state’s HealthChoices program for physical health services; the status of the state’s implementation of its Community HealthChoices program of managed long-term services and supports for low-income, elderly Pennsylvanians who seek to continue living independently in the community; the potential impact of a repeal of the Affordable Care Act on Pennsylvanians; and Pennsylvania’s receipt of a Certified Community Behavioral Health Clinic demonstration grant from the federal government to improve services and care coordination for individuals on Medicaid or CHIP. Go here for the latest edition of PA Health … Read More
Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance. The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment. HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements … Read More
The Pennsylvania Health Law Project has published the April 2016 edition of Health Law News, its monthly newsletter. Included in this edition are articles about a new, faster process the state has introduced for people to enroll in Medicaid; the awarding of contracts to managed care organizations to participate in the state’s HealthChoices program; an update on the Community HealthChoices program that will help nursing home-eligible seniors remain independent in the community; new funding for the state’s “Money Follows the Person” demonstration program; and more. Find the latest edition of Health Law News here.
Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program. Eight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions. All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members. Learn more … Read More
The Pennsylvania Health Law Project has published the January 2016 edition of Health Law News, its monthly newsletter. Included in this edition are an update on the state’s proposed Community HealthChoices program, which would require dual-eligible Pennsylvanians to receive long-term services and supports through new managed care organizations; a summary of the Pennsylvania Health Law Project’s formal comments about that proposed program; and information about the state’s Medical Assistance Transportation Program and its proposed transition plan for home and community-based services. Find the latest edition of Health Law News here.
In an op-ed piece in the Scranton Times-Tribune, Pennsylvania Department of Human Services Secretary Ted Dallas has outlined his organization’s major achievements of 2015 and its plans for 2016. Among them are the state’s expansion of its Medicaid program and its plans to establish new contracts with HealthChoices managed care organizations that seek to shift the program’s emphasis from volume of care to value and outcomes through greater use of accountable care organizations (ACOs), bundled payments, patient-centered medical homes, and other value-based initiatives. Find Secretary Dallas’s commentary here.
When Pennsylvania put its HealthChoices contracts up for bid, the sizeable market to be served – more than 2.5 million people – was expected to draw interest from major national managed care organizations that serve Medicaid patients. It didn’t happen. Instead, of the nine companies that submitted bids, only one came from a national company that did not already participate in HealthChoices: Centene, a St. Louis company that serves six million Medicaid patients in 21 states. National Medicaid managed care organizations Anthem, Molina Healthcare, and WellCare did not bid. Three much smaller organizations submitted bids to enter the Pennsylvania Medicaid market: Accendia, a subsidiary of Capital Blue Cross; Meridien Health Plan, a Detroit-based company serving 700,000 Medicaid recipients in six … Read More
The Pennsylvania Department of Human Services describes two recent steps to improve the delivery of health care to low-income Pennsylvanians – the introduction of its new “Community HealthChoices” program and the re-bidding of managed care organization contracts for its HealthChoices physical health program – in the latest edition of its newsletter The Impact. Find that edition here.
The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program. The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January. The contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years. Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes. With a projected value of about … Read More
Recent changes in how Pennsylvania processes Medicaid applications has greatly shortened the waiting period for gaining access to care for qualified applicants. The waiting period during which applications were considered, approximately 70 days just a few months ago, is now much shorter, with only two percent of applicants waiting more than 30 days for a decision compared to 13 percent in January. Most applicants, according to the Pennsylvania Department of Human Services, have an answer within 22 days. To learn more about how the state has reduced the time it takes to review Medicaid eligibility applications as well as more about the state’s Medicaid program, see this Pittsburgh Post-Gazette article.