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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 Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon. First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and raise the cap on rebates. The Commission then revisited hospital payment policy, with a draft chapter and recommendation on how … Read More

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PA to Experiment with Global Budgets for Rural Areas

Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals. The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals. According to a Pennsylvania Department of Health news release, The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the global budget will include multiple-payers, including private and public insurers. The global budgeting project is a joint venture of the state’s Department of … Read More

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Health Care Lobbying Rose in 2018

Hospitals and health systems spent $99.7 million lobbying in Washington, D.C. last year, just barely more than in 2017 but much less than in 2009, when the focus of health care lobbying was the Affordable Care Act, then just a proposal and not a law. The issues on which they spent the most money lobbying were the 340B program, site-neutral Medicare payments for outpatient services, safety-net hospitals, Medicare-for-all proposals, and Medicaid funding. Learn more about what hospitals spent their lobbying money on, who were the biggest lobbying spenders, and where industry groups figure in the overall spending in the Healthcare Dive article “Hospital lobbying in 2018 — by the numbers.”

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Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them. At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission. According to a presentation delivered at a MACPAC meeting last week: Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists. Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole. Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept … Read More

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SNAP Comments on Proposed Federal Managed Care Reg

The Safety-Net Association of Pennsylvania has submitted formal comments to the Centers for Medicare & Medicaid Services in response to CMS’s proposed changes in federal Medicaid managed care regulations. SNAP’s letter addressed three aspects of the proposed regulation:  payment rate ranges, directed Medicaid payments, and Medicaid pass-through payments.  The overall theme underlying SNAP’s comments was that the proposed changes represent positive steps but could be taken further to provide additional flexibility for Pennsylvania’s Medicaid program to take stronger steps to ensure the ability of Pennsylvania safety-net hospitals to serve their communities. SNAP expressed support for CMS’s restoration of the use of actuarial rate ranges in setting Medicaid managed care rates but urged CMS to make those rate ranges even broader … Read More

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CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform. CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details. See a brief notice about the new office here.

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Number of Uninsured Children Rises

For the first time since 2008, the number of uninsured children in the U.S. increased in 2017, according to a new report from the Georgetown University Health Policy Institute. While the total increase in the number of uninsured children is small – just 276,000 – 2017 marked the first time in nearly a decade that the number of uninsured children has risen.  For the year, 3.9 million were uninsured, up from 3.6 million in 2016. Passage of the Affordable Care Act and extension of the Children’s Health Insurance Program (CHIP) have contributed to declines in the number of uninsured children. In 2017, however, the number of uninsured children rose even as the overall uninsured rate in the U.S. remained the … Read More

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Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries. As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City, These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too.  If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to … Read More

Posted in Medicare, social determinants of health, Uncategorized

PA Insurers Drop Pre-Authorization Requirement for Medication-Assisted Opioid Treatment

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

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Bill Would Advance Telemedicine in PA

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.

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