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Archive for Pennsylvania safety-net hospitals

Court Rejects 340B Cuts

A federal court has ruled that the Centers for Medicare & Medicaid Services overstepped its authority in reducing Medicare payments for prescription drugs covered by the section 340B prescription drug discount program. While the court conceded that CMS has the authority to address 340B payments, it found that CMS’s drastic payment cuts, introduced in FY 2018, “…fundamentally altered the statutory scheme established by Congress…” for determining 340B payment rates. The court suggested that CMS either change its methodology for determining 340B payments to justify the specific cuts it proposes or raise its objections with Congress, which created the program and has the authority to change it. According to documents submitted to the court by the parties that filed the suit, … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

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

Bill Would Overhaul Medicaid DSH

A new Senate proposal would change how the federal government allocates Medicaid disproportionate share money (Medicaid DSH) to the states. The State Accountability, Flexibility, and Equity (SAFE) for Hospitals Act, introduced by Senator Marco Rubio (R-FL), seeks to …create equity for all states by updating a metric used to determine how much each state is allotted, which has not been reformed since the early 1990s. A news release issued by Senator Rubio explains that the bill Gradually changes the DSH allocation formula so states’ allocations are based on the number of low-income earners living in the state, as a percentage, of the total U.S. population earning less than 100% of the Federal Poverty Level (FPL). Prioritizes DSH funding to hospitals … Read More

Posted in Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

MACPAC Looks at Medicaid DSH

Last week the federal Medicaid and CHIP Payment and Access Commission met in Washington, D.C. and one of the subjects on its agenda was Medicaid DSH. The Affordable Care Act mandated major reductions of Medicaid disproportionate share (Medicaid DSH) allotments to states and those reductions have been delayed by Congress several times but are now scheduled to begin in FY 2020. At the MACPAC meeting the commission’s staff presented three proposed recommendations that address Medicaid DSH allotments; these recommendations were based on a consensus reached by MACPAC commissioners at their October meeting.  Those recommendations are: Phase in Medicaid DSH reductions more gradually over a longer period of time. Apply reductions to unspent DSH funds first. Distribute reductions in a way … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

Ambulances Respond Slower to Low-Income Communities

People living in low-income communities wait about four minutes longer for ambulances to respond to their call for help when they are having a heart attack, a new study has found. In communities with annual median incomes between $57,000 and $113,000, the study found that ambulances arrive in an average of 37.5 minutes – faster than in communities where the annual median income is between $20,250 and $42,642, where the typical wait time is 43 minutes. Neither result is anywhere near industry benchmarks of 4, 8, and 15 minutes for delivering specific services in response to heart attack symptoms. Among the possible reasons for the difference in response times, the study’s authors suggest, are hospital closures in and around low-income … Read More

Posted in Pennsylvania safety-net hospitals

Medicaid to Help Pay for Food, Heat, Rent?

Maybe. At least that is what Department of Health and Human Services Secretary Alex Azar hinted during a recent symposium held in Salt Lake City. During the event, Azar said that HHS’s Center for Medicare and Medicaid Innovation seeks …solutions for the whole person, including addressing housing, nutrition, and other social needs. Azar hinted at future CMMI action, saying that What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food? If that sounds like an exciting idea … I want you to stay tuned to what CMMI is up to. CMMI currently operates one major program that … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries. Under the newly proposed regulation, states would: be free to implement more changes in their managed care programs without seeking federal permission; have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval; be permitted to redefine what constitutes an adequate provider network for managed care plans; and not be required to publicize beneficiary grievance and appeals processes as prominently as they currently do. Overall, the proposed regulation appears … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The October 2018 MACPAC meeting covered a range of front-line issues in Medicaid, leading off with an analysis of disproportionate share hospital (DSH) allotments on Thursday morning. Following the analysis, the Commission discussed options for March recommendations on how to structure DSH allotment reductions that are scheduled to begin in fiscal year 2020. The Commission later resumed the discussion it began in September on work and community engagement requirements, presenting new data from Arkansas on compliance and disenrollments, as well as information gathered since that meeting about Arkansas’s approach to implementation. On Thursday afternoon, … Read More

Posted in DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals

Medicaid Expansion Helping Diabetics

The Affordable Care Act’s Medicaid expansion has led to a 40 percent increase in the number of prescriptions for diabetes medicine filled in the 30 states that expanded their Medicaid programs. Meanwhile, there was no change in the number of diabetes-related prescriptions filled in states that did not expand their Medicaid programs. This is considered important because it suggests that many low-income people who either could not afford their diabetes medicine or whose illness was undiagnosed are now being treated for the disease – a significant development because every diabetic who is treated for the condition represents a cost savings of $6394 a year, mostly because of fewer hospitalizations. As a Medicaid expansion state, Pennsylvania and the safety-net hospitals that … Read More

Posted in Affordable Care Act, Pennsylvania safety-net hospitals

S&P: 340B Cuts Will Hurt

Payment cuts in the 340B prescription drug program will most likely hurt hospital financial performance, and among those most likely to be hurt are DSH hospitals, small hospitals, and rural hospitals. These are among the conclusions in a report recently issued by S&P Global Ratings. The report concludes that …the impact of the cuts to the 340B Drug Pricing Program on not-for-profit hospitals that rely on 340B drug savings will likely weaken their operating performance at a time of already tightening margins. Effective the beginning of 2018, the Centers for Medicare & Medicaid Services cut the 340B program 16 percent, or $1.6 billion, reducing the reimbursement 340B-eligible hospitals receive for dispensing prescription drugs on an outpatient basis to eligible patients. … Read More

Posted in 340b, DSH hospitals, Medicare, Pennsylvania safety-net hospitals
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2012 Safety-Net Association of Pennsylvania