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SNAP Endorses Governor’s Proposal for Paying for Tobacco Borrowing

Debt service on the state’s borrowing against future proceeds from the national master tobacco settlement agreement should be paid using state sales and use tax revenue, SNAP has declared in a new position statement. Last year the state borrowed $1.5 billion against future proceeds from the tobacco settlement.  Some tobacco settlement money is used to help hospitals with the cost of uncompensated care they provide via tobacco uncompensated care payments and tobacco extraordinary expense payments made to hospitals that meet specific criteria:  how much uncompensated care they provide, the proportion of their patients insured by Medicaid, and the proportion of low-income seniors they serve.  All Pennsylvania safety-net hospitals qualify for these payments. Because the state’s borrowing against future tobacco settlement … Read More

Posted in Medicaid supplemental payments, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2020 budget, Pennsylvania safety-net hospitals, Pennsylvania state budget issues

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

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

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the July/August 2018 edition of its newsletter. Included in this edition are articles about: proposed changes in Medicaid-covered behavioral health services for children; the launch in southeastern Pennsylvania of Community HealthChoices, the state’s program of managed long-term services and supports for the dually eligible Medicare/Medicaid population; Community HealthChoices’ person-centered services plans; and changes in how individuals will seek health insurance for 2019 through the federal health insurance marketplace. Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published the June 2018 edition of its monthly newsletter. Included in this edition are articles about: Changes in Pennsylvania Medicaid’s medical transportation program governing non-emergency transportation. The renewal of the state’s hospital tax and an increase in that tax. Challenges surrounding the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports, in southwestern Pennsylvania. Information about the launch of Community HealthChoices in southeastern Pennsylvania. A provision in a recent bill modifying the state’s human services code that calls for the Department of Human Services to develop a new, outcomes-based program for hospitals and Medicaid managed care plans that will be oriented toward preventing potentially avoidable medical events. Find these … Read More

Posted in long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its May 2018 newsletter. Included in this month’s edition are stories about: The continued implementation of Community HealthChoices, the state’s new program of managed long-term services and supports for dually eligible Medicaid and Medicare beneficiaries. The introduction of a new tool for determining whether Medicaid beneficiaries shall be deemed eligible for Medicaid long-term-care services. State legislation that, if adopted, would establish presumptive eligibility for older adults applying for in-home care. A new framework for participants in state Medicaid managed care programs to appeal denials of services. New processes to streamline the determination of eligibility for Medicaid of individuals recently released from prison. Pending legislation that would permit selected mental health facilities to deem … Read More

Posted in HealthChoices, long-term care, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

A Look at Medicaid Managed Care

With 74 million people enrolled in Medicaid managed care plans – roughly 71 percent of the U.S. Medicaid population – the Health Affairs Blog has taken a broad look at Medicaid managed care, addressing the question of how it works, whether it’s working, and what its future may be. The two-part report notes that some Medicaid managed care companies are highly profitable and that this profitability has increased in recent years.  It also notes that the manner in which these companies serve their members varies greatly, that their medical loss ratios vary considerably from state to state, and that the reserves managed care companies hold vary greatly as well. In addition, the two-part report seeks answers to a number of … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has just published the March 2018 edition of its monthly newsletter. Included in this edition are articles about: new procedures that will make it easier for Medicaid recipients to be treated for opioid abuse the continued implementation of the Community HealthChoices program of managed long-term services and supports for nursing home-eligible seniors, including its introduction in southeastern Pennsylvania beginning next year the work of special needs units in the HealthChoices managed care plans the confirmation of Teresa Miller as Secretary of the Pennsylvania Department of Human Services Find these stories and others here, in the latest edition of the Pennsylvania Health Law Project’s newsletter.  

Posted in HealthChoices, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has just published the latest edition of its Health Law News newsletter. Included in this edition are articles about the elimination of Medicaid restrictions on prescription drugs for hepatitis C, the launch of the Community HealthChoices program of managed long-term services and supports in the southwestern part of the state, and more. Find these stories and others here, in the latest edition of Health Law News.  

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy
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2012 Safety-Net Association of Pennsylvania