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Archive for 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

New Medical Assistance Bulletin Addresses Hospital Uncompensated Care

The Pennsylvania Department of Human Services has issued a new Medical Assistance Bulletin titled “Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans.” According to the document, The purpose of this Medical Assistance (MA) Bulletin is to remind hospitals of the requirements for the Hospital Uncompensated Care Program (Program) and reinforce the responsibility of hospitals to actively engage patients when determining eligibility for the Program. See the entire Bulletin here.  

Posted in Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News. Included in this edition are articles about: The January 1 introduction of Community HealthChoices, a mandatory program of managed long-term services and supports, in southwestern Pennsylvania the January 1 implementation of the federal ordering, referring, or prescribing rule that requires that all such actions involving Pennsylvania Medicaid patients be undertaken by providers enrolled with the state to serve Medicaid patients various Medicare issues Find these stories here in the latest edition of Health Law News.

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy
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