In the May 19, 2012 edition of the Pennsylvania Bulletin, the PA Department of Public Welfare (DPW) published rules and regulations on Long-Term Living Home and Community-Based Services. (See article below.) The new rules that were developed under Act 22 establish or revise provider payment rates or fee schedules, reimbursement models and payment methodologies for certain services and establish provider qualifications. The final-omitted rulemaking affect providers participating in the Aging, Attendant Care, COMMCARE, Independence and OBRA home and community-based (HCBS) waiver programs and the Act 150 program. DPW says that the new rules are intended to ensure that expenditures for FY 2011-2012 remain within the aggregate amount appropriated for HCBS programs by the General Appropriations Act of 2011. DPW notes that the Commonwealth HCBS programs have grown 452% in the past 11 years and the costs have increased from $66 million in FY 2000 to $1.014 billion in FY 2011. DPW said that it is promulgating regulations to strengthen program integrity and to improve cost efficiencies of these programs, the Department is promulgating regulations. The final-omitted rulemaking creates two payment methods for the payment of services under the HCBS programs. The first method establishes a fee schedule rate for the provision of a service. DPW will publish the fee schedule rates as a notice as part of the MA fee schedule in the Pennsylvania Bulletin. The second payment method is for a limited number of goods and services provided through the HCBS programs. The list of vendor goods or services will also be published as a notice in the Pennsylvania Bulletin. FMI: See www.pabulletin.com. The waivers are at http://www.portal.state.pa.us/portal/server.pt?open=514&objID=733116&mode=2.
In the May 19, 2012 edition of the Pennsylvania Bulletin, the PA Department of Public Welfare (DPW) published final rules and regulations on Long-Term Living Home and Community-Based Services (HCBS). The final-omitted rulemaking applies to HCBS providers rendering services for the Aging, Attendant Care, COMMCARE, Independence and OBRA HCBS waivers (waivers) and the Act 150 program. The final rulemaking addresses prerequisites for participation, ongoing responsibilities of providers, service coordinator qualifications and training, critical incident and risk management. The rules require providers to report critical incidents and to adhere to policies and procedures regarding prevention, reporting, notification, investigation and management of critical incidents. Providers are also required to meet the risk management requirements as specified in the approved applicable waivers. DPW will be conducting provider monitoring at least once every 2 years. The rules detail how a corrective action plan will be developed and implemented by a provider who is found to be in noncompliance. Providers are required to create and implement quality management plans. Under the final rule services are to be paid as either a fee schedule service or a vendor good or service. DPW will publish services specific to each waiver and the Act 150 program. The rules establish a fee schedule rate for a waiver or Act 150 service under the MA Program fee schedule. FMI: See www.pabulletin.com.
On May17 the Pennsylvania Health Care Cost Containment Council (PHC4) released its Hospital Financial Analysis 2011, Volume One. PHC4 reports the state’s acute care hospitals saw their profit margin increase during the 2011 fiscal year while uncompensated care increased substantially. The statewide total margin of the 168 General Acute Care (GAC) hospitals in Pennsylvania increased during the fiscal year that ended June 30, 2011 by 1.67 percentage points, from 5.26% to 6.93%. The value of care for which hospitals were not compensated — either bad debt or charity care — grew by 11.2 percent in FY 11, or about $99 million, from $891 million the prior year to $990 million. Overall net income grew by $769 million, from $1.92 billion in Fiscal Year 2010 (FY 10) to $2.69 billion in FY 11. Of that, $551 million, or 72 percent, came from improvement in operating income; the remaining $218 million came from non-operating income. With the $551 million gain in operating income, from about $1.58 billion in FY 10 to $2.13 billion in FY 11, the statewide average operating margin grew from 4.37% to 5.58%. Last year, 33 hospitals, or 20 percent, posted a negative total margin. The previous year, 39 hospitals, or 24 percent of those reporting, had a negative total margin. In FY 09, 74 hospitals, or 45 percent, reported losses. The number of hospitals that sustained a three-year average loss declined to 37, or 23 percent, by the end of FY 11. For the three-year period ending in FY 10, 41 hospitals had a negative average total margin. The 165 GAC hospitals included in the analysis collectively posted an increase in operating revenue of $2.07 billion, or 5.7%, from FY 10 to FY 11, while operating expenses increased by $1.52 billion, or 4.4%. The number of hospitals with negative operating margins declined from 54 in FY 10 to 44 in FY 11. Of those, 35 were smaller hospitals with less than $150 million in net patient revenue. The Volume One Financial Analysis of GAC hospitals is the first of three that PHC4 publishes annually. Volume Two on Ambulatory Surgery Centers and Volume Three on non-GAC hospitals will appear later this year. See www.phc4.org.
In the May 19, 2012 edition of the Pennsylvania Bulletin, the PA Department of Health, Bureau of Family Health announced officially that that the Bureau of Family Health (Bureau) is accepting public comments on the Commonwealth’s draft of the Title V Maternal and Child Health Services Block Grant 2011 Report and 2013 Application from June 4, 2012, through July 3, 2012. A draft of the application will be electronically accessible through the Department of Health’s web site at http://www.health.state.pa.us. Comments must be submitted in writing to Steve Heuer at firstname.lastname@example.org or in hard copy to the following address. Comments must be received no later than 5 p.m. on July 3, 2012. FMI: See www.pabulletin.com.
On May 18 Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin from the Center for Medicaid and CHIP Services (CMCS) with new guidance on affordable insurance exchanges. Consumers in every state will have access to coverage through an Affordable Insurance Exchange on January 1, 2014. If a state decides not to operate an exchange for its residents, the US Department of Health and Human Services (HHS) will operate a federally-facilitated exchange (FFE). The CMCS bulletin is available at http://cciio.cms.gov/resources/files/FFE_Guidance_FINAL_VERSION_051612.pdf
The bulletin describes how HHS will consult with a variety of stakeholders to implement a federally-facilitated exchange (FFE), how States can partner with HHS to implement selected functions in an FFE, and key policies organized by exchange function. The CMCS bulletin outlines key areas of coordination among FFEs, Medicaid, and CHIP programs related to information technology, business processes, and customer service. In addition, the CMCS bulletin describes approaches for determining applicants’ eligibility for Medicaid and CHIP based on information from applications submitted to an FFE. PARF members are encouraged to review the guidance document closely. Please contact Jessica Kahn with questions at (410) 786-9361 or via e-mail at Jessica.Kahn@cms.hhs.gov. On May 18 HHS also released an Exchange Blueprint that states may use to demonstrate how their Affordable Insurance Exchange will work to offer a wide range of competitively priced private health insurance options. The Blueprint also sets forth the application process for states seeking to enter into a Partnership Exchange. If a state chooses to operate its own exchange or a partnership exchange, HHS will review and potentially approve or conditionally approve the Exchange no later than January 1, 2013, so it can begin offering coverage on January 1, 2014. To see the State Exchange Blueprint, visit http://cciio.cms.gov/resources/other/index.html#hie, or access it directly at http://cciio.cms.gov/resources/files/Exchangeblueprint05162012.pdf.
On May 3, 2012 the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a proposed rule that would revise Medicaid regulations to define and describe State plan home and community-based services (HCBS) under the Medicaid program, as amended by the Affordable Care Act (ACA). The proposed rule would also provide home and community-based setting requirements for the Community First Choice State plan option, as added by the ACA. The proposed rules supersede previous proposed rules (April 2, 2008 regarding State plan HCBS and February 25, 2011 regarding the Community First Choice State Plan Option home and community-based setting requirements). PARF is working with its national association partner ACCSES to provide comment to the Centers for Medicare and Medicaid Services (CMS) on newly proposed requirements for community based settings for home and community based services issued on May 3, 2012. The new rules would affect services provided through the CommCare waiver program and other HCBS services. CMS explains that it plans to fully consider all comments received and align decision making and language pertaining to home and community-based setting requirements across Community-First Choice, State plan HCBS under Section 1915(j), as well as HCBS waivers under Section 1915(c). CMS has proposed a 60 day comment period. The comment close date for the proposed rules is July 2, 2012. Comments should be forwarded to PARF at email@example.com.