October 2022 - Safety-Net Association of Pennsylvania

PA Health Policy Update for Friday, October 28

The following is an update of selected state health policy developments in Pennsylvania for the week of October 24-28, 2022. (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf signed House Bill 1630 into law earlier today. Act 98, as it is now known, gives the Pennsylvania Auditor General authority to audit and review pharmacy benefit managers (PBMs) that subcontract with Medicaid managed care organizations. In addition, the bill abrogates a number of regulations to permit the following:

audio-only outpatient psychiatric services
telehealth services in outpatient drug and alcohol clinic services
virtual supervision for psychiatric rehabilitation services
physician assistants and nurse practitioners to order home care, home health services, and personal care services under the supervision of a physician

General Assembly

The state House and Senate convened for session this week. The following is an overview of selected health-related legislation that received consideration.

The Senate unanimously passed House Bill 2293, which requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities, and sent it to the governor for his signature.
The Senate also unanimously passed House Bill 1393, which seeks to prevent overdose deaths by legalizing fentanyl test strips for personal use, and sent it to the governor for his signature.
The House passed Senate Bill 225, which seeks to streamline and standardize the process for prior authorization of medical services, on third and final consideration Wednesday. The Senate subsequently voted to concur with the House amendments and sent it to the governor for his signature.
The House passed Senate Bill 522, which requires all pregnant women and children in Pennsylvania to receive blood tests to detect lead poisoning, on third and final consideration Wednesday. The Senate concurred with the House amendments and sent it to the governor for his signature.
The Senate passed House Bill 2527, which expands Pennsylvania’s “Good Samaritan” law to cover all opioid reversal medicines approved by the FDA, on third and final consideration and sent it to the governor for his signature.
The Senate passed House Bill 220, which specifies that a person does not need to test positive for drugs to begin addiction treatment. The House subsequently concurred with the Senate’s amendment, which added language that enables counties to establish overdose death or suicide review teams, and sent it to the governor for his signature.
The Senate unanimously passed House Bill 2800, which amends the Medical Practice Act to address an issue related to the licensure of prosthetists, orthotists, pedorthists, and orthotic fitters in Pennsylvania, and sent it to the governor for his signature.
The Senate passed Senate Bill 358, which categorizes maternal deaths and severe maternal morbidity complications as reportable events within the Department of Health and requires the Maternal Mortality Review Committee to submit a report including each reportable event to the Department of Health. The bill was received in the House and referred to the Health Committee.

The state House and Senate are now in recess until the week on Monday, November 14.

Department of Health

Pennsylvania’s Independent Regulatory Review Commission has approved the first significant revision of the state’s nursing home regulations since the late 1990s. Among other things, the updated regulations call for higher levels of nurse staffing and publication of changes in the ownership of nursing homes. The Department of Health also will have to take a more rigorous approach to determining whether it will accept or reject such transactions. Learn more from this Philadelphia Inquirer article. A formal notice of the adoption of these new rules should be published shortly in the Pennsylvania Bulletin.

The Department of Health has lowered the age at which individuals may request a copy of their birth certificate in Pennsylvania from 18 to 16 and introduced a new waiver to enable individuals aged 16-24 who are, or have been, involved in foster care or juvenile justice to obtain their birth certificate without the $20 fee; the same fee waiver will apply to homeless persons. Learn more from this Department of Health news release.

Department of Human Services

The federal Centers for Medicare & Medicaid Services (CMS) has approved Pennsylvania’s application to extend Medicaid and CHIP eligibility for newborns and their mothers to 12 months of postpartum care, an option temporarily available to states under the American Rescue Plan. Learn more from this CMS news release.
The Department of Human Services (DHS) has issued the publication “5 Things to Know About the End of the Federal Public Health Emergency.” While the Medicaid-focused publication is primarily directed to consumers, it includes explanations providers can use when interacting with Medicaid patients and resources to which those who work with Medicaid beneficiaries can direct those clients and patients. Find that publication here.
DHS has posted the presentations delivered during the October 27 meeting of the Medical Assistance Advisory Committee. See the presentations from the:
DHS has closed the county assistance office in the Nicetown/Ridge Avenue area of Philadelphia and is directing residents of that area to other offices in Philadelphia. Learn more from this DHS news release.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases reported in Pennsylvania over the past week declined nearly 12 percent; the number of deaths was unchanged.
According to the Department of Health, the number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus remains relatively steady while the CDC reports a 15 percent decrease in the seven-day rolling average of new daily COVID-19 hospital admissions.
The decline in the number of reported COVID-19 cases is reflected in the rate of community transmission among Pennsylvania counties – a major shift after months of virtually all counties experiencing high rates of community transmission with scattered counties occasionally experiencing only substantial rates. As of October 26, 34 counties are experiencing high rates of community transmission; 31 are experiencing substantial rates of community transmission; and two counties – Clarion and Snyder – are experiencing moderate rates of community transmission, the first Pennsylvania counties to see their rate decline to this level in months.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has published “Common Procedures Report – October 1, 2020 through September 30, 2021 Data.” The report shares volume and outcome information for three common orthopedic procedures – spinal fusion, total hip replacement, and total knee replacement – performed in Pennsylvania acute-care hospitals that typically perform these procedures on adults. For further information, including a news release, data, a report summary, the report itself, and more, go here.

Stakeholder Events

Department of Human Services – Medical Assistance Advisory Committee – Managed Long-Term Services and Support Subcommittee – November 2

The Managed Long-Term Services and Support Subcommittee of DHS’s Medical Assistance Advisory Committee will meet publicly on Wednesday, November 2 at 10:00 in Harrisburg. Interested parties may attend in person or via webinar; those participating through the webinar must register in advance. For information about the location of the meeting, how to join it virtually, how to register, and how to offer comments or submit questions, see this DHS notice.

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – November 2

The Department of Health’s Human Immunodeficiency Virus Community Prevention Planning Committee will hold a public meeting in Harrisburg on Wednesday, November 2 at 9:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Organ Donation Advisory Committee Meeting – November 3

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting in Harrisburg on Thursday, November 3 at 10:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Human Services – Trauma-Informed Care – November 3

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Jewish Healthcare Foundation a webinar on trauma-informed care for skilled nursing facilities. The webinar will be held on Thursday, November 3 at 2:00. Learn more about the webinar and how to participate from this notice.

PHC4 – PHC4 Council Meeting – November 3

PHC4 will hold a regular council meeting at 10:00 on Thursday, November 3. An agenda will be available here 24 hours in advance. The public is invited to participate; contact rgreenawalt@phc4.org at least 24 hours in advance for participation instructions.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – November 4

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Camp Hill, PA on Friday, November 4 at 10:00. For information about the role of the board, the purpose of the meeting, and the location of the meeting, see this Pennsylvania Bulletin notice.

Department of Human Services – Management Strategies When Working With Individuals With Acquired Brain Injuries – November 10

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Jewish Healthcare Foundation a webinar on understanding basic management strategies for working with individuals with acquired brain injuries. The

webinar will be held on Thursday, November 10 at 2:00. Learn more about the webinar and how to participate from this notice.

jsteinbock2022-10-28T19:54:44+00:00October 28th, 2022|COVID-19, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for Friday, October 21

The following is an update of selected state health policy developments in Pennsylvania for the week of October 17-21, 2022. (Some of the language used below is taken directly from state documents.)

General Assembly

The state Senate convened for session this week. The following is an overview of selected health-related legislation that received consideration.

The Senate passed on third and final consideration Senate Bill 1330, which requires insurance coverage for genetic counseling and genetic testing for the BRCA1 and BRCA2 gene mutation if a person is diagnosed with breast or ovarian cancer or has a family history of breast or ovarian cancer. The bill was received in the House and referred to the Insurance Committee.
The Senate passed Senate Bill 1225, which provides enhanced coverage of MRIs and ultrasounds for women with certain risk factors. The bill was received in the House and referred to the Insurance Committee.
The Senate Health & Human Services Committee met on Tuesday, October 18 and favorably reported the following bills.
- Senate Resolution 352 requires the Joint State Government Commission to study the specific data, calculations, and mechanisms the Department of Human Services uses to determine the capitation rate paid to drug and alcohol treatment providers in Pennsylvania.
- Senate Bill 359 requires the Secretary of DHS to apply for a waiver that would extend Medicaid coverage for pregnancy-related and postpartum medical assistance for up to ten additional months.
- Senate Bill 1136 amends the Vital Statistics Law to expressly include the Legislative Budget and Finance Committee as a government entity and to clarify that it may have access to vital statistics for research purposes.
- Senate Bill 1358 places certain restrictions on non-compete clauses for health care practitioners and requires patient notification.
- House Bill 293 allows FDA-approved anti-obesity drugs to be considered a compensable service under the state’s Medicaid program.
- House Bill 1443 permits certain diagnostic laboratory services to be directly marketed to Pennsylvania consumers.
- House Bill 1630 and Senate Bill 917 grant the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid.
- House Bill 2293 requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.
- House Bill 2357 prohibits the preparation, manufacture, sale, or distribution of unsafe kratom products and the sale or distribution of kratom products to individuals younger than 21 years of age.
- House Bill 2530 ends the practice of prudent pay in DHS’s Office of Developmental Programs.
The Senate Consumer Protection & Professional Licensure met on Tuesday, October 18 and favorably reported, among other bills, House Bill 2800, which amends the Medical Practice Act to address an issue related to the licensure of prosthetists, orthotists, pedorthists, and orthotic fitters in Pennsylvania.

The Senate Aging & Youth Committee met on Tuesday, October 18 and favorably reported House Bill 2425, which requires the Department of Health or Department of Human Services to report allegations of older adult abuse to local area agencies on aging and the Department of Aging.
The state House and Senate will convene for voting session next Monday (10/24), Tuesday (10/25), and Wednesday (10/26).

Department of Human Services

The Department of Human Services (DHS) has extended its calendar for issuing Medical Assistance remittance advice notifications, mailing checks, and making electronic transfers into early December. Find the updated calendar here.
DHS has published a Medical Assistance Bulletin to inform Medical Assistance providers that it has added CPT code 0094A to the Medical Assistance program fee schedule for the administration of a booster dose of the Moderna COVID-19 vaccine. Find that bulletin here.
DHS has announced the addition of new procedure codes to the Medical Assistance fee schedule for the administration of a pediatric booster dose or a pediatric dose of Pfizer and Moderna COVID-19 vaccines. Find the codes, the payment rates, and the effective dates of the new codes in this Pennsylvania Bulletin notice.
DHS has published a final notice of its funding allocation for FY 2021-2022 to establish a new class of supplemental payments to promote the continuation of quality medical services to individuals enrolled in the Pennsylvania Medical Assistance program and provide financial relief to hospitals during the COVID-19 pandemic. DHS is not otherwise changing the qualifying criteria or payment methodology for these payments. The FY 2021-2022 impact of these payments is $70 million in total funds. Learn more from this Pennsylvania Bulletin notice.
DHS has published a final notice of its funding allocation for FY 2021-2022 to establish a new class of supplemental payments to qualifying acute-care general hospitals that provide a high volume of services to Medical Assistance-eligible and low-income populations in non-rural medically underserved areas. The FY 2021-2022 budget impact of these payments is $5.283 million in total funds. Learn more from this Pennsylvania Bulletin notice.
DHS has announced that the Pennsylvania Patient and Provider Network (P3N), the statewide federated health information exchange, has successfully transitioned to a new, cloud-based system that it believes will improve health care delivery across the state. The P3N is a centralized platform that connects independent health information organizations (HIOs) and facilitates information-sharing, connecting health care providers that participate with the goal of improving care coordination and outcomes for patients. Providers connected to a P3N-certified HIO can find patient medical records anywhere on the P3N network and receive notifications when their patients obtain services from other providers in the state, such as an emergency room visit. Learn more about the new system and its capabilities from this DHS news release.
Kristen Houser has resigned as deputy secretary of DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS). Dr. Dale Adair will serve as acting deputy secretary.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases reported in Pennsylvania over the past week rose slightly after several weeks of declines; the number of deaths was unchanged.
According to the Department of Health, the number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus remains relatively steady while the CDC reports a nine percent increase in the seven-day rolling average of new daily COVID-19 hospital admissions after a comparable decrease the previous week.
Sixty-two of Pennsylvania’s 67 counties continue to experience a high rate of community transmission of reported COVID-19 cases. The remaining five counties – Adams, Centre, Philadelphia, Snyder, and Sullivan – are experiencing moderate rates of community transmission.

Stakeholder Events

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – October 25

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will hold its next meeting on Tuesday, October 25 at 9:30. The meeting location will depend on COVID-19 mitigation efforts at that time. If the meeting can be held in person it will be in Room 129 in the Pennsylvania Health and Welfare Building at 625 Forster Street in Harrisburg. If the meeting is held virtually it will be held at bit.ly/ABC_MAP. To dial in, call 267-332-8737, conference ID 440 338 696#. Learn more from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – October 26

The Medical Assistance Advisory Committee’s Consumer Subcommittee will meet virtually on Wednesday, October 26 at 1:00. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – October 27

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, October 27 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program – Advisory Council – October 27

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, October 27 at 10:00. Interested individuals may attend in person or participate virtually. For information on the location of the meeting and how to join the meeting virtually, see this Department of Health notice.

DHS – Trauma-Informed Management – October 27

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on trauma-informed management for skilled nursing facilities. The webinar will be held on Thursday, October 27 at 2:00. Learn more about the webinar, the skilled nursing professionals to whom it is directed, and how to participate from this notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Support Subcommittee – November 2

The Managed Long-Term Services and Support Subcommittee of DHS’s Medical Assistance Advisory Committee will meet publicly on Wednesday, November 2 at 10:00 in Harrisburg. Interested parties may attend in person or via webinar; those participating through the webinar must register in advance. For information about the location of the meeting, how to join it virtually, how to register, and how to offer comments or submit questions, see this DHS notice.

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – November 2

The Department of Health’s Human Immunodeficiency Virus Community Prevention Planning Committee will hold a public meeting in Harrisburg on Wednesday, November 2 at 9:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Organ Donation Advisory Committee Meeting – November 3

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting in Harrisburg on Thursday, November 3 at 10:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – November 4

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Camp Hill, PA on Friday, November 4 at 10:00. For information about the role of the board, the purpose of the meeting, and the location of the meeting, see this Pennsylvania Bulletin notice.

jsteinbock2022-10-21T20:30:06+00:00October 21st, 2022|COVID-19, Medicaid supplemental payments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for Friday, October 14

The following is an update of selected state health policy developments in Pennsylvania for the week of October 10-14, 2022. (Some of the language used below is taken directly from state documents.)

The Wolf Administration

Governor Wolf has announced that Pennsylvania is proposing to enter a new profit-sharing agreement with its Medical Assistance physical health managed care organizations. Under the proposed agreement, the physical health managed care organizations would be limited to three percent profits annually with the requirement to invest additional profits in approved projects and initiatives that directly benefit the health and well-being of Pennsylvanians. The agreement would take effect for the 2023 contract year. Learn more about the proposal from this Wolf administration news release.

General Assembly

The state Senate will return to session next week. Monday, October 17 is a non-voting session day. Tuesday, October 18 and Wednesday, October 19 are voting session days. The state House will continue to be in recess next week.

The Senate Health & Human Services Committee will convene on Tuesday, October 18 to consider the following bills.

Senate Resolution 352 requires the Joint State Government Commission to study the specific data, calculations, and mechanisms the Department of Human Services (DHS) uses to determine the capitation rate paid to drug and alcohol treatment providers in Pennsylvania.
Senate Bill 359 requires the Secretary of DHS to apply for a waiver that would extend Medicaid coverage for pregnancy-related and postpartum medical assistance for up to an additional ten months.
Senate Bill 1136 amends the Vital Statistics Law to expressly include the Legislative Budget and Finance Committee as a government entity and to clarify that it may have access to vital statistics for research purposes.
Senate Bill 1358 places certain restrictions on non-compete clauses for health care practitioners and requires patient notification. Legislative text is not currently available.
House Bill 293 allows FDA-approved anti-obesity drugs to be considered a compensable service under the state’s Medicaid program.
House Bill 1443 permits certain diagnostic laboratory services to be marketed directly to Pennsylvania consumers.
House Bill 1630 grants the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid.
House Bill 2293 requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.
House Bill 2357 prohibits the preparation, manufacture, sale, or distribution of unsafe kratom products and the sale or distribution of kratom products to individuals younger than 21 years of age.
House Bill 2530 ends the practice of prudent pay in the Department of Human Services’ Office of Developmental Programs.

Department of Human Services

The Department of Human Services (DHS) has posted information for providers about an electronic submission process that will soon be available in the PROMISe portal for fee-for-service 180-day exception requests and other claims requiring documentation. Find DHS notice here.
Effective October 1, Pennsylvania has increased the income threshold for applicants for the Supplemental Nutrition Assistance Program (SNAP) to 200 percent of federal poverty income guidelines. This will make more than 420,000 Pennsylvanians and more than 174,000 households newly eligible for SNAP and an average of $63 a month to help pay for groceries. For additional information about these changes and where to direct individuals to apply for them, see this DHS news release.
DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has released “Pennsylvania Behavioral Health Telehealth Phase II Roadmap,” which offers and prioritizes recommendations for short-term and long-term implementation of telehealth services in the state.

Centers for Medicare & Medicaid Services

The federal Centers for Medicare & Medicaid Services (CMS) has approved Pennsylvania’s request for a statewide waiver to extend the October 6, 2022 deadline for temporary nurse aides (TNAs) to gain certification to April 5, 2023 or until the end of the COVID-19 public health emergency (whichever comes first). This statewide approval applies to all nursing care facilities in Pennsylvania, so individual facilities do not need to request a waiver. For information about how temporary TNAs can pursue certification, see this notice.

To evaluate Medicaid and the Children’s Health Insurance Program (CHIP) coverage for children, states report data to CMS about program eligibility, enrollment, operations, expenditures, program goals, and more. CMS has published CHIP data submitted to it by Pennsylvania for FY 2021. Find that data here.

Department of Health

The Department of Health has issued a health alert giving providers interim guidance on risk assessment and management of patients who may have been exposed to the Ebola virus. It issued this guidance after a case of Ebola was recently diagnosed in Uganda but notes that no reported or confirmed cases have been found in the U.S. Learn more from this health advisory.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases in Pennsylvania over the past week was down 18 percent from the previous week (which was 20 percent less than the week before that) and the number of deaths was unchanged.
According to the Department of Health, the number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus remains relatively steady while the CDC reports a nine percent decrease in the seven-day rolling average of new daily COVID-19 hospital admissions (after a seven point increase the previous week).
Sixty-two of Pennsylvania’s 67 counties are experiencing a high rate of community transmission of COVID-19. The remaining five counties – Adams, Centre, Lebanon, Philadelphia, and Snyder – are experiencing moderate rates of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs (DDAP) announced that the 2022 open enrollment period is under way for licensed substance use disorder treatment providers in Pennsylvania to submit their information to be included in the Addiction Treatment Locator, Assessment, and Standards Platform (ATLAS). Treatment facilities currently not enrolled in ATLAS may submit their information during this open enrollment period through December 30, 2022. In addition, current enrollees may update facility information during this period. For additional information, see this DDAP news release.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has released its state ambulatory surgery center financial analysis for 2021. Its report shows that the average total margin for ambulatory surgery centers increased 1.61 percentage points, from 23.36 percent in fiscal year 2020 to 24.97 percent in FY 2021. The average statewide operating margin for ambulatory surgery centers increased 1.58 percentage points, from 22.29 percent in FY 2020 to 23.87 percent, in FY 2021. Learn more from this PHC4 news release and the PHC4 report “Financial Analysis 2021: Ambulatory Surgery Centers.” Go here for downloadable data in Excel format (this link opens to a download).

Stakeholder Events

Department of Health – Special Supplemental Nutrition Program for Women, Infants and Children Advisory Committee – October 18

The Department of Health’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Advisory Committee will meet virtually on October 18 at 1:00 to elect officers and discuss future suggestions and next steps for the committee. For information about participating in the meeting and obtaining an agenda, see this Pennsylvania Bulletin notice.

DHS – Office of Mental Health and Substance Abuse Services and Office of Developmental Programs – Suicide Prevention – October 21

The Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs will host a quarterly “Statewide Positive Approaches & Practices” meeting that will share the most recent research and resources to help people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities live everyday lives. The specific subject of the meeting, to be held on Friday, October 21 at 9:00, will be suicide prevention and intervention. Find the meeting agenda and information about how to register to participate from this DHS notice.

Department of Health – Renal Disease Advisory Committee – October 21

The Department of Health’s Renal Disease Advisory Committee will hold its quarterly meeting in person and virtually on Friday, October 21 at 10:00. For information about participating in the meeting, see this Pennsylvania Bulletin notice.