By Bill O’Boyle - [email protected]

Capitol Roundup: PA Department of Human Services awards landmark Medicaid agreements

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WILKES-BARRE — Pennsylvania Department of Human Services Secretary Ted Dallas announced last week the state has agreed to move forward and negotiate contracts with eight managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements mark the most significant change in Pennsylvania’s Medicaid program since we moved to managed care 18 years ago,” Dallas said. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health, rather than just providing services for a fee. The result will be higher levels of quality care for the 2.1 million Pennsylvanians served by Medicaid.”

In the northeast part of the state, Geisinger Health Plan has recently entered into a value-based relationship with CleanSlate Addiction Treatment Centers to combat the opioid epidemic. Through this arrangement, Geisinger is bundling all payments for these services into one global payment. The result is that CleanSlate can focus on the quality of care and outcomes rather than the quantity of services provided.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS.

The result will be that more than $6 billion in funds that would have otherwise been spent on traditional fee-for-service arrangements will instead be invested in outcome- or value-based options such as:

• Accountable care organizations (voluntary networks of hospitals, doctors and other providers that work together to provide coordinated care to patients);

• Bundled payments (increases value-based purchasing);

• Patient-centered medical homes; and

• Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services,” Dallas said. “You get what you pay for, so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity, of care they give patients. In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

The shift will complement the department’s existing program of performance-based contracts, which has improved the quality of care for Medicaid recipients. As an example, the department’s existing performance-based contracts have helped achieve statistically significant improvements in diabetes screening and controlling high blood pressure.

While some MCOs have already begun to shift to these value-based arrangements, the new contracts will require all MCOs to make this shift and to accelerate the pace at which they enter into these contracts.

“Today’s announcement means Pennsylvanians will receive higher quality of care when they are sick, while using taxpayer dollars more effectively,” Dallas said. “It doesn’t matter if you are a health plan, a provider, a government agency or a patient, we all need to focus on building a health care system that delivers better care and results in healthier people.”

House acts to protect

Americans’ email privacy

The U.S. House of Representatives, on a 418-0 vote last week, approved H.R. 699 — the Email Privacy Act — that protects email privacy the same way the government is prevented from going through citizens’ regular mail without a search warrant.

U.S. Reps. Lou Barletta, R-Hazleton, and Tom Marino, R-Lycoming Township, co-sponsored the bill. They each issued news releases following the vote, stating the importance of the legislation.

“We haven’t updated federal email privacy laws since 1986, the same year the Space Shuttle Challenger exploded, which tells you how long ago that was,” Barletta said. “Government will need a warrant to look at private emails – otherwise, the IRS could be reading your old emails right now without your knowledge. This bill is a victory for privacy and 4th Amendment rights against unreasonable searches.”

According to Barletta and Marino, under current federal law, if emails are stored on a third-party server, such as Gmail or Yahoo, they are considered abandoned after 180 days, clearing the way for the government to sift through them at will by simply issuing a subpoena.

H.R. 699 would require a warrant issued by a court for the government to examine emails, no matter how old they are. Additionally, the government must notify citizens if their emails become the subject to a warrant. When the original law was drafted, Congress envisioned most Americans would have their own email servers in their homes and did not contemplate such widespread use of third-party providers.

“The Email Privacy Act will reform out-of-date laws that have failed to address the technological advancements of the last decade,” Marino said. “While many Americans use email on a daily basis now, this was not the case when current privacy law was enacted 30 years ago. This common sense update will afford email communication the same protection already given to phone calls and paper documents.”

Marino said there are still discrepancies in current law regarding electronic communication. Specifically, issues arise when dealing with communications stored in foreign nations. User privacy and law enforcement access to electronic information are just as important when data is stored abroad as it is when stored within the U.S., Marino said.

Casey introduces bill to make college

more affordable by helping families save

U.S. Senators Bob Casey, D-Scranton, and Richard Burr, R-North Carolina, have introduced the “Boost Saving for College Act,” which will enhance 529 college savings accounts to help more American families save for college.

According to information provided by Casey’s office, the legislation would provide a tax credit to low-income and middle-income families who might not ordinarily save for college, encourage employers to match the college savings of their employees, allow savings that aren’t needed for college to be rolled over into a Roth IRA for retirement, and enable families with a disabled child to rollover a 529 account into an ABLE account.

“Saving for a college education is a substantial challenge for families that Congress should be working to make easier,” Casey said. “A college education is the surest ticket to the middle class and a family sustaining income. This bill will help more families save and ensure that more young Americans have a fair shot to attend college.”

College savings accounts, also known as “529 accounts,” enable families to better prepare financially for the cost of sending their child to college, Casey said in an emailed release. These accounts allow families to save tax-free, and they can use these savings to pay for higher education expenses, such as tuition, fees, books, room and board and computer equipment.

As the cost of higher education continues to rise, 529 accounts have become an increasingly popular and necessary tool for families to save for college so they do not have to rely so heavily on student loans. Today, the average cost of obtaining a degree from a two-year institution is more than $19,000 and it is nearly $100,000 from a four-year university.

Reach Bill O’Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.

By Bill O’Boyle

[email protected]





Reach Bill O’Boyle at 570-991-6118 or on Twitter @TLBillOBoyle.