Archive for Pennsylvania Medicaid

Medicaid MCOs Skimping on Care?

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

Posted in Pennsylvania Medicaid, Pennsylvania safety-net hospitals

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

PA Among States Looking at PBMs

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

Posted in Pennsylvania Medicaid

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

PA Looking at Social Determinants of Health

One of the emerging trends in health care is a greater focus on what are called the “social determinants of health” – factors and conditions  in individuals’ lives that may affect both their health and their ability to obtain the medical services they need to stay healthy or recover when they are sick or injured. Pennsylvania’s Department of Human Services, which runs the state’s Medicaid program, has increased its focus on the social determinants of health as it looks to Medicaid providers and Medicaid managed care plans to do more than provide medical services:  it wants them to join with others in addressing the social determinants of health of the communities they serve. Recently, Pennsylvania Department of Human Services deputy … Read More

Posted in Pennsylvania Medicaid

Battle Over Medicaid Work Requirements Not Over

The Secretary of Health and Human Services is not accepting a recent federal court ruling as the final word on Medicaid work requirements. Although the court ruled against a federally approved plan to permit the state of Kentucky to implement a work requirement for some able-bodied Medicaid recipients, HHS Secretary Alex Azar insists that his department will continue to support work requirements for Medicaid beneficiaries. Azar told a Heritage Foundation audience that We suffered one blow in district court in litigation, but we are undeterred.  We’re proceeding forward…We’re fully committed to work requirements and community participation in the Medicaid program…we will continue to litigate, we will continue to approve plans, we will continue to work with states.  We are moving … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers. This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs. The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers.  The two biggest risks, the GAO concluded, were: incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for … Read More

Posted in Federal Medicaid issues, Pennsylvania Medicaid

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

CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.” The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability. The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state … Read More

Posted in Pennsylvania Medicaid, Pennsylvania Medical Assistance
P:(717)234-6970; F:(717)234-6971
2012 Safety-Net Association of Pennsylvania