December 2022 - Safety-Net Association of Pennsylvania

PA Health Policy Update for Friday, December 23

The following is an update of selected state health policy developments in Pennsylvania for the week of December 19-23, 2022. (Some of the language used below is taken directly from state documents.)

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin informing providers about new procedures for dispensing 340B-purchased drugs to Medical Assistance beneficiaries and about the implementation of the program’s 340B drug exclusion list. Find the bulletin here. Find the policies this new bulletin replaces here.
DHS has extended its schedule for sending Remittance Advice documents, Medicaid payment checks, and electronic transfers of payments into early February. Find the updated schedule here.
DHS has announced that it will add several prescription drugs to the Medical Assistance program’s list of services and items requiring prior authorization: corticotropin; targeted systemic immunomodulators for atopic dermatitis, designated as preferred on the program’s preferred drug list (PDL); PCSK9 inhibitor lipotropics, designated as preferred on the PDL; and obesity treatment agents designated as preferred on the PDL. Learn more from this Pennsylvania Bulletin notice.
DHS has posted revisions of the participating drug company list for the Medicaid drug rebate program.
DHS has announced its intent to allocate funds in FY 2023 for several classes of inpatient disproportionate share hospital (DSH) payments (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled, qualifying inpatient acute-care general hospitals. It does not intend to otherwise change the qualifying criteria or payment methodology for these payments. See the announcement, including information about the different purposes for which Medicaid DSH payments will be made, in this Pennsylvania Bulletin notice.
DHS has circulated the following materials from the December 7 meeting of the Medical Assistance Advisory Committee meeting.

Department of Health

The Department of Health (DOH) has announced that Pennsylvania will receive $98 million in federal funding to enhance public health infrastructure, including staffing, health planning, and equity and data modernization efforts. A portion of the funding, from the CDC’s Public Health Infrastructure grant program will be allocated to 10 county and municipal health departments. Learn more from this Department of Health news release.
DOH has issued a health advisory informing providers to be aware of possible increases in group A streptococcal infections. The alert also informs providers about symptoms, testing, and treatment; provides instructions for laboratories that identify cases; and reminds providers and laboratories that they are required to report such cases to DOH. Find the alert here.
DOH has issued a health advisory with interim guidance for clinicians on how to prioritize antiviral flu treatment at a time when there is limited availability of the drug oseltamivir (Tamiflu). Find the advisory here.
DOH has revised long-term-care nursing facility regulations recently approved by the Independent Regulatory Review Commission to correct typographic errors. Find the revised, final regulations in this Pennsylvania Bulletin notice.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania remained steady over the past week but still at an elevated post-Thanksgiving level. The number of new deaths remains within the usual range for recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and in hospital ICUs remained steady over the past week but the number on ventilators rose 17 percent.
The CDC reports no change over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 21, 46 Pennsylvania counties were experiencing high rates of community transmission of COVID-19; 15 were experiencing substantial rates of community transmission; and six counties were experiencing a moderate rate of community transmission.
As 2022 draws to a close, Pennsylvania has now experienced 3.4 million confirmed, reported cases of COVID-19 and suffered nearly 49,000 deaths from the virus.

jsteinbock2022-12-23T21:11:29+00:00December 23rd, 2022|COVID-19, long-term care, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off

SNAP Asks PA Delegation for Help With Medicare Issues (Letter)

SNAP has asked Pennsylvania’s congressional delegation to support provisions in the federal FY 2023 omnibus spending bill that would delay a Medicare sequestration cut, restore reduced Medicare payments to doctors, and improve how Medicare Advantage insurers handle prior authorization requests.

PA Safety Net Admin2022-12-23T21:54:29+00:00December 19th, 2022|Advocacy|Comments Off

PA Health Policy Update for Friday, December 16

The following is an update of selected state health policy developments in Pennsylvania for the week of December 12-16, 2022. (Some of the language used below is taken directly from state documents.)

Department of Human Services

The Department of Human Services has issued Medical Assistance Bulletins addressing requirements for prior authorization and the type of information that will be needed, as of January 9, to evaluate the medical necessity of prescriptions for:

Department of Health

The Department of Health (DOH) is working to implement Act 128 of 2022, which requires temporary health care services agencies to register with DOH. Under the act, temporary health care services agencies are agencies that provide temporary health care personnel (RNs, LPNs, nurse aides, or direct care staff) to long-term-care nursing facilities, personal care homes, or assisted living residences. DOH has developed a survey for long-term-care facility administrators so it can compile information about temporary health care services agencies operating in Pennsylvania. Long-term-care facility officials can go here to complete the brief survey.
DOH has issued an alert advising providers of an outbreak of measles in neighboring Ohio, informing providers about the symptoms they should look for among possible measles patients and how to prevent, test for, and treat measles. The alert also reminds providers that they are required to report measles cases to the state. Learn more from this health alert.
DOH has issued an alert updating providers on its latest guidance for treating COVID-19. The alert notes that the most common strains of the virus cannot be treated by the monoclonal antibodies that were effective against earlier strains and that the federal government currently authorizes no such products for use in treating COVID-19 patients. Despite this, selected anti-viral therapeutics are still available to treat such patients. Learn more from this health alert.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania remained steady over the past week but still at an elevated post-Thanksgiving level. The number of new deaths remains within the usual range for recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs rose, but just slightly, over the past week.
The CDC reports a modest increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 14, 52 Pennsylvania counties were experiencing high rates of community transmission of COVID-19; 14 were experiencing substantial rates of community transmission; and one county was experiencing a moderate rate of community transmission. This represents deterioration from the previous week, when 39 Pennsylvania counties experienced high rates of community transmission of COVID-19, 25 experienced substantial rates of community transmission, and three experienced moderate rates of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs recommends that businesses that provide addiction treatment and supports consider training employees and volunteers regularly on preparing for and responding to an active shooter incident. Learn more from this message from the department to stakeholders.

Pennsylvania Health Care Cost Containment Council

PHC4 has released “Hospital Performance Report – October 2020 through September 2021 Data,” which presents information about the performance of Pennsylvania acute-care hospitals for 13 common medical conditions. Among the factors reported are hospital-specific mortality, 30-day readmission ratings, case volume, and hospital charges for patients between October 1, 2020 and September 30, 2021. The report also looks at changes in statewide rates over time. For additional information see PHC4’s news release; a report summary; an introduction to the report; a summary of key findings; downloadable data sets; technical notes; and data about Medicare payments.

jsteinbock2022-12-16T21:54:49+00:00December 16th, 2022|COVID-19, Medical Assistance Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

End of PHE Could Cut Kids From PA Medicaid Rolls

When the formal COVID-19 public health emergency ends, as many as one out of every four Pennsylvania children enrolled in Medicaid could lose their state-sponsored health insurance, according to new research by the Pennsylvania Partnership for Children.

During the PHE, the number of uninsured children in the state fell from 4.6 percent to 4.4 percent, but some of that improvement could be reversed as the state begins to redetermine the eligibility of more than 3.5 million people currently on the state’s Medicaid rolls after a more than two-year hiatus in eligibility reviews. Today, more than 1.4 million children in Pennsylvania are enrolled in Medicaid or CHIP.

Even with the PHE-inspired improvements, 5.5 percent of children in the state who qualify for some kind of free or subsidized health insurance remain uninsured, according to the research.

Uninsured children, like the uninsured population at large, are far more likely than not to be treated by Pennsylvania’s safety-net hospitals such as those that belong to the Safety-Net Association of Pennsylvania (SNAP). As a result, any reduction in the rate of uninsured children would have a correspondingly damaging effect on the financial health of those safety-net hospitals – and potentially, on the residents of the medically vulnerable communities those hospitals serve.

Learn more about how the end of the PHE may affect health care coverage for Pennsylvania children in the Pennsylvania Capital-Star article “Report: Ranks of uninsured Pa. kids dropped during pandemic.”

jsteinbock2022-12-14T15:26:58+00:00December 14th, 2022|COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus|Comments Off

PA Health Policy Update for Friday, December 9

The following is an update of selected state health policy developments in Pennsylvania for the week of December 5-9, 2022. (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Shapiro announced that he will appoint Uri Monson, the chief financial officer of the School District of Philadelphia, as Budget Secretary. He also announced Jennifer Selber will be appointed General Counsel and Larry Hailsham, Jr. will be Executive Deputy Chief of Staff. Selber currently serves as the Executive Deputy Attorney General of Pennsylvania in charge of the criminal division and Hailsham most recently served as the Shapiro campaign’s political director.

General Assembly

Democrats and Republicans continue to struggle over control of the state House. On Wednesday Representative Joanna McClinton (D-Philadelphia) was sworn in during an unannounced ceremony as majority leader. Republicans swiftly denounced the swearing-in as an “illegitimate power grab.” In addition, Representative Summer Lee (D-Allegheny County) and Representative Austin Davis (D-Allegheny County) formally submitted their resignations on Wednesday. At the same time they won re-election to those seats Ms. Summer was elected to Congress and Mr. Davis was elected Lieutenant Governor. Their resignations, along with the passing of Representative Tony DeLuca (D-Allegheny County), make the current breakdown in the state House 101 Republicans and 99 Democrats.
The state Senate released its 2023 session calendar through June. The calendar can be viewed here.

Department of Human Services

The Department of Human Services (DHS) has announced its intent to allocate $18.034 million in state and federal funds for FY 2023 Medicaid disproportionate share hospital payments (Medicaid DSH) to acute-care general hospitals that qualify as a trauma center. DHS also is amending the qualifying criteria and payment methodology for these payments for newly accredited trauma centers and hospitals seeking trauma center accreditation. See the announcement and learn more about the changes in the qualifying criteria and payment methodology in this Pennsylvania Bulletin notice. Public comments are due within 30 days.
DHS has issued a Medical Assistance Bulletin to inform providers about updates to the statewide Preferred Drug List (PDL) that take effect on January 9. Find the bulletin here.
DHS has issued Medical Assistance Bulletins addressing requirements for prior authorization and the type of information that will be needed, as of January 9, to evaluate the medical necessity of prescriptions for:
DHS has posted guidance for providers on procedure code/modifier combinations to be used when requesting home accessibility durable medical equipment and durable medical equipment repairs in the Medicaid fee-for-service program. Find the instructions here.
DHS is updating the Medical Assistance fee schedule for disposable breast milk collection and storage bags and breast pump replacement supplies. Learn about the new fees and new procedure codes to accompany them from this Pennsylvania Bulletin notice.
Beginning on December 16, providers will find a new question on the electronic provider enrollment application: “Will your provider agency be rendering Personal Care Services or Home Health Care Services that are subject to EVV [electronic visit verification]?” DHS has posted information for providers about what this question means and how they should approach answering it.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania rose nearly 30 percent in the past week, an increase possibly attributable to social gatherings over the Thanksgiving holiday. The number of new deaths remains within the usual range for recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs remains relatively unchanged.
The CDC reports a 22 percent increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 7, 39 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 25 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission. This is almost identical to the previous week.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued an information bulletin explaining that as a result of a new Pennsylvania law passed last month, private and public treatment and rehabilitation facilities may not deny addiction treatment to individuals based solely on a negative result on a drug test. This policy takes effect on January 1. Learn more from this information bulletin.
The Department of Drug and Alcohol Programs has announced that it has awarded nearly $19 million in grant funding through its substance use disorder loan repayment program to help substance use disorder treatment professionals repay their outstanding qualifying educational loans. More than 280 practitioners, including case managers, counselors, licensed social workers, physician assistants, and registered nurses, shared in the funding. Learn more from this department news release.

State Board of Nursing

The State Board of Nursing proposes amending its process for reactivating nursing licenses. Learn more from this Pennsylvania Bulletin notice. Public comments on the proposed changes are due within 30 days.

jsteinbock2022-12-09T21:00:26+00:00December 9th, 2022|COVID-19, DSH hospitals, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

SNAP Asks PA Congressional Delegation for End-of-Year Help (Letter)

SNAP has asked members of Pennsylvania’s congressional delegation to support efforts to delay implementation of a new four percent Medicare sequestration cut, protect doctors from a 4.5 percent Medicare payment reduction, and streamline the prior authorization process used by Medicare Advantage plans.

PA Safety Net Admin2022-12-12T18:29:09+00:00December 6th, 2022|Advocacy|Comments Off

PA Health Policy Update for Friday, December 2

The following is an update of selected state health policy developments in Pennsylvania for the week of November 28 to December 2, 2022. (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf has announced the availability of more than $9 million in state grant funding for Single County Authorities to establish or expand crisis stabilization services for individuals with co-occurring mental health and substance use disorders. Grants of up to $3 million will be awarded to eligible Single County Authorities and can be applied toward a range of activities, including construction and building infrastructure, staffing, and programming. Learn more about how the state envisions counties using this money from this announcement from the governor’s office.

Governor-Elect Shapiro

The Shapiro-Davis transition team announced that Dana Fritz will serve as chief of staff in a new Shapiro administration. Immediately prior to joining the incoming administration, Ms. Fritz, a long-time aide to Shapiro, served as his campaign manager. Find additional information about the transition here.

Revenue Collection Update

The Department of Revenue has released its monthly revenue update for November. General Fund revenue collections were $201.9 million, or 6.8 percent, below estimate for the month. The shortfall is due, in part, to personal income tax revenue being deposited in December rather than November. Fiscal year-to-date General Fund collections total $15.7 billion, which is $183.2 million, or 1.2 percent, above estimate.

Department of Human Services

The Department of Human Services (DHS) has announced its intent to update the qualifying criteria and payment methodology for Medicaid disproportionate share hospital (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled and qualifying emergency departments in acute-care general hospitals by adding references to the report used in determining the eligibility for and the payment amounts beginning FY 2022-2023. This announcement appears to be a codification of current state policy. Learn more from this Pennsylvania Bulletin notice.
DHS has announced that it plans to expand the Living Independence for the Elderly (LIFE) Program to serve Carbon County and Monroe County as one area and is soliciting expressions of interest in serving this area. Learn more about the LIFE program, DHS’s intentions for Carbon and Monroe counties, and the process for pursuing an opportunity to establish a LIFE program in those counties from this Pennsylvania Bulletin notice.
CMS has written to states to remind them that with the passage of the Inflation Reduction Act, Medicaid and Children’s Health Insurance Program (CHIP) programs will be required to provide coverage for approved adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) without cost-sharing for certain enrollees beginning October 1, 2023. Learn more from this CMS notice.
DHS has circulated the minutes of the October 26 meeting of the Medical Assistance Advisory Committee’s consumer subcommittee. Find those minutes here.

Department of Health

The Department of Health (DOH) issued a press release announcing its plans to distribute approximately $11.7 million in federal CDC funding to help long-term-care facilities build resilience to sustain quality care. The money will be invested for purposes such as workforce development, staff retention, and infrastructure developments that support infection prevention control and emergency preparedness. Eligible applicants include skilled nursing facilities, personal care homes, assisted living facilities, and intermediate care facilities. Learn more about the program and find links to additional information about it here. The deadline for applying for funding is December 31.
DOH has issued a health alert informing health care providers of a recent increase in reports of mushroom poisoning received by poison control centers in the state. The majority of these cases have involved individuals consuming wild mushrooms foraged from backyards, public parks, wooded areas, and other locations in the southeastern part of the state. Learn more from this department health alert.
DOH has updated the guidelines and fees that health care providers and facilities may charge in response to requests for production of medical charts or records. Learn more, including the new fees, from this Pennsylvania Bulletin notice.
In preparation for the holiday season, DOH has established ten temporary COVID-19 testing and home test distribution sites across the state. Go here for information about the location and hours for these sites.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases reported daily in Pennsylvania and the number of new deaths has remained steady in recent weeks, with the state averaging about 1400 new daily cases and 16-20 new daily deaths.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs remains relatively steady as well.
The CDC reports a modest decrease in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of November 30, 38 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 26 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission.

Pennsylvania Health Care Cost Containment Council

PHC4 has issued “COVID-19 Disaster Emergency Report,” to provide data on the effect of the COVID-19 emergency on the financial performance of Pennsylvania hospitals and health care facilities. According to the report, Pennsylvania hospitals and health systems reported $206 million in COVID-19 costs, between related expenses and revenue losses, for the period April-June of 2022. Total COVID-19-related expenses and lost revenue reported by Pennsylvania hospitals and health systems through December 2021 are $7.8 billion but these figures do not reflect emergency funding provided under federal or state laws. Learn more from this PHC4 news release and the report itself.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – December 7

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, December 7 at 10:00. Interested parties can join the meeting in person or via webinar. For information about the location of the meeting and how to join virtually, see this DHS notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – December 7

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, December 7 at 1:00. Go here to register to participate.

Department of Health – Infant Hearing Screening Advisory Committee – December 8

The Infant Hearing Screening Advisory Committee will hold a public meeting in Harrisburg on Thursday, December 8 at 1:00; individuals also may participate virtually. For more information about the meeting, including its location and how to join virtually, see this Pennsylvania Bulletin notice.

Department of Aging – Pennsylvania Long-Term Care Council – December 8

The Department of Aging’s Pennsylvania Long-Term Care Council will meet publicly on Thursday, December 8 at 10:00. For information about how to attend in person or virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – December 8

The board of directors of the state’s Patient Safety Authority will meet virtually on Thursday, December 8 at 1:00. Learn about how to register for and participate in this meeting from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – December 8

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, December 8 at 10:00. Go here to register to participate.

jsteinbock2022-12-05T13:53:45+00:00December 2nd, 2022|COVID-19, Federal Medicaid issues, Medicaid supplemental payments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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