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Seven of the largest health insurers serving Pennsylvanians have agreed to end pre-authorization requirements for patients needing medication-assisted treatmen for opioid addictions. As explained in a news release issued by the governor’s office, These guidelines apply to individual, small group, and large group fully insured plans. Self-funded plans, where employers provide health care coverage administered by a third party, are regulated by the federal government and are not included in this agreement. In addition, The guidelines implement thresholds for prior authorization for long- and short-acting opioids, morphine milligram equivalents (MME) and exceptions for active cancer, sickle cell crisis, and palliative care/hospice patients. Generally, commercial insurers are requiring prior authorization for all long-acting opioid prescriptions and short-acting opioid prescriptions after seven … Read More
A bill proposed in the Pennsylvania state legislature would require private insurers to cover telemedicine services under selected circumstances. Senate Bill 780, currently under consideration by the House Professional Licensure Committee, was the subject of a recent committee hearing during which hospital officials from across the state spoke in support of fostering greater use of telemedicine in the delivery of health care services. Learn more about the bill and why hospital executives traveled to Harrisburg to express their support for it in this article in the publication Lehigh Valley Business or go here to see the bill itself.
People are using hospital emergency departments less frequently for low-acuity medical problems, turning instead to retail clinics and urgent care. According to a new study of a limited patient population published in JAMA Internal Medicine, Visits to the ED for the treatment of low-acuity conditions decreased by 36% (from 89 visits per 1000 members in 2008 to 57 visits per 1000 members in 2015), whereas use of non-ED venues increased by 140% (from 54 visits per 1000 members in 2008 to 131 visits per 1000 members in 2015). There was an increase in visits to all non-ED venues: urgent care centers (119% increase, from 47 visits per 1000 members in 2008 to 103 visits per 1000 members in 2015), retail … Read More
In a letter to the U.S. Secretary of Health and Human Services and Secretary of Labor, the Pennsylvania Insurance Department has outlined how it plans to implement at the state level the recent federal regulation governing association health plans. In the letter, state Insurance Commissioner Jessica Altman notes ambiguities in the federal regulation and describes how the state Insurance Department intends to address those ambiguities and other aspects of the federal regulation that she believes are unclear. See the Insurance Department’s news release on this issue here and read Commissioner Altman’s letter here.
Paul Mango, who earlier this year ran unsuccessfully for the Republican nomination for governor of Pennsylvania, has joined the Centers for Medicare & Medicaid Services as chief principal deputy administrator and chief of staff. Mango previously worked as a health care consultant for more than 25 years, including for the McKinsey & Company consulting firm. Among his past Pennsylvania clients were hospitals and insurers.
Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients. Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C. The Washington Examiner reports that at that event, Verma said that We are looking at what the court said. We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals. CMS currently has applications from eight states to establish new Medicaid work requirements. While Pennsylvania is not among them, some members of the state’s General … Read More
Health care providers and drug manufacturers should expect changes in the section 340B prescription drug discount program in the near future. That was the message conveyed by Health and Human Services Secretary Alex Azar during a recent conference held by the 340B Coalition. The 340B program, which provides discounts on the prescription drugs dispensed on an outpatient basis by eligible providers to their low-income patients, has become increasing controversial in recent years as it has expanded and pharmaceutical companies have objected to the discounts they must provide. Among the changes Azar suggested are coming are greater accountability among participating hospitals for how they use the savings they derive from the discounts and a narrowing of the difference between the prices … Read More
The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans: three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn more about physician turnover in Medicaid managed care plans in the Health Affairs study “Network Optimization And The Continuity Of … Read More
2017 hospital admissions for heroin overdoses in Pennsylvania rose nearly 13 percent but admissions for overdoses of pain medication fell more than two percent that year, according to the Pennsylvania Health Care Cost Containment Commission. Nearly ten percent of those heroin patients died in the hospital, as did half that proportion of pain medication overdose patients. The average age of the heroin overdose patients admitted was 33 and nearly two-thirds of them were insured by Medicaid. Of the pain medication patients admitted, the average age was 53 and 42 percent were insured by Medicare, 34 percent by Medicaid, and 19 percent by commercial insurers. Learn more about trends in hospital admissions for heroin and pain medication overdoses in the Pennsylvania … Read More
They may if they serve Medicaid patients. Or so suggests a new Health Affairs report. As growing numbers of Medicaid managed care plans reduce their provider networks as a means of managing costs, provider turnover appears to be growing. According to the report, narrow networks tracked during a five-year period experienced a 20 percentage point greater rate of physician turnover than non-narrow plans. Such turnover is thought to be a potential problem for Medicaid patients who are socially or clinically vulnerable and present complex medical needs. The loss of a physician can disrupt and complicate the care of such patients – and disrupt it in ways that may not necessarily be detected by current quality measures. This could pose a … Read More