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CMS Provides Guidance on Medicaid DSH Calculations

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

Posted in Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy

PA Health Law Project Newsletter

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.

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

COVID-19 Update: March 25, 2020

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

Posted in Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy

COVID-19 Update: March 20, 2020

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

Posted in Coronavirus, COVID-19, Federal Medicaid issues, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy, Uncategorized

COVID-19 Update: March 17, 2020

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

Posted in Coronavirus, COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

SNAP Rallies PA Delegation to Oppose MFAR

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

Posted in Federal Medicaid issues, Pennsylvania Medicaid policy, Uncategorized

Wolf Administration Proposes New Human Services Initiatives for FY 2021

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

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2021 budget, Pennsylvania safety-net hospitals, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania

Pennsylvania Health Law Project Newsletter

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.

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance

PA Says No to Medicaid Block Grants

Pennsylvania is not interested in pursuing the new Medicaid block grants being offered by the administration, leading state officials said last week. In a news release, Governor Wolf said that I expanded Medicaid in Pennsylvania to allow for more than 700,000 people to have reliable health care access. Pennsylvania will not go backwards. I will not risk jeopardizing our progress by going along with another short-sighted, insensitive plan to cut Medicaid… Department of Human Services Secretary Teresa Miller, who oversees the Pennsylvania Medicaid program that serves approximately 2.8 million people, echoed this sentiment: Changing any part of Medicaid to a block grant structure is the federal government permitting states to grow health inequities experienced by the poorest Americans. This cruel … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy

Medicaid Transportation Program Defies Fixing

Pennsylvania is trying to fix its Medical Assistance Transportation Program – but that is proving harder than proponents of change envisioned. For years, county governments ran their own programs, which provided free non-emergency transportation to doctor offices for Medicaid patients.  About 55,000 Pennsylvanians served by Medicaid use this program. But with a growing trend among states of dividing a state into regions and awarding regional contracts to transportation brokers and amid objections from county governments, the General Assembly directed the state’s departments of Aging, Human Services, and Transportation to look into the matter. And in the report those departments filed with the legislature, they say they do not know what to do. Learn more about the challenges facing the Medical … Read More

Posted in Pennsylvania Medicaid policy, Pennsylvania Medical Assistance
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2012 Safety-Net Association of Pennsylvania