Archive for Pennsylvania Medicaid


Pennsylvania to Introduce Medicaid PDL on January 1

Starting on January 1, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services, which administers the state’s Medicaid program.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon:  the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1.  Here’s why.”


PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania.

The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019.

Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018.

Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid.

Learn more about the program’s delay in southeastern Pennsylvania in this Philadelphia Inquirer article.


PA Governor Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.

 Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.

Pennsylvania Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.

The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s hospital assessment.

HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.

The Pennsylvania Department of Human Services, which administers the state’s Medicaid program, has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.…

New Pennsylvania MLTSS Program Delayed Six Months

The launch of Community HealthChoices, Pennsylvania’s new approach to the delivery of managed long-term services and supports for seniors eligible for both Medicare and Medicaid, will be delayed six months.
The program was scheduled to begin in southwestern Pennsylvania on January 1, 2017 but state officials recently announced that they have pushed back the start date to July 1, 2017.

In a message to interested parties, state officials wrote that

The decision to extend our start date builds on this approach and allows more time for the 420,000 Pennsylvanians who will ultimately benefit from CHC to understand the program adjustments that will occur, including how access to and receipt of home- and community-based services will be improved. We will continue to work with all stakeholders, such as the Area Agencies on Aging and Centers for Independent Living, on a robust CHC education and outreach effort to ensure that we reach as many consumers and caregivers as possible. 

The time-frame for implementation in other parts of the state remains unchanged.

To learn more about what Community HealthChoices is and why its launch has been delayed, see this Pittsburgh Post-Gazette article.…