Highlight on Pennsylvania: Better Medicaid spending through technology

Pennsylvania lawmakers introduced legislation attempting to reduce spending and improve patient care within the state’s Medicaid program. Under the proposed legislation, Senate Bill 600, the state would adopt new technology to monitor and identify areas of unnecessary or wasteful health care services and procedures. The state would have 90 days within enactment of the bill to pick a technology company and implement the monitoring. Lawmakers noted that by providing more information, patients and providers, alike, could make better health care decisions. Consequently, this would reduce Medicaid spending. Pennsylvania is one of the highest spenders per Medicaid enrollee in the U.S., with one out of every four dollars in the state’s annual budget accounted for by Medicaid.

The lawmakers have started to review tech companies with prior experience in collecting and monitoring patients to improve care, notably companies that have worked with Alaska’s Medicaid program. The tech company involved  reduced misdiagnosis rates, improved outpatient care, cut waste, and reduced Medicaid expenditures in Alaska by over 14 percent. According to Pennsylvania lawmakers, a similar program could generate between $2 billion and $4 billion in annual savings.

In fiscal year 2015-16, the federal government spent about $15.3 billion on Medicaid in Pennsylvania, while the state spent about $10.6 billion, bringing the total to $25.9 billion; the state’s Department of Health and Human Services budget over the past few years has increased by about $500 million annually. The influx of approximately 700,000 new patients into the Medicaid system is a 20 percent increase and has cost an additional $4.6 billion. State lawmakers are concerned that the push for health care reform by the federal government will result in a cut in the federal portion of Medicaid to the state.

 

Highlight on Pennsylvania: State hit hard by opioid addiction, struggles to find solutions

Although Pennsylvania is due to receive $1.8 million in federal funding to combat opioid abuse, none of that money is going to Pittsburgh. Although the rising number of heroin deaths in the city may seem to indicate that the area is in drastic need of the funding, heroin use is a widespread problem throughout the state.

Federal funding

On March 11, 2016, HHS announced a $94 million award to health centers across the country to be directed toward combating the heroin epidemic. This funding was made available by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and went to 45 states, Washington D.C., and Puerto Rico. Estimates of opioid-related deaths have risen sharply: unintentional overdoses from pain medications has almost quadrupled since 1999, and the agency believes that deaths related to heroin increased 39 percent in one year, from 2012 to 2013.

Pennsylvania’s overdose journey

The University of Pittsburgh Graduate School of Public Health studied accidental overdose deaths in the state over time and found that the number has increased 14 times in the last three-and-a-half decades. The deaths were concentrated in southwestern Pennsylvania, around Philadelphia, and near Scranton. The Lehigh County Coroner was forced to request more money to cover drug overdose autopsies in 2015, Northampton County had 50 percent more opiate related deaths in the first three months of 2015 than the entirety of 2014. Although adults ages 34-44 had the greatest increase in overdose death rates since 1979, the younger 25-34 year old age bracket had the highest death rate in 2014. Death rates were higher in men than women, but the death rate in young white women was the fastest-climbing demographic. The report also noted that non-fatal overdoses requiring hospitalizations surged dramatically.

Small towns not exempt

An NPR reported traveled to a rural Pennsylvania county to see how a small town is impacted by addiction. A paramedic revealed that heroin is cheap and easily available from surrounding towns, and that there is no pattern to the addiction. He spoke of seeing young and old, well-off and poor using the drug. The paramedics are familiar with using naloxone, a rescue drug that reverses an overdose and can wake an unresponsive patient. As of the second week of March, they had already used the drug on ten patients. He admitted that they never have to worry about their stockpile expiring because they go through it so quickly.

Schools shaken by tragedy

High schools in the area reported losing six students to heroin overdoses in a two-year span. Some believe that small-town boredom lends itself to drug use, and Kutztown Area High School has formed a group to provide diversion for students, such as basketball tournaments. The state mandates a student assistance team, which includes teachers, counselors, and a contracted specialist, who keep an eye out for at-risk kids. Although it is difficult to know whether these groups help at all, the staff believes their efforts are crucial.

Pittsburgh left out of funding, despite high overdose rates

Pennsylvania received a $1.8 million chunk of the $94 million in federal funding, but the Pittsburgh region is left out in the cold. Philadelphia is the number one area in the state for heroin overdoses, but Allegheny County, where Pittsburgh is located, runs second. A local Pittsburgh paper reported that the county lost 157 people to heroin overdoses in 2014, which rose to 217 in 2015. An HHS spokesman stated that the funding awards were competitive, but did not say whether any southwestern Pennsylvania health centers applied. He did note that several Pittsburgh treatment centers are already federal funding recipients.

Were Thousands Improperly Dropped from Pennsylvania’s Medicaid Program?

Between August 2011 and May 2012, the number of Pennsylvania residents covered by its Medicaid program dropped by nearly 130,000 people. Out of that number, 89,000 children were removed from the state’s Medicaid rolls, despite a steady increase in the number of children covered by the program in the past years. The federal government has taken notice after advocates for the poor received hundreds of reports from residents who claimed to have been improperly denied participation in the program.

In a letter issued by the federal Centers for Medicare and Medicaid Services (CMS) to the Pennsylvania Department of Public Welfare (DPW) on June 14, 2012, CMS noted that an unusually high number of cases were closed for “failure to return renewal form” or “failure to provide information” during a period of time that the state was ill-equipped to review cases in a timely manner. The letter stated that DPW was suspected of failing to follow protocol given that these rejections occurred “when DPW has reported that it was unable to process within appropriate time frames all the information beneficiaries had submitted to verify their eligibility.”

The letter also addressed an April 2012 meeting between DPW and CMS officials, in which DPW agreed to re-review 12,000 closed cases and re-instate Medicaid benefits to any cases that had been improperly closed, as well as identify patterns in that re-review that may have contributed to the improper denial of benefits. Three thousand pregnant women and babies were to be included in the initial review. CMS indicated that it was still awaiting DPW’s findings from the re-review, which needs to answer a number of questions such as whether any “systemic problems” were discovered, whether those residents wrongfully dropped from the rolls had their benefits reinstated, and whether DPW has a plan to avoid improper case closures in the future. In April, DPW had promised to produce its findings “soon.”

Last week, a DPW spokesperson stated that human error is a factor that could have resulted in the improper loss of benefits, but that the department would “correct it as expeditiously as [it] can.” She revealed that DPW had not completed the re-reviews as of that time.

 

Connecticut Proposes Deaf Child Bill of Rights to Address Education Gap

Deaf and hard of hearing (HOH) children generally do not differ cognitively from their peers in a way that would prevent them from learning the same material just as well. So why is it that in Connecticut, as well as other locations, children with hearing disabilities appear to be falling behind hearing children in state tests? In 2011, approximately 71 to 81 percent of children with hearing disabilities failed to reach state standards in Connecticut Mastery Tests (CMTs) and Connecticut Academic Performance Tests (CAPTs). Comparatively, between 35 to 58 percent of hearing students failed to meet the goals.

The answer, according to advocates for deaf and HOH persons, is not the disability itself, but the manner in which the children are being taught.  According to Terry Bedard, president of Hear Here Hartford, a deaf advocacy group, “Their needs are not being addressed in the way they should be, and that’s resulting in this wide achievement gap.” Advocates believe that since there is a relatively “low incidence” of hearing disabilities, they are commonly overlooked. In Connecticut, approximately 700 children are registered with the education department as having a hearing disability; however, the number could be greater since such students are not tracked carefully.

Consequently, the Connecticut General Assembly’s education committee will be considering legislation this term to address the gap. “A Deaf Child Bill of Rights,” introduced by the Connecticut Council of Organizations Serving the Deaf, would focus on an individualized education program (IEP) centered around each student’s communication and language needs. Each student’s IEP would be connected to a formal “Language and Communication Plan” that would address that child’s specific needs. The measure would also require that the team implementing the IEP includes at least one educational professional who specializes in hearing disabilities. The bill would compel the state to execute a more specific tracking system in order to better identify hearing disabled children and chart their academic progress.

If the bill is passed, Connecticut will be the 12th state in the country to implement a deaf child bill of rights, joining California, Colorado, Delaware, Georgia, Louisiana, Montana, New Mexico, Pennsylvania, Rhode Island, South Dakota and Texas.