Even before the federal government announced that it would release data on hospital and nursing home ownership as a means of casting light on the impact of private equity on provider quality and costs, regulators in Pennsylvania were proposing their own approach by seeking to vet those aspiring to purchase nursing homes in their state.

Under nursing home regulations proposed by the Pennsylvania Department of Health, regulators would have an opportunity to examine the past performance and financial strength of entities seeking to purchases nursing homes.  As more for-profit entities enter the industry, the department notes, they bring with them more complex financial arrangements, such as separate entities that divide the facility, the real estate on which it stands, and the company that manages the facility.  This is adding a new level of complexity to the challenge of holding operators accountable, understanding their financial performance, and analyzing the adequacy of the state’s Medicaid payments for long-term-care services, which the state’s nursing home industry has long complained are inadequate.

Learn more about Pennsylvania’s attempt to regulate entry into the long-term-care industry in the state in these proposed regulations that would govern nursing homes and their sale and the Philadelphia Inquirer article …

Medicaid enrollment in Pennsylvania has risen nearly 14 percent in the past year as rising unemployment resulting from COVID-19 drives people to turn to the state for health insurance.

As a result, Pennsylvania has added nearly 400,000 people to its Medicaid rolls in the past year.  Today, 3.2 million Pennsylvanians are enrolled in the state’s program, although among them are approximately 250,000 who would have been dropped from the program except for a federal requirement that the state not drop people from the program in exchange for a major increase in federal aid for the state’s program.

As a result of the increase, the state’s Department of Human Services, which runs its Medicaid program, has asked the legislature for nearly $1 billion in supplemental funding to help finance its services for this expanded enrollment through the rest of the state’s FY 2021 year.

Learn more about the past year’s increase in Medicaid enrollment, who the new enrollees are, and how the state is accommodating them in the Philadelphia Inquirer article “A huge spike in Medicaid enrollment in Pa. shows how devastating the coronavirus has been.”

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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.”

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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.

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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.…