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PA Outlines Implementation of Association Health Plans

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.

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Former PA Gubernatorial Candidate Lands at CMS

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.

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CMS: Not Done With Medicaid Work Requirements

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

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HHS Chief Says 340B Changes are Coming

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

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Medicaid Managed Care Plans Suffer High Physician Turnover

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

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Mixed Results for PA Overdose Admissions in 2017

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

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Do “Narrow Networks” Jeopardize Care?

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

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PA Awards Grants to Improve Coordination of Care for Medicaid Patients

The Pennsylvania Department of Human Services has awarded $8 million in grant money “…to increase efficiency in the delivery of health care services to Medicaid patients.” According to a DHS news release announcing the grants, The grants will help connect hospitals, nursing homes, and ambulatory practices to the Pennsylvania Patient & Provider Network, or P3N, which enables electronic health information exchange (eHIE) across the state through the connection of health care providers to health information organizations (HIO), and the participation of the HIOs in the P3N. Dividing the $8 million are the Clinical/Connect Health Information Exchange, the HealthShare Exchange, the Keystone Health Information Exchange, and the  Mount Nittany Exchange. To learn more, see this DHS news release.

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Hospital Financial Health Generally Stable, PHC4 Reports

General acute-care hospitals experienced up and downs in their financial performance in 2017, the Pennsylvania Health Care Cost Containment Council has reported. In 2017, net patient revenue rose 3.9 percent operating margins fell from 6.02 percent to 5.15 percent but total margins rose from 5.96 percent to 6.62 percent uncompensated care declined from $844 million to $761 million – the fourth consecutive year of decline For more on these and other measures of hospital financial performance, including data on individual hospitals, go here to see the new PHC4 report Financial Analysis 2017:  General Acute Care Hospitals.

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Short-Term Plans May Short-Change Purchasers

The short-term health insurance plans that the administration proposes making more available to consumers as an alternative to comprehensive health insurance that meets Affordable Care Act coverage requirements may leave consumers with greater out-of-pocket costs and less coverage for some critical services. According to a Kaiser Family Foundation review of available short-term, limited duration plans in 10 markets across the country, those plans: often do not cover mental health and substance abuse services and outpatient prescription drugs may turn down individuals or charge them higher premiums based on age, gender, or health status, including pre-existing conditions require greater cost-sharing by their purchasers do not cover maternity services at all Such plans are not required to comply with the Affordable Care … Read More

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