Archive for Pennsylvania


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.”


State to Experiment with Global Budgets for Rural Areas

The Commonwealth of 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 Human Services, Department of Health, Insurance Department, the Pennsylvania Office for Rural Health, five participating hospitals, and five health insurers.  The federal Center for Medicare and Medicaid Innovation, another partner, is investing $25 million over five years to fund a rural health redesign center to support the project’s launch.

The state hopes to add more hospitals and insurers in the future.

The project is needed, according to the state, because “Nearly half of all rural hospitals in …

PA Hospitals Reducing Readmissions, Mortality

Pennsylvania hospitals have seen a state-wide decrease in their mortality and readmission rates, according to new data released by the Pennsylvania Health Care Cost Containment Commission.

According to the new numbers, which cover hospital performance from January 1 through September 30 of 2015, hospital mortality rates fell for ten of the 16 conditions PHC4 tracks while readmissions fell for nine of the 13 conditions for which the agency collects data.

PHC4 estimates that this improved performance saved 3900 lives and avoided 2700 hospital readmissions.

For a closer look at the data PHC4 collected, the conditions it tracked, and a hospital-by-hospital, region-by-region, and state-wide look at hospital performance go here, to the PHC4 web site, to find a summary of the report, the news release that accompanied its publication, and three separate reports with all of the numbers and findings.


PA Looking to Update Nursing Home Regulations

A special task force has proposed major changes in regulations that govern nursing homes in Pennsylvania.

The Nursing Home Quality Improvement Task Force, created by Department of Health Secretary Dr. Karen Murphy, recommended four areas of focus for new regulations:

  • Improve collaboration between policy makers, lawmakers, providers, health care professionals, and most importantly, the residents of nursing homes and their advocates;
  • Change regulations and expand facility inspections to focus on the quality of life for residents who live in that facility;
  • Perform more comprehensive and consistent surveys to collect data that allows for consistent evaluation of quality of life in nursing homes; and
  • Redesign workforce composition and competencies.

It offered these recommendations after concluding that it found

…a misalignment between outdated nursing home care regulations and the type of care that is needed in today’s nursing homes. It concluded that in the past, state regulations were designed to evaluate the quality of the actual nursing home facility, but did not fully account for the quality of life of the residents themselves.

Learn more about the state’s plans for its nursing homes in this Department of Health news release.…

Pennsylvania Launches Prescription Drug Monitoring Program

The Pennsylvania Department of Health has launched its much-anticipated prescription drug monitoring program.

Previously operated by the state’s office of the attorney general but assigned to the state’s Health Department through 2014 legislation, the program requires those authorized to prescribe controlled substance prescription drugs to collect and submit information to the PDMP each time they do so within 72 hours. That information is then stored in a database that is available to health care professionals to help them identify patients who may have problems with controlled substances or may even be going from provider to provider to gain additional prescriptions.

The state Health Department has created a web site for the program that includes FAQs about how the PDMP works for those who prescribe and dispense controlled substances. Visit that web site here.…