RCPA - Rehabilitation and Community Providers Association


MR Update #05-17: State Medicaid Sessions, Loophole Issues, Available Awards, College of Direct Support Update, Incident Management, Federal Issues, and HCSIS Update
September 1, 2005

Medicaid “Listening” Sessions
Governor Rendell announced his administration will hold a "listening tour" across the state to ask providers, consumers, insurers, and the public to help identify innovative ways to control the growth in Medicaid spending, improve the delivery of services, and increase the quality of care. The state expects an additional annual loss of up to $1 billion of federal Medicaid funds for at least the next five years. Nearly 19% (or $4.5 billion) of the state’s budget is used to fund Medicaid. This year there was a $400 million reduction in federal Medicaid funds, but during the same time 100,000 additional Pennsylvanian’s will qualify for this program.

The listening panels will be composed of administrative officials, secretaries of the budget and public welfare, and members of the legislature. Experts and stakeholders are asked to provide information. Details on registration and locations will be available soon from www.governor.state.pa.us. The tentative schedule is: September 22 -Philadelphia; September 23 - Pittsburgh; September 29 - Allentown; September 30 - Scranton; October 6 - State College; October 7 - Somerset; october 14 - Erie; October 28 - special session on long-term care and behavioral health in Harrisburg.

MA Loophole
The Pennsylvania Health Law Project has provided additional information regarding the Medical Assistance premiums for certain children with disabilities called the "loophole" category. There are 39,000 loophole recipients. On August 5 the Department of Public Welfare (DPW) submitted to the federal government a request for permission to charge premiums; a formal request will be developed to address any issues and questions. The currently known details of the state’s proposed premiums which would be start until at least October include:

  • Premiums charged only for children under age 18 in the PH95 (loophole) category;
  • Families of children on SSI or one of the waivers (consolidated, person/family, etc.) or on adoption assistance or in foster care will not be charged;
  • Families with gross incomes below two times the federal poverty level will not be charged; and
  • Premium to be based only on parents gross income.

Comments on these changes, which are listed in the PA Bulletin, may be forwarded to DPW through September 11. (Edward Zogby, DPW Bureau of Policy, Room 431 Health and Welfare Building, Harrisburg, PA 17120)

The GlaxoSmithKline Ninth Annual IMPACT Awards in the US are designed to reward excellence in the delivery of non-profit community healthcare. GlaxoSmithKline (GSK) will award a total of $400,000 to small and mid-size community-based healthcare organizations in the greater Philadelphia area. Nominees in the following counties are eligible: Berks, Bucks, Chester, Delaware, Lancaster, Montgomery, and Philadelphia or in the City of Camden, NJ. Up to ten award winners will receive $40,000 each. To qualify for an IMPACT Award, non-profit healthcare organizations must be nominated by individuals knowledgeable of the complexities and challenges of healthcare delivery in their communities. Award nominations are now open and must be submitted to GSK by 4:00 p.m. September 26. Details are available at www.gsk.com, select "The Community" for details.

The selection criteria include commitment to serving people in need; facilitating access to healthcare delivery, education, creative partnerships, and policy development; and demonstration of a solid record of achievement, management and leadership. Organizations must have an annual operating budget under $2 million and must have been in existence as a 501(c)3 for at least five years.

Betts Award
The American Association of People with Disabilities is seeking nominees for the Henry Betts Award which was created to annually honor an individual whose work and scope of influence has significantly improved the quality of life for people with disabilities in the past and will be a force of change in the future. The recipient will be a person at the pinnacle of his/her career. Successful nominees will have demonstrated a strong vision and understanding of how to improve the quality of life for people with disabilities and possess a record of accomplishments that have affected a wide disability population. The winner receives an unrestricted $50,000 cash award. For information and an application access www.AAPD.com.Entry deadline of October 7.

DPW Web Site
The Department of Public Welfare has updated their web site to include the following:

College of Direct Support
The College of Direct Support indicated that Pennsylvania has surpassed the 11,000 mark in the number of learners using this web-based training. New learners are being added at a rate of 500 each month. Beginning August 15 the course for Frontline Supervision and Management is available. This was developed with the support of the US Department of Education and addresses the need to support direct care workers in a career ladder.

HCSIS Update
HCSIS Release 5.2.0 will go live in late September. Highlights include:

  • Customizing notices to properly fit county or provider letterhead;
  • Changing the sort sequence for the Provider Service Status report; and
  • Enhancements to the Incident Management screens.

For assistance call the Help Desk at 866-444-264, email c-hhcsishd@state.pa.us, or fax 717-540-0960.

Incident Management Reports
In order for providers to access the quarterly incident data that the state will issue, providers must assign the "“Provider IM Representative Role" in HCSIS to selected staff. The designation can be assigned to more than one person so there is a back-up, as well as more than one person be assigned the Quality Manager Role. Providers may wish to assign both roles to the same persons so they can take the training which is only offered to the Quality Manager Role through the Learning Management System (LMS). For technical problems when registering through HCSIS’s LMS contact the Help Desk at 866-444-1264.

Federal Medicaid Commission
The federal Medicaid Commission unanimously adopted its short-term recommendations for $10 billion in savings in the Medicaid program over the next five years. The recommendations were sent to US Department of Health and Human Services Secretary Leavitt and will be considered by Congress. Recommendations include:

  • Allow states to charge beneficiaries increased co-payments for certain non-preferred prescription drugs (anticipated savings over 5 years is $2 billion);
  • Increased penalties for people who transfer assets to qualify for long-term care;
  • Prescription drug reimbursement formula reform; and
  • Reform of Medicaid managed care organization provider tax requirement.

Dual Eligibles Tool
The Centers for Medicare and Medicaid Services posted a demonstration of how the web-based drug plan finder tool will work at http://media.cms.hhs/gov. This tool is being developed to help people, including dual eligibles, make decisions about which Medicare Part D drug plan will work best for them.

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