COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
SUBJECT: Medical Assistance Advisory Committee Minutes
TO:
Members and Interested Parties
Medical Assistance Advisory Committee
FROM:
Robert J. Gardner, Director
Bureau of Policy, Analysis and Planning
Attached are the minutes of the Medical Assistance Advisory Committee
(MAAC) meeting of September 26, 2013. The next MAAC meeting will be on Thursday,
October 24, 2013, at 10:00 a.m. Lecture Hall 246/248, Temple University Harrisburg,
234 Strawberry Square, Harrisburg, PA.
The MAAC, as an advisory forum for the Medical Assistance Program, relies on
the attendance of and input by its members. We strongly encourage your continued
participation through attendance at the MAAC meetings and recommendations for
future agenda items.
If you have any suggestions for agenda items, please contact my staff at (717)
772-6341.
Attachments
cc:
Secretary Mackereth
Secretary Duke
Mr. Harris
Mr. Serafin
Mr. Rosenstein
Ms. Logan
Ms. Padilla
Mr. Kauffman
Ms. Utz
Ms. Minzenberg
Ms. Deklinski
Mr. Lokuta
Mr. Marion
Mr. Gordon
Ms. Allen
Ms. Rose
Ms. Patterson
Ms. Rock
Ms. Calla
Mr. Gardner
Mr. Sorge
File
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MEDICAL ASSISTANCE ADVISORY COMMITTEE MEETING
SEPTEMBER 26, 2013
Mr. Nick Watsula, Chair, called the September 26, 2013, meeting of the Medical
Assistance Advisory Committee (MAAC) to order at 10:05 am. Members and guests
were asked to introduce themselves.
Ms. Yvette Long made a motion, Dr. Eve Kimball second to approve the minutes
from the July 25, 2013, meeting. The motion carried.
Department Of Public Welfare Reports
Ms. Beverly Mackereth, Secretary of Public Welfare, gave a presentation on
Healthy PA.
Secretary Mackereth stated this is the beginning of a comprehensive strategy to
address healthcare in Pennsylvania. Pennsylvania does not have a document that is
written in stone.
The Department of Public Welfare (Department) submitted the document to the
federal government in the form of a concept paper and it remains a concept paper until
the Department is prepared to write an 1115 waiver, which is a demonstration project.
Three key priorities in Healthy PA are improving access, ensuring quality, and
providing affordability to more Pennsylvanians.
Improving access includes getting all kids insured. 95% of Pennsylvania
children are currently enrolled in health care coverage. This is one of the highest
percentages in the nation. Another aspect is to add funding to increase coverage to
previously uninsured and under-insured children. Another piece of improving access is
to eliminate the mandatory CHIP six month waiting period.
The second piece is to promote access to primary health care. There was $4
million included in the budget to build new and expanded community-based, primary
care health clinics. There are also federal dollars that Pennsylvania will be looking to
bring in so the Department can put up new and expanded clinics. There is also a loan
forgiveness program to incentivize primary healthcare providers to practice in rural and
underserved areas of Pennsylvania. The Department needs to ensure that there is a
primary care physician for everyone.
The third piece looks to enhancing care delivery through technology. As the
Department is looking to expand the primary care physicians across Pennsylvania,
there won’t be enough for specialists to meet the needs in every pocket of
Pennsylvania. The Secretary commented that she and Governor Corbett observed a
telemedicine demonstration. Telemedicine is being used for stroke, pediatric,
psychiatry, infectious diseases and burns. The next part of this piece is electronic
access to secure patient health records. Doctors need to know when their patient is
being treated elsewhere to ensure continuity of care. The secretary would also like to
add technology such as an iPad for seniors to remind them what medications to take
and when, and it can also check your blood pressure and your blood sugar.
The first piece for ensuring quality is supporting older Pennsylvanians and
persons with disabilities. An additional $68 million to help older Pennsylvanians and
persons with disabilities come off of waiting lists and stay in their homes and
communities was included in the budget. The governor is very concerned about waiting
lists. The Department is convening a long-term care commission. Pennsylvania has
the fourth largest population of senior citizens.
The second piece is to promote public health, by hosting a “Healthy
Pennsylvania Summit” to extend preventative health best practices, and support and
expand community-based health partnerships.
The third piece is ensuring safe and appropriate access to prescription
medications including enhancing the prescription drug monitoring program and support
the statewide “Drug Take-Back” program.
The Department wants to continue to reform Pennsylvania’s medical liability
system with the adoption of the “apology rule”. This rule allows doctors to show
empathy to families if the patient passes away through no fault of the doctor.
The Department wants to reform Pennsylvania’s Medicaid Program by aligning
Medicaid benefits with private, commercial insurance; by cost-sharing and individual
responsibility; and by job training and work search. The Department now has a national
standard of what a benefit package should look like.
The Department will reinvest savings to increase access for the uninsured by
exploring the use of a private option to enroll ”newly eligible” uninsured adults in private
health insurance plans through the federal exchange.
A member of the audience asked about the timeline and the benefit
package. Secretary Mackereth stated she can’t answer the timeline question at this
point. Secretary Mackereth stated the Department is actually thinking about having two
benefit packages, a low risk and a high risk.
A member of the audience asked where comments could be submitted. The
email address to submit comments is RA-PWHealthyPA@pa.gov. Written comments
can be mailed to:
Department of Public Welfare
Office of the Secretary
Health and Welfare Building
625 Forster Street
Harrisburg, PA 17120
Dr. Kimball asked if the loan forgiveness program includes dentists or just
primary care physicians. Mr. Todd Shamash, from the Governor’s office, stated the
Commonwealth is looking to see if they can change the parameters of the existing
program.
A member of the audience asked if Secretary Mackereth could give some
examples of underutilized services. Secretary Mackereth stated she does not have that
information as it is still being looked at.
Ms. Dorothy Young asked who will make the determination and definition of the
high risk and low risk consumers. Secretary Mackereth stated she does not have that
information.
Ms. Vicki Hoak asked about the approval for the waiver. Secretary Mackereth
stated at this point she does not have a date because this is a huge change for
Pennsylvania. Pennsylvania has one chance to get this right. Ms. Hoak then asked if
the concept paper was public. Secretary Mackereth stated it is on the website.
A member of the audience asked if the benefit packages are separate from the
Home and Community-Based Waivers. Secretary Mackereth stated the benefit
packages are separate from the waivers.
A member of the audience asked when the premiums would begin and what
would the sliding scale be. Secretary Mackereth stated this is just the beginning and
she is not sure when the premiums would begin or what the sliding scale would be. Mr.
Shamash added that the Centers for Medicare and Medicaid Services (CMS) has been
giving some feedback on the premiums but not enough for Pennsylvania to decide what
they would be. Secretary Mackereth stated healthy behaviors by the consumers would
erase the premium.
Ms. Jonna DiStefano asked if behavioral health services would be included in
the clinics. Secretary Mackereth stated behavioral health services would be included.
A member of the audience asked about the point of entry. A member of the
Secretary’s staff stated there was no wrong door; if you apply through COMPASS, you
are switched to the exchange or vice versa. Secretary Mackereth stated Pennsylvania
is on target to be ready by October 1.
A member of the audience asked for clarification on the point of entry for
someone who is applying for benefits through the health insurance marketplace and if
they are found to be Medicaid eligible, will they be transferred to the COMPASS system
or will it be within the marketplace that the determination is actually made. A member of
the Secretary’s staff stated beginning October 1 through December 31, the
determination will be made by the marketplace; however, because of the transfer
issues, the Department is still waiting to see when exactly that will be transferred to the
Department. Secretary Mackereth stated the Department does not have all the answers
yet.
Ms. Long asked if any of this information changed since Tuesday. They were
told consumers would be given a piece of paper to take into the County Assistance
Office to complete a COMPASS application and re-verify everything. A member of the
Secretary’s staff stated until the federal government is able to transfer the files to the
Department, this is the case.
Mr. Joe Glinka asked what is envisioned as a role the managed-care
organizations can play. Secretary Mackereth stated the Department would like to see
those plans as part of the marketplace.
Dr. Kimball asked what about the folks that fallout with no insurance if Medicaid
expansion does not happen. Secretary Mackereth stated they would go through the
exchange.
A member of the audience asked what happens if someone becomes
unemployed. Secretary Mackereth stated they would go to the exchange.
A member of the audience asked about the emergency room copayment and
the discussion around inappropriate versus appropriate use of the emergency room and
if there was any decision on where mental health and substance abuse services would
fall along that line. Secretary Mackereth stated the Department is working on that and
all that information will be brought back to the MAAC. Mr. Shamash stated the
determination is actually up to the provider to determine if the recipient has an
appropriate use of the emergency room.
A member of the audience asked specific to behavioral health the expansion
and improvement of services that has existed over the past decade and a half has been
largely due to recovery, planning, and programming and those have been funded by the
behavioral health managed care organizations. The behavioral health benefit is really
not intended to be impacted. Is that what is being referred to, to maintain that level of
programming?
Secretary Mackereth stated that is what she was referring to.
A member of the audience asked if there were discussions regarding
exemptions for the work search. Secretary Mackereth stated this is for people who are
able to work, not the people who are not able to work.
A member of the audience asked what about the people that are working.
Secretary Mackereth stated it would be up to the individual to make that decision.
Ms. Long asked if it has been determined who will be doing the oversight.
Secretary Mackereth stated all those details haven’t been worked out yet.
Ms. Young asked about the staffing situations and the caseworkers.
Secretary Mackereth stated because Pennsylvania is using the exchange, the
Department will need more caseworkers just not as many as originally thought.
OMAP Update
Mr. Vince Gordon, Deputy Secretary for Medical Assistance Programs, gave an
update on the Affordable Care Act (ACA).
The ACA is a federal health care reform law that was signed by President
Obama on March 23, 2010. The goals of the ACA are to expand coverage, control
healthcare costs, and improve healthcare delivery system.
The ACA requires coverage regardless of pre-existing conditions or gender. It is
intended to increase the rate of individuals covered by insurance through the creation of
insurance exchanges and expansion of Medicaid eligibility, mandates on employers and
individuals, premium subsidies, and tax credits. It is intended to decrease the number
of uninsured individuals.
What does the ACA establish? It facilitates provisions of qualified health
coverage, mandates health benefit exchanges (also known as marketplaces) by
January 2014 in every state, and is a regulatory overhaul of the US healthcare system.
Pennsylvania opted for the Federally Facilitated Marketplace (FFM).
The federally facilitated exchange is also referred to as the FFD or
FFM. Individuals may apply through the exchange. The exchange will determine
eligibility for advanced premium tax credits and cost-sharing reduction.
The ACA is very complex for many states to implement. There are over 70
requirements that are mandatory for each state, regardless of Medicaid expansion,
which is optional. The Department has extended Medicaid drug rebates to drugs paid
by Medicaid managed care organizations, implemented several new program integrity
and provider enrollment screening processes, began increased payments to Medicaid
primary care providers, implemented recovery audit contractor to identify payment
issues and recoup overpayments, and implemented payment policies for hospitals that
prohibited payment for a healthcare acquired condition, such as infections acquired in
the hospital.
One goal of ACA is to provide a seamless and simplified enrollment process for
all insurance affordability programs. Pennsylvania will accomplish this requirement for
simplified enrollment by providing multiple ways to apply including: exchange which can
be electronic or paper application, a new Pennsylvania paper application form called the
PA 600 HC, COMPASS which was updated to comply with ACA, and phone
applications. There is ”no wrong door” when applying for medical assistance and other
healthcare plans.
The Modified Adjusted Gross Income (MAGI) standard will now be used for
Medicaid eligibility. MAGI will apply to adults, children, pregnant women, parents,
caretaker relatives, and individuals eligible for family planning services. MAGI does
NOT apply to SSI recipients; children in foster care; individuals eligible based on being
aged, blind, or disabled; working disabled; or for individuals in a facility/eligible for home
and community-based care.
Medicaid eligibility changes are for children ages 6 to 18 with income up to
133% of the Federal Poverty Level (FPL) and for former foster care children up to age
26. ACA will NOT change eligibility for benefits for our waiver programs for individuals
with physical and intellectual disabilities.
Pennsylvania’s complex IT infrastructure supports over 2.2 million individuals, as
well as thousands of providers through claims processing. The Department is currently
focused on ensuring our IT systems support the ACA requirements.
System development to support eligibility and application changes include:
implementation of MAGI eligibility determination on October 1, interfacing with the
federally facilitated marketplace and, training staff for the many changes to processing
and operations as a result of ACA. NOTE: To implement the COMPASS changes,
COMPASS will experience downtime at the end of September. More information will be
available on the COMPASS website; CIS/eCIS/PROMISe - Medicaid eligibility rules
under ACA, system design and screen changes, ability to obtain information from data
matches in “real time”; developing provider enrollment requirements; and developing
presumptive eligibility guidelines and policies.
The Department continues to work diligently in meeting all of the ACA
requirements. The next key milestones have significant IT system changes that will
affect 2.2 million Pennsylvanians on Medicaid
Critical milestone dates for Pennsylvania are October 2013 when the Medicaid
enrollment applications under the new MAGI eligibility rules begin to be accepted; and
January 2014 the exchange coverage begins for Pennsylvania.
Ms. Hoak asked about presumptive eligibility. Mr. Robert Gardner, Director,
Bureau of Policy, Analysis and Planning, stated the Department has a workgroup for
presumptive eligibility. The group is looking at exactly who will be included in that
implementation
January 1, 2014. The Department anticipates publishing a bulletin in October.
A member of the audience asked about the ACA provision regarding moving
children in households up to 138% of the poverty limit from CHIP into the Medicaid
program. Mr. Gordon stated both the Governor and Secretary Sibelius want to ensure
that if children are moved from CHIP to Medicaid that there is very little disruption in the
care and/or provider-patient relationship. The federal government, as of September 23,
2013, is willing to work with the Department on a transition.
Dr. Kimball stated the benefits for children in Medicaid are far superior to the
benefits in CHIP. There is a large number of providers that participate in CHIP that do
not participate in Medicaid. Has the thought come up how to get providers to participate
in Medicaid?
Mr. Gordon stated there has been discussions about how to get providers to participate
in Medicaid.
A member of the audience asked if MAAC, advocates, and consumers will have
an opportunity to review the presumptive eligibility workgroup work before it is set in the
implementation phase. Mr. Gardner stated the Department is hoping to have a bulletin
out in mid-October. The bulletin is mainly to allow hospitals to ask to be part of
presumptive eligibility. Ms. Yvette Long stated Secretary Mackereth told the iMAC
would have the opportunity to review the information.
A member of the audience asked when you’re talking about children in foster
care and MAGI not applying to children in foster care, is that referring to the federal
definition of a child in substitute care not just in foster care. Mr. Jerry Koerner
responded that former foster children up to age 26 will apply through COMPASS.
Mr. Joe Glinka asked what is being contemplated as far as the notification
process for families with children in CHIP. Mr. Gordon stated the CHIP program is
through the Department of Insurance but he is certain the Department of Insurance is
working on notifications to the impacted families.
Mr. Gordon stated Ms. Jolene Calla has been selected as the director of the
Bureau of Managed Care Operations.
Mr. Brandon Levan gave a COMPASS demonstration.
Citizens will have the opportunity to answer brief questions about their
household which will help determine if they may want to visit the health insurance
marketplace or if they should apply through COMPASS.
Ms. Hoak asked if the waivers can be applied for through COMPASS. A
representative from OIM stated you should be able to apply for any services through
COMPASS.
Dr. Kimball asked if recipients without a mycompass account on medical
assistance today have to generate a username and password. Mr. Levan stated if a
consumer is receiving benefits but has not been on mycompass, when they apply for
additional benefits it will allow them to set up a mycompass account at that point.
Mr. Bernie Lynch asked if this will automatically bring data from the federal data
hub as far as what is essentially going to be the basis for anything. Mr. Levan stated
this is for identity proofing. It uses a service within the data services hub that reaches
out to Experian and if the individual is found in that system it will ask questions that only
the individual will be able to answer; based on the responses, they would be identity
proofed.
Subcommittee Reports
Consumer Subcommittee
Mr. Laval Miller-Wilson gave the update from the Consumer Subcommittee
meeting. The Subcommittee met on September 25, 2013.
The Subcommittee received information from the Department on Healthy PA
and had good dialogue about the information. The Subcommittee plans to submit
written comments as noted during the Secretary’s presentation.
The next meeting is October 23, 2013.
Fee-for-Service Delivery System Subcommittee (FFSDSS)
The FFSDSS did not meet. The next meeting is November 14, 2013.
Long Term Care Delivery System Subcommittee (LTCDSS)
Ms. Hoak gave the LTCDSS update. The LTCDSS met on August 13, 2013.
The LTCDSS received a budget overview and submitted priorities to the
secretary on how to revamp the long-term care system.
The next meeting is in October.
Managed Care Delivery System Subcommittee (MCDSS)
Mr. Glinka gave the MCDSS update. The MCDSS met on September 12, 2013.
Value Behavioral Health has been selected for Greene County, effective
January 1, 2014.
There was concern about the enrollment timing and credentialing process, and
there is discussion about reconvening a credentialing workgroup to study an expedited
process considering the number of plans and the information required.
The Department shared that an analysis was done regarding physical health
providers mapping against CHIP; in the Departments analysis, they have about 80%
mapped.
There was an update on the behavioral health specialist regulations
licensure. To date, 2,205 applications have been submitted, 540 applications have
been approved, 1,255 are marked as in process or they have discrepancies. The
resolution of discrepancies is taking place within 30 days. The group is also working on
a pharmacy alert on behalf of all the plans that highlight the ability to provide a five-day
emergency supply when a patient is going through the benefit limitation exceptions
process.
There was an update from all the plans as to where they are in the ACA provider
payment. All the plans appear to be on track.
The next meeting is October 10, 2013.
MEDICAL ASSISTANCE BULLETINS AND REGULATIONS
Mr. Gardner discussed the list of MA Bulletins that were issued since the last
meeting.
There were four pharmacy feedback documents issued. Comments are due by
October 10, 2013.
Old Business
Dr. Kimball stated there is one managed care organization that is not paying the
ACA rates as of yet.
New Business
The next meeting of the MAAC will be Thursday, October 24, 2013, in Lecture
Hall 246/248, Temple University Harrisburg, 234 Strawberry Square, Harrisburg, PA.
Adjournment
The meeting was adjourned at 12:00 Noon.