PRINTER'S NO. 3050
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE RESOLUTION
No.
421
Session of
2024
INTRODUCED BY BOROWSKI, KHAN, HANBIDGE, PROBST, VENKAT, HOWARD,
SANCHEZ, CURRY, DONAHUE, D. WILLIAMS, O'MARA, SHUSTERMAN,
STEELE, KENYATTA, ROZZI, WEBSTER, MUNROE, KINKEAD, MAYES,
GIRAL, SMITH-WADE-EL AND FREEMAN, MAY 3, 2024
REFERRED TO COMMITTEE ON HUMAN SERVICES, MAY 3, 2024
A RESOLUTION
Directing the Joint State Government Commission to conduct a
study on maternal-health-related medical assistance payments
to hospitals and health care providers and make
recommendations to increase payment rates to hospitals and
health care providers, including fee-for-service and managed
care payment rates.
WHEREAS, Residents of this Commonwealth deserve the highest
quality of health care regardless of health insurance policies;
and
WHEREAS, Approximately 3.4 million residents in this
Commonwealth are covered by medical assistance; and
WHEREAS, Payment rates to each hospital under medical
assistance are important components of each hospital's ability
to sustain specific services and remain financially viable; and
WHEREAS, Each hospital and health care provider receives
medical assistance support through base payments for each
service and through supplemental payments to ensure that each
hospital is paid at a rate that is greater than each hospital's
charge of service; and
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WHEREAS, A hospital may appeal a rate because the negotiated
rate is insufficient for providing the level of care that
patients deserve and receive; and
WHEREAS, For medical assistance to support needy residents in
this Commonwealth, medical assistance must provide rates that
attract hospitals and providers to enroll; and
WHEREAS, In this Commonwealth, 24.2% of counties do not have
full access to maternity care and nearly 200,000 residents in
need of maternity care live in these counties; and
WHEREAS, In this Commonwealth, 7.6% of counties do not have a
hospital or birth center offering obstetric care; and
WHEREAS, The maternal mortality rate for this Commonwealth
from 2015 to 2019 was 10.9 per 100,000 live births; and
WHEREAS, The current structure of medical assistance that
utilizes managed care organizations to make payments for care
lacks transparency; therefore be it
RESOLVED, That the House of Representatives direct the Joint
State Government Commission to conduct a study on maternal-
health-related medical assistance payments to hospitals and
health care providers and make recommendations to increase
payment rates to hospitals and health care providers, including
fee-for-service and managed care payment rates; and be it
further
RESOLVED, That the study contain, at a minimum, the following
information:
(1) A review and analysis of maternal-health-related
medical assistance payments to hospitals and health care
providers, including physicians and nurse practitioners, for
both inpatient hospitals and health care practitioners in
inpatient settings, including all of the following:
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(i) The factors and variables taken into
consideration when determining the payment rates for each
hospital and health care provider for fee schedule rates
and the rates for All Patients Refined Diagnosis Related
Group.
(ii) The process that managed care organizations use
for rate setting and rate appeals.
(iii) The Commonwealth-directed payments that
managed care organizations are obligated to fulfill.
(iv) The impact of disproportionate share hospital
and supplemental payments on how enrolled hospital and
health care provider payments are determined.
(v) The way fee-for-services and managed care
payment structures account for inflation and increasing
prices.
(2) An analysis of payment shortages to hospitals and
health care providers for maternal-health-related services to
medical assistance enrollees across this Commonwealth.
(3) An analysis of the potential for hospitals and
health care providers to not participate in medical
assistance.
(4) An analysis of the impact on patient access to care
and the impact of Medicaid rates on commercial rates set by
hospitals and health care providers.
(5) A review of recently closed maternal-health-related
services locations in this Commonwealth and the proportion of
patients who are recipients of the services and who are also
enrolled in medical assistance.
(6) A review of maternal-health-related Medicaid payment
rates in other states, including fee-for-service, managed
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care, Maryland Total Cost of Care Model, Centers for Medicare
and Medicaid Services All-Payer Health Equity Approaches and
Development Model, which identifies best practices in
providing Medicaid payments that provide hospitals with
competitive funding.
(7) Regulatory and legislative recommendations, as
appropriate, on the means to revise maternal-health-related
payment rates or payment methodologies to enrolled hospitals
and health care providers, including changes to the way
managed care organizations set maternal-health-related
payment rates and evaluate rate appeals;
and be it further
RESOLVED, That the Joint State Government Commission issue a
report with its findings and recommendations no later than 18
months after the adoption of this resolution to all of the
following:
(1) The President pro tempore of the Senate.
(2) The Speaker of the House of Representatives.
(3) The Majority Leader and the Minority Leader of the
Senate.
(4) The Majority Leader and the Minority Leader of the
House of Representatives.
(5) The chair and minority chair of the Appropriations
Committee of the Senate.
(6) The chair and minority chair of the Appropriations
Committee of the House of Representatives.
(7) The chair and minority chair of the Health and Human
Services Committee of the Senate.
(8) The chair and minority chair of the Health Committee
of the House of Representatives.
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(9) The chair and minority chair of the Human Services
Committee of the House of Representatives.
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