Archive for Pennsylvania Medicaid policy
The federal government does not adequately monitor how states finance their Medicaid programs. It also lacks a sufficiently clear understanding of how they pay providers of Medicaid-covered services. These are among the conclusions in a new study on Medicaid financing and payments by the U.S. Government Accountability Office. According to the GAO report, GAO estimated that states’ reliance on provider taxes and local government funds decreased states’ share of net Medicaid payments (total state and federal payments) and effectively increased the federal share of net Medicaid payments by 5 percentage points in state fiscal year 2018. It also resulted in smaller net payments to some providers after the taxes and local government funds they contribute to their payments are taken … Read More
The Pennsylvania Health Law Project has published its November 2020 newsletter Health Law News. Included in this month’s edition are articles about: How the renewal of the federal COVID-19 public health emergency declaration extends key Medicaid protections. State planning for children with complex needs. State efforts to connect people to COVID-19 testing and care. An upcoming webinar about challenging Medicaid and Community HealthChoices waiver service denials. Read about these subjects and more in the Pennsylvania Health Law Project’s November 2020 newsletter.
State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services. In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date, CMS will enforce its own interpretation of the policy. In new guidance, CMS presents two methodologies for accounting for its mid-year policy change and reminds stakeholders about its new methodology for calculations after June 2, 2017. Pennsylvania’s Department of Human Services and its … Read More
The Pennsylvania Health Law Project has published its August 2020 newsletter Health Law News. Included in this month’s edition are articles about: The Department of Human Services’ selection of new managed care plans to serve Pennsylvania Medicaid’s Community HealthChoices program. The end of ensured continuity of long-term services and supports for participants in the Community HealthChoices program in northeastern Pennsylvania. The availability of navigators to help connect people to COVID-19 testing and treatment. Read about these subjects and more in the Pennsylvania Health Law Project’s August 2020 newsletter.
The following is a summary of the major COVID-19-related developments in Pennsylvania as of 5:15 on March 25. State Legislature Today the Senate passed House Bill 1232, as amended, which includes up to $50 million of additional funding to be made available for the state’s COVID-19 response efforts. The legislation stipulates that funding shall only be used to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand. It also requires available federal funding and any funding made available through the governor’s disaster proclamation to be used before these funds. The authority to transfer funds expires on September 30, 2020. Senate leadership noted that this is the first phase in … Read More
The following is a summary of the major COVID-19-related developments in Pennsylvania today as of 5:30 p.m. on March 20, 2020. Pennsylvania Administration Since yesterday, the Department of Human Services has issued the following four new guidance documents: Billing Guidance for Alternative Screening Sites Related to COVID-19 Virtual Drop Ins Mental Health Revised Due Dates for Case Mix Index (CMI) Reporting, Cost Report Submissions, and Nursing Facility Assessment Payment Plan Requests Interim Guidance on Visitation in Nursing Facilities During COVID-19 We notified you last night that the governor issued an order to close all “non-life-sustaining businesses.” Below please find two resources for additional information. Any business that would like to seek a waiver to the mandate to close can send … Read More
The following is a summary of the major COVID-19-related developments in Pennsylvania today. Telemedicine The Office of Medical Assistance Programs has issued guidance for providers on the use of telemedicine services for Medicaid patients – those covered both by managed care plans and on a fee-for-service basis. Learn more from the newly posted telemedicine guidelines and a separate memo to the HealthChoices managed care plans from the state. In addition, CMS issued a waiver for certain restrictions on the provision of telemedicine services under the Medicare program. The details of the wavier are described in a Fact Sheet and FAQ. New Guidance From the State Today the state published a number of COVID-19-related resources: ICD-10-CM Official Coding Guidelines Related to … Read More
A proposed federal Medicaid regulation could limit Pennsylvania’s ability to finance its Medicaid program and jeopardize supplemental payments to the state’s private safety-net hospitals, so SNAP has asked members of the state’s congressional delegation to sign a letter to CMS Administrator Seema Verma asking her to reconsider the potentially damaging Medicaid fiscal accountability regulation. In its letter to members of the state’s congressional delegation, SNAP wrote on behalf of private Pennsylvania safety-net hospitals that The proposed Medicaid fiscal accountability regulation (MFAR) would, if implemented, impose new limits on how states may raise their share of funds to support their Medicaid programs. If adopted, the commonwealth would face a serious challenge raising the money it needs to finance its share of … Read More
New human services efforts to support vulnerable populations are a major part of Governor Tom Wolf’s proposed $36.06 billion FY 2021 budget for Pennsylvania. The proposed budget, presented to the state legislature earlier this week, includes the following new initiatives: creating pathways to success in the workforce for low-income Pennsylvanians increasing the minimum wage to $15 increasing Department of Human Services staffing to support licensing and oversight supporting adults in long-term-care facilities legal services for vulnerable populations direct care worker comprehensive training commitment to performance-based metrics, accountability, and transparency in services and licensing supporting vulnerable populations through home- and community-based services and reducing waiting lists prevention services to support at-risk families improving food security while supporting agriculture Go here to … Read More
The Pennsylvania Health Law Project has published its January 2020 newsletter. Included in this month’s edition are articles about: the transition to a new Medicaid prescription drug list (PDL); the rollout of a new electronic visit verification system for Medicaid-paid home health services; and progress in the state’s effort to introduce major changes in its Medical Assistance transportation program (MATP). Read about these subjects and more in the Pennsylvania Health Law Project’s January 2020 newsletter.