Medical Assistance Advisory Committee (MAAC)

Department of Public Welfare

3/28/13, 10:00 a.m., Lecture Hall 246/248, Temple University Harrisburg,

234 Strawberry Square

By John Jewett

Chairman Nick Watsula, of UPMC for You, Pittsburgh, called the meeting to order shortly after 10:00 a.m. Sixteen MAAC members were present along with several staff members from the Department of Public Welfare (DPW). There were approximately 50 people in the audience which included several staff members from a variety of professional associations, businesses and lobbyist firms.

The minutes for the meeting on February 28, 2013, were approved without discussion or revision. Chairman Watsula announced that DPW Acting Secretary Beverly Mackereth would be joining the meeting later. For this reason, he went to subcommittee reports.

Laval Miller-Wilson, of the Pennsylvania Health Law Project, spoke on behalf of the Consumer Subcommittee and thanked DPW staff for updates on the human services block grant expansion. Currently, the block grant is in only 20 counties. Appreciation of the update on HealthChoices was also extended. Miller-Wilson asked about getting data from Medicaid organizations, which adopted a six prescription limit, about appeals and denials of appeals and frequency on emergency room visits from July 2012 to present. He also was interested in similar data relating to dental and pharmacy claims. DPW staff said they would look into these issues.

Bernard Lynch, of the Pennsylvania Medical Society, reported that the Fee for service Subcommittee did not meet. The subcommittee will meet on April 8 at the offices of the Hospital and Healthsystem Association of Pennsylvania.

Joseph Glinka, of Gateway Health Plan, reported on the Managed Care Subcommittee. He deferred to Sec. Mackereth, but mentioned that the Request for Proposal for a new enrollment broker for physical health will be issued soon. The subcommittee discussed a forthcoming policy for behavioral health specialist for autism. Glinka noted deadlines for license applications are coming soon and there are concerns over processing the applications.

Sec. Mackereth addressed the group, first providing a brief review of her past experience. She noted she was a caseworker and then a supervisor at York County Children and Youth Services from 1980 to 1987. Managing intake investigations in cases involving alleged child abuse and neglect was one of her primary responsibilities. She also worked for the York County district attorney’s office in developing several programs to assist and coordinate services for crime victims. Sec. Mackereth opined her life experiences prepared her for work at DPW. She said concerns over tax issues involving the local municipality got her attention, so she ran for and was elected to the Spring Grove borough council. Sec. Mackereth also served as mayor of Spring Grove from 1996 to 2000.

In 1997, Gov. Tom Ridge appointed Mackereth as deputy director of the Governor’s Community Partnership for Safe Children.

From 2000 to 2008, she was a member of the Pennsylvania House of Representatives for the 196th House district. Later in 2008, she was appointed the Executive Director of York County Human Services Department. Gov. Corbett appointed her as DPW Deputy Secretary of the Office of Children, Youth and Families and last month she was appointed to serve as acting secretary.

Along the way, Sec. Mackereth commented, she learned about issues involving work choices and family and working out-of-town when one’s children are teenagers. She recalled a day when her youngest child, her son, called her when she was working out-of-town and reported his older sister had a boy over. Sec. Mackereth said she learned that often teenagers need as much or more supervision than younger children.

Sec. Mackereth promised to participate in future MAAC meetings and pledge open communication. She said “we don’t know everything” and DPW needs to hear from others, adding that her staff would be responsive.

Robert Gardner, Director of DPW Bureau of Policy, Analysis and Planning, updated MAAC concerning a handful of policy areas.

DPW submitted its state plan amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) in the US Department of Health and Human Services (HHS) on rates for primary care physicians, which includes a new rate methodology and a new table. Gardner said these will be published in the Pennsylvania Bulletin after approval by CMS. Gardner discussed rate variations for different counties and referred to the tables and formulas as “algebraic.”

Gardner stated vaccine codes are not set in stone and reported CMS will be doing a crosswalk between specific vaccine product codes and existing general codes. He reported differences have caused confusion.

Eve Kimball, of the Pennsylvania Chapter of American Academy of Pediatrics, asked for more information about the crosswalk of codes.

Robert Greenwood, of the Hospital and Healthsystem Association of Pennsylvania, asked about the CMS primary care attestation process and increases in primary care physician costs, and also about specialties. A DPW staff member in audience replied CMS has a mechanism for primary care and specialties in the attestation process. It was noted the attestation deadline is April 1 with retroactive payment to January 1.

DPW HIT Coordinator Matt McGeorge provided a Health Information Technology (HIT) update. He stated Pennsylvania ranks sixth nationally in payments in Electronic Health Record (HER) Incentive Program. He mentioned a “webinar,” provider walk-through and focus groups for the Medical Assistance Provider Incentive Repository Resources (MAPIR) program.

A Managed Care Expansion update was given by Darlene DeMore, Operations Chief, DPW Division of MCO (managed care organization) Monitoring and Compliance. DeMore indicated that market share is at 28 percent for AmeriHealth NE, 23 percent for Coventry Care, and 49 percent for Geisinger. Transfers have slowed, she said, stating that 13,000 transfers were processed and Geisinger picked up most switches.

Michael Hale, Director of Bureau of Quality and Provider Management in DPW Office of Long-Term Living, gave an update on Public Partnerships, LLC (PPL), which is now the single entity that handles payroll services for home and community based services. Before PPL, payments to direct care workers were handled by 37 different payroll providers. The transition is high at approximately 97 percent. He stated approximately 200 direct care workers have not been paid but should be paid by next week.

Patty McCool, Director, DPW Bureau of Support for People with Intellectual Disabilities, reported that participation in the adult autism waiver self-help program had increased to 330.

Acting Deputy Secretary Dennis Marion of DPW Office of Mental Health & Substance Abuse Services (OMHSAS) mentioned that he met with Consumer Subcommittee. He discussed the human services block grants in 20 counties.

Marion discussed grant concerns over impact on consumers and a need for 20 counties to submit plans for use of block grants.

George Kimes, of the Pennsylvania Community Providers Association, asked a question about non-block grant counties and partnerships. Marion indicated that OMHSAS is reaching out for input.

Diana Fullem, of Recovery InSight, Inc., asked about meetings for communication in the south-central region and how will stakeholders know when and where meetings will occur. DPW indicated the process would be open.

Miller-Wilson asked about the issues of monitoring and enforcement concerning the use of dollars by county for block grants to be sure that counties are spending funds on human services and mental health assistance. Yvette Long, of the Philadelphia Welfare Rights Organization, stated that money should be allocated with flexibility. Kimes also asked about responsibility for monitoring block grant.

DPW staff stated the department will accept comments on the proposed changes to “prior authorization” policies in the seven Medical Assistance Bulletin handouts. Comments should be submitted by April 11, 2013. DPW staff also provided copies of feedback on input on the Bulletin handouts distributed during the last MAAC meeting.

Lloyd Wertz, of the Family Training and Advocacy Center, Philadelphia Mental Health Care Corporation, asked about “Arkansas-model.” Vincent Gordon, DPW Deputy Secretary, Office of Medical Assistance Programs, stated DPW is looking at programs at other states not just Arkansas.

Dr. David O’Gurek, of the Lancaster General Family Medicine Residency Program) asked if subcommittees can learn more about DPW review of other states and submit comments. Glinka stated that the Health Insurance Premium Payment (HIPP) program in Pennsylvania resembles the Arkansas program. The Arkansas program pays for insurance premiums for health coverage. Miller-Wilson also expressed interest in an opportunity to comment. Kimball and Glinka commented on HIPP and access. Gardner and Jim Weaver, Chief Information Officer, DPW Bureau of Information Systems, joined the conversation and mentioned discussing an interface with the federally-run exchange at a future MAAC meeting.

Lynch asked about seconding O’Gurek’s motion for MAAC to be informed on models and other states’ programs being reviewed by DPW. Chairman Watsula stated the Arkansas system could be more expensive than straight-forward expansion. DPW staff stated that no specific model has been selected and no decision has been made. No formal action was taken on a possible motion by O’Gurek.

Members of the audience were talking after the meeting about how the MAAC Consumer Subcommittee had passed a resolution on February 27, 2013, urging the Commonwealth to pursue Medicaid Expansion. The Governor is planning to meet with HHS Secretary Kathleen Sebelius on April 2, to listen to her case for Medicaid expansion.

Additional materials distributed at the meeting are available here.

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