Archive for Pennsylvania Medicaid
Pennsylvania’s Medicaid resources should follow now-closed Hahnemann University Hospital’s Medicaid patients as those patients turn to new providers, the Safety-Net Association of Pennsylvania declared in a position statement issued this week. According to SNAP, …the best way to protect access to care and prevent additional financial strain on Philadelphia hospitals is to ensure that all state resources reallocated in the wake of Hahnemann University Hospital’s closure follow the displaced patients. In preparation for addressing this challenge, SNAP performed a data-based analysis of where Medicaid patients turned for care upon the closing of St. Joseph’s Hospital, like Hahnemann a high-volume Medicaid provider and located in the same community as Hahnemann, in 2016. This analysis identified where patients went when St. Joseph’s … Read More
Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation. This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits. The proposal will be considered by the Senate Health and Human Services Committee. The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them. Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war … Read More
The plan to introduce major changes in Pennsylvania’s free medical transportation program for the Medicaid population has temporarily been halted. As envisioned by the state, the current program, in which individual counties contract independently with transportation providers to serve their residents on Medicaid, was to be replaced by a regional approach in which the state contracts with three vendors to serve all of Pennsylvania. Objections by members of the state legislature and county officials, however, led to legislation that requires the Department of Human Services, Department of Transportation, and Department of Aging to study the implications of such a change for patients and taxpayers and to report their preliminary findings to the legislature in September. Learn more about Pennsylvania’s Medical … Read More
Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act. And Medicaid-covered admissions and ER visits are up, according to a new analysis. The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent. The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise. While the Affordable Care Act is likely the cause of most of these changes, other contributing factors include the emergence of urgent care facilities, telemedicine, and free-standing ERs as well … Read More
The Pennsylvania Health Law Project has published the February 2019 edition of its newsletter. Included in this edition are articles about: Governor Wolf’s proposed FY 2020 Medicaid budget Medicare Part D co-pay problems for some dual-eligibles new Medicare Part D monitoring for prescription drug abuse Community HealthChoices Find these stories and others in the latest edition of the Pennsylvania Health Law Project’s Health Law PA News.
Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices. Learn more in the Kaiser Health … Read More
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
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
Pennsylvania is one of a number of states looking the operations and profits of pharmacy benefits managers employed by managed care plans that serve the state’s Medicaid population. One state has already passed a law governing PBMs and others are doing the same as states zero in on how PBMs make their money when serving a Medicaid population whose care is paid for with public money. One specific target is PBM’s “spread”: the suggestion that in addition to the fees they are paid by managed care organizations, PBMs charge managed care plans more than they pay pharmacies that dispense prescriptions and keep the difference for themselves as profit. Pennsylvania’s Department of Human Services, its auditor general, and the state Senate … Read More
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.