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MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

MACPAC kicked off its January meeting with a review of a draft chapter for the March 2021 report to Congress and recommendations on a mandatory extension of Medicaid coverage for 12 months postpartum. The Commission received extensive public comment on the recommendations. On Friday, the Commission approved three recommendations as drafted related to postpartum coverage. The Commission recommended that Congress should:

  • extend the postpartum coverage period for individuals who were eligible and enrolled in Medicaid while pregnant to a full year of coverage, regardless of changes in income. Services provided to individuals during the extended postpartum coverage period will receive an enhanced 100 percent federal matching rate;
  • extend the postpartum coverage period for individuals who were eligible and enrolled in the State Children’s Health Insurance Program (CHIP) while pregnant (if the state provides such coverage) to a full year of coverage, regardless of changes in income; and
  • require states to provide full Medicaid benefits to individuals enrolled in all pregnancy-related pathways.

Commissioners then turned their attention to Medicaid estate recovery policies that affect beneficiaries using long-term services and supports (LTSS). Commissioners on Friday approved recommendations to:

  • make estate recovery optional rather than required;
  • allow states with managed long-term services and supports to pursue recovery based on the cost of services where it is less than the capitation payment paid to a managed care plan; and
  • direct the Secretary of the U.S. Department of Health and Human Services (HHS) to establish minimum hardship waiver standards, including a minimum estate value threshold for estate recovery.

Next, the Commission considered recommendations for countercyclical financing adjustments in Medicaid. This would allow federal financial stimulus to be directed to states more quickly during economic downturns and provide states with greater budget predictability. The Commission approved a recommendation that Congress should adopt a statutory mechanism to amend the Social Security Act to provide an automatic Medicaid countercyclical financing model, using the prototype developed by the U.S. Government Accountability Office as the basis. The Commission also recommended this policy change should include:

  • an eligibility maintenance of effort requirement for the period covered by an automatic countercyclical financing adjustment;
  • an upper bound of 100 percent on countercyclical adjusted matching rates; and
  • exclusion of countercyclical adjusted federal matching rate from services and populations that receive special matching rates (e.g., for the new adult group) or are otherwise capped or have allotments (e.g., disproportionate share hospital payments, territories).

After a break on Thursday, Commissioners discussed a draft chapter for the March 2021 report on design considerations for creating a new program for dually eligible beneficiaries and reviewed a report to Congress by the U.S. Secretary of Health and Human Services (HHS) on Medicaid housing supports for individuals with substance use disorder (SUD). The Commission plans to send a letter to HHS and leadership of relevant congressional committees commenting on the Secretary’s report to Congress on Medicaid housing supports for people with SUD who are experiencing or at risk of homelessness.

Next, Commissioners heard a panel discussion on the outlook for state budgets and the implications for Medicaid with Emily Blanford, program principal at the National Conference of State Legislatures; Shelby Kerns, executive director for the National Association of State Budget Officers; and Susie Perez Quinn, government affairs director for the National Governors Association. * The day ended with a presentation on value-based payment for maternity services.

On Friday, Commissioners heard a panel discussion on how Medicaid serves people with intellectual or developmental disabilities with Sharon Lewis, a principal at Health Management Associates; Melissa Stone, director of Arkansas’ Division of Developmental Disabilities Services; and Elizabeth Weintraub, a senior advocacy specialist at the Association of University Centers on Disabilities. * Additional sessions focused on a congressionally mandated MACPAC study of non-emergency medical transportation (NEMT), which will be included in the June 2021 report to Congress. In addition, Commissioners heard a new analyses of care integration for dually eligible beneficiaries, and a discussion of potential new models for payment and coverage of high-cost specialty drugs. The meeting concluded with a discussion of mental health parity in Medicaid.

Supporting the discussion were the following briefing papers:

  1. Postpartum Coverage: Review of Draft Chapter and Recommendation Decisions
  2. Medicaid Estate Recovery Draft Chapter and Recommendations
  3. Automatic Countercyclical Financing Adjustment Review of Draft Chapter and Recommendation Decision
  4. Establishing a Unified Program for Dually Eligible Beneficiaries Design Considerations
  5. Review of the Secretary’s Report on Medicaid Housing Supports for Individuals with Substance Use Disorder
  6. Value-Based Payment for Maternity Care in Medicaid
  7. Mandated Report on Non-Emergency Medical Transportation Further Findings
  8. Integration of Care for Dually Eligible Beneficiaries: New Analyses
  9. Payment and Coverage of High-Cost Specialty Drugs Report from Technical Advisory Panel
  10. Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site here.

 

2021-02-02T06:00:35+00:00February 2nd, 2021|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off on MACPAC Meets
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Wolf Agenda Addresses Health Care Both Directly, Indirectly

In advance of introducing his proposed FY 2022 budget next week, Pennsylvania Governor Tom Wolf has issued a statement outlining his policy priorities for the coming year.

In this statement he addresses health care both indirectly, with references to health equity and opportunity, and directly as well.

Highlights include:

The COVID-19 pandemic has caused major disruptions and layoffs to Pennsylvania’s workforce, disproportionately impacting low-wage workers, people of color, people with disabilities, and certain industries. Our economic recovery requires a strategic investment in workforce development that addresses these inequities, supports workers most significantly impacted by the pandemic, and focuses on high-quality, well-paying jobs and careers. Building on the bipartisan Keystone Economic Development and Workforce Command Center, the governor is proposing a multi-billion-dollar injection into the workforce development system to provide rapid re-employment assistance to workers impacted by the pandemic and address barriers to employment.

Also,

Harrisburg, PA capital buildingBuilding on the overwhelming bipartisan support to establish the state-based health insurance exchange in Pennsylvania, increasing access to affordable care and saving money for both the state and taxpayers, Governor Wolf offers a plan that addresses comprehensive health reforms focusing on both physical and behavioral health and promoting affordability, accessibility and value in health care. The Health Value Commission, a key component to the health reform package, would be charged with keeping all payors and providers accountable for health care cost growth, to provide for the long-term affordability and sustainability of our health care system, and to promote whole-person care.

Next Tuesday Governor Wolf will unveil his proposed FY 2022 budget, which is expected to proposed specific programs and investments in pursuit of these objectives.

Learn more from this news release from the governor’s office.

2021-01-29T06:00:48+00:00January 29th, 2021|Pennsylvania proposed FY 2022 budget|Comments Off on Wolf Agenda Addresses Health Care Both Directly, Indirectly
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COVID-19 Update: Wednesday, January 27

The following is the latest COVID-19 information from the state government as of 3:30 p.m. on Wednesday, January 27.

Department of Health

  • The Department of Health has amended its hospital reporting order effective on January 27, 2021 to require daily reporting to the CORVENA system by 10:00 a.m. instead of the previous 8:00 a.m. deadline.  The order also was amended to include as a required data field “Other categories or data fields required by the federal data reporting system (TeleTracking)” to ensure that facilities are completing all necessary information for the Health Department’s upload from CORVENA into the Teletracking system.  Go here for the amendments to the order and here for a memo about these changes.
  • The Department of Health has posted slides that were presented during a recent meeting of the Health Care Coalition containing information about vaccine strategies for long-term-care facilities.
  • The Department and Health and Department of Human Services has posted a COVID-19 vaccine toolkit for long-term and congregate care facilities.

Department of Health – by the numbers

  • The number of new daily COVID-19 cases has remained steady in recent days – well below November and December highs but more than twice the daily highs recorded in the spring.
  • The daily death toll remains very high and the state-wide total rose past 21,000 today.
  • For the week from January 15 through January 21 the state’s overall COVID-19 test positivity rate fell to 10.5 percent; it was 12.7 percent the week before that.  This marked the fifth consecutive week the rate fell.
  • The numbers of Pennsylvanians hospitalized with COVID-19, in hospital ICUs, and on ventilators has remained steady in recent days.
  • More than 22,000 health care workers in the state have contracted COVID-19.
  • More than 74,000 long-term-care facility residents and employees have contracted COVID-19 in 1533 facilities in all 67 Pennsylvania counties.
  • Currently, 18 percent of adult ICU beds in the state are unoccupied, as are 15 percent of medical/surgical beds, 14 percent of pediatric ICU beds, 27 percent of pediatric beds, and 33 percent of airborne isolation units.  All of these numbers are down in recent days.
  • In its “Reduction of Elective Procedures” dashboard that tracks the criteria the state is using to determine whether to order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients, the state continues to flag a growing staffing shortage in hospitals in the state’s Keystone health care coalition region (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, and York counties).  In that region, 41 percent of the region’s hospitals anticipate a staffing shortage in the coming week – more than the 33 percent level that the state believes poses a potential problem.  The overall situation in the Keystone region, however, has not reached a point where the state would direct hospitals in this region to reduce or eliminate their elective surgeries.  This situation has remained the same for the past three weeks.
  • As of January 27 the state’s vaccine dashboard shows that 491,000 Pennsylvanians have received their first dose of a COVID-19 vaccine and nearly 140,000 have received both doses of vaccine.
  • The vaccine dashboard shows vaccine totals by county both on a map and in lists.
  • A spreadsheet of facilities that have received vaccines can be found here.
  • As ordered by the Department of Health in late 2020, health care institutions – hospitals, FQHCs, and others – must reserve 10 percent of the doses of COVID-19 vaccines they received for non-hospital health care providers.  The vaccine page on the department’s web site features a map of locations where non-hospital providers can obtain vaccines.  The map includes contact information for non-hospital providers identifying whom they can contact to schedule their vaccines.  State officials say more sites will be added to this map as more doses of COVID-19 vaccine become available.

Department of Human Services

DHS has issued a new Medical Assistance Bulletin explaining its decision to increase the Medical Assistance program fee schedule rate for the administration of the COVID-19 vaccine from its current rate to the rate paid by Medicare.  This change is effective December 1, 2020 and DHS will reprocess claims submitted between December 1, 2020 and the issuance of this bulletin.  Providers do not need to resubmit the claims.

Department of State

Under current waivers, pharmacy interns may administer vaccinations, including COVID-19 vaccinations, under the direct supervision of a licensed pharmacist.  In anticipation of the possibility that some pharmacies may have more pharmacy interns capable of administering COVID-19 vaccinations than they have licensed pharmacists capable of providing the requisite direct supervision, the Department of State has temporarily broadened the scope of “eligible supervisors” to include other licensed and trained health care professionals whose current scope of practice permits them to immunize, thereby making it possible for pharmacy interns to administer COVID-19 vaccinations under the direct, immediate, and personal supervision of a pharmacist or certain other health care practitioners.  Specifically, appropriate supervisors pursuant to this waiver include other licensed health care professionals who are trained in the administration of immunizations and emergency care of patients:  physicians, physician assistants, and nurse-midwives licensed by the State Boards of Medicine and Osteopathic Medicine, registered nurses, and certified registered nurse practitioners licensed by the State Board of Nursing.  This waiver applies solely to COVID-19 vaccines and shall be valid for the duration of the governor’s disaster emergency declaration plus an additional 90 days thereafter, unless terminated sooner.  Learn more about the waiver here.

General Assembly

  • House Bill 55 was approved by the House of Representatives on Wednesday by a vote of 116-86. This legislation would amend Pennsylvania’s constitution to limit gubernatorial emergency declarations to no more than 21 days unless the General Assembly agrees to extend it in whole or part.  In addition, once a disaster emergency expires, the governor would not be able to declare a new one based on “the same or substantially similar facts” without approval from the General Assembly.  Further, the bill would clarify that the General Assembly, through a concurrent resolution, could vote to terminate a disaster declaration without having to present it to the governor.  The bill will now go to the Senate for concurrence. If the Senate approves the bill before mid-February, it will be able to be placed on the May 18 primary ballot for voter consideration.
  • Senate Bill 109 was approved by the Senate Wednesday afternoon by a vote of 48-0 and sent to the House of Representatives for consideration. SB 109, a $912 million COVID-19 relief package, provides funding to support restaurants, schools, employers, tenants, and landlords as they continue to confront the financial challenges caused by COVID-19. The measure provides $569.8 million for rental and utility assistance; $197 million for education programs; and $145 million to support the hospitality industry. The funds appropriated by the bill are provided through federal COVID-19 stimulus money. The legislation does not designate any funds for health care. It could be approved by the House as early as next week.

Around the State

  • Forest County, Pennsylvania has experienced more COVID-19 cases in the past two weeks than it had since the start of the pandemic until that point, according to the Philadelphia Inquirer.
  • The Inquirer also reports that the city of Philadelphia has terminated its relationship with Philly Fighting COVID, which ran the city’s largest mass vaccination site and operated a vaccine preregistration website.
  • Westmoreland County, a major COVID-19 hotspot in recent months, has seen its new case numbers fall to their lowest level since October, according to the Pittsburgh Tribune-Review.
  • Philadelphia hospitals have begun giving COVID-19 vaccines to their patients, WHYY radio reports.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

2021-01-28T09:07:25+00:00January 28th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Wednesday, January 27
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COVID-19 Update: Monday, January 25

The following is the latest COVID-19 information from Pennsylvania’s state government as of 3:30 p.m. on Monday, January 25.

Department of Health

The Department of Health has updated it guidance on the use and interpretation of point-of-care antigen test results.

The Department of Health has issued an updated health alert for long-term-care facilities on the use of point-of-care antigen tests, recommending a follow-up molecular test within 48 hours for any asymptomatic person with a positive antigen test result or symptomatic person with a negative result.

Department of Health – by the numbers

  • Over the weekend Pennsylvania’s total number of COVID-19 cases surpassed 800,000.  That means that more than six percent of the state’s population has had the virus.
  • Although the daily numbers remain very high, the decline in the number of new cases reported every day has fallen significantly in the past week.
  • The daily death toll remains very high and the state-wide total rose past 20,000 in recent days.
  • For the week from January 15 through January 21 the state’s overall COVID-19 test positivity rate fell to 10.5 percent; it was 12.7 percent the week before that.  This marked the fifth consecutive week the rate fell.
  • Despite these positive signs, 66 of Pennsylvania’s 67 counties remain in “substantial level of community transmission.”  This week, Cameron County fell out of this group.  Even so, all  counties have positivity rates greater than five percent, which is the level that is considered “concerning.”
  • The numbers of Pennsylvanians hospitalized with COVID-19 has fallen below 4000 for the first time since the week of Thanksgiving.  The number of Pennsylvanians in hospital ICUs has fallen again for the second consecutive week, as has the number on ventilators.
  • More than 22,000 health care workers in the state have contracted COVID-19.
  • More than 73,000 long-term-care facility residents and employees have contracted COVID-19 in 1529 facilities in all 67 Pennsylvania counties.
  • Currently, 22 percent of adult ICU beds in the state are unoccupied, as are 19 percent of medical/surgical beds, 17 percent of pediatric ICU beds, 34 percent of pediatric beds, and 34 percent of airborne isolation units.
  • In its “Reduction of Elective Procedures” dashboard that tracks the criteria the state is using to determine whether to order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients, the state continues to flag a growing staffing shortage in hospitals in the state’s Keystone health care coalition region (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, and York counties).  In that region, 41 percent of the region’s hospitals anticipate a staffing shortage in the coming week – more than the 33 percent level that the state believes poses a potential problem.  The overall situation in the Keystone region, however, has not reached a point where the state would direct hospitals in this region to reduce or eliminate their elective surgeries.  This situation has remained the same for the past three weeks.
  • As of January 25 the state’s vaccine dashboard shows that 451,000 Pennsylvanians have received their first dose of a COVID-19 vaccine and more than 114,000 have received both doses of vaccine.
  • The vaccine dashboard shows vaccine totals by county both on a map and in lists.
  • A spreadsheet of facilities that have received vaccines can be found here.
  • As ordered by the Department of Health in late 2020, health care institutions – hospitals, FQHCs, and others – must reserve 10 percent of the doses of COVID-19 vaccines they received for non-hospital health care providers.  Now, the vaccine page on the department’s web site features a map of locations where non-hospital providers can obtain vaccines.  The map includes contact information for non-hospital providers identifying whom they can contact to schedule their vaccines.  State officials say more sites will be added to this map as more doses of COVID-19 vaccine become available.

Department of Human Services

DHS’s Office of Children, Youth, and Families has updated its general guidance reflecting the state’s COVID mitigation orders affecting services to children, youth, and families served by counties and providers licensed by the office.  The guidance covers safety precautions and visitation requirements.

Pennsylvania State MapAround the State

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

2021-01-26T09:42:38+00:00January 26th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Monday, January 25
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Wolf Makes Major Health Appointments

Pennsylvania Governor Tom Wolf has nominated Alison Beam to be Secretary of the state’s Department of Health.

Beam, currently Wolf’s deputy chief of staff, is a graduate of the Drexel University of Law.  If confirmed by the state Senate, Ms. Beam would replace Dr. Rachel Levine, who has been nominated by President Biden to serve as Assistant Secretary of the U.S. Department of Health and Human Services.

Governor Wolf also has appointed Dr. Wendy Braund to be the state’s Interim Acting Physician General.  Dr. Levine currently serves in that capacity as well.  Dr. Braund, currently the COVID-19 response director in the state’s Department of Health, earned a master’s degree in public health from Johns Hopkins and an M.D. from the Penn State College of Medicine.

Learn more about the two nominees from this news release from the Wolf administration.

2021-01-25T06:00:23+00:00January 25th, 2021|Pennsylvania Department of Health and COVID-19|Comments Off on Wolf Makes Major Health Appointments
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COVID-19 Update: Tuesday, January 19

The following is the latest COVID-19 information from the state government as of 3:30 p.m. on Tuesday, January 19.

Office of the Governor/Vaccination Plan

The state has expanded its categories of individuals eligible to receive the COVID-19 vaccine as part of phase 1A of Pennsylvania’s vaccination plan; this change is incorporated into the Department of Health’s vaccine web page.  To introduce this policy change, the governor’s office also sent the following message to selected stakeholders:

The Pennsylvania Department of Health today will announce two additional categories of eligible individuals to receive the COVID-19 vaccination as part of Phase 1A. Beginning today, all individuals 65 and older, and individuals ages 16-64 with certain medical conditions, as defined by the Centers for Disease Control and Prevention (CDC) that increase the risk of severe illness from the virus, are eligible for the COVID-19 vaccination. The Departments’ Updated Interim Vaccine Plan can be found here.

Those conditions are outlined by the CDC here and include: Cancer; Chronic kidney disease; COPD (chronic obstructive pulmonary disease); Down Syndrome; Heart conditions such as heart failure, coronary artery disease, or cardiomyopathies; Immunocompromised state (weakened immune system) from solid organ transplant, blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines; Obesity; Severe Obesity; Pregnancy; Sickle cell disease; Smoking; and Type 2 diabetes mellitus. 

If you are part of a group that is eligible for vaccination, you can use the Pennsylvania Vaccine Provider Map to find a place to schedule your vaccine. Contact the vaccine provider of your choice directly to schedule an appointment. This map will be updated as more locations receive vaccine. Although a provider may have received vaccine, there is no guarantee that they have open appointments as supply is still very limited. Check back frequently as the map will be updated multiple times per week. 

We’ll be releasing additional information later today, including an FAQ, with more detailed information on how individuals can find a provider to schedule a vaccination. Thank you for your partnership and for all you are doing to serve Pennsylvania. 

Department of Health

President-elect Biden has nominated Pennsylvania Department of Health Secretary Rachel Levine to become assistant secretary of the U.S. Department of Health and Human Services.

Department of Health – by the numbers

  • Although the numbers remain very high, the decline in the number of new daily COVID-19 cases has generally continued since late last week.
  • The death toll remains very high, with more than 19,000 Pennsylvanians dying from COVID-19 – 18 percent of them since January 1.
  • For the week from January 8 through January 14 the state’s overall COVID-19 test positivity rate fell to 12.7 percent; it was 14.4 percent the week before that.  This marked the fourth consecutive week the rate fell.
  • Despite these positive signs, all 67 Pennsylvania counties remain in “substantial level of community transmission,” as has been the case the past several weeks, and all counties have positivity rates greater than five percent, which is the level that is considered “concerning.”
  • Four of those counties have positivity rates greater than 20 percent, down from 14 counties last week and 27 counties two weeks ago.
  • The numbers of Pennsylvanians hospitalized with COVID-19 has fallen below 5000 for the first time since early December.  The number of Pennsylvanians in hospital ICUs has fallen in the past week, as has the number on ventilators.
  • More than 21,500 health care workers in the state have contracted COVID-19.
  • More than 71,000 long-term-care facility residents and employees have contracted COVID-19 in 1521 facilities in all 67 Pennsylvania counties.
  • Currently, 18 percent of adult ICU beds in the state are unoccupied, as are 16 percent of medical/surgical beds, 16 percent of pediatric ICU beds, 32 percent of pediatric beds, and 34 percent of airborne isolation units.
  • In its “Reduction of Elective Procedures” dashboard that tracks the criteria the state is using to determine whether to order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients, the state continues to flag a growing staffing shortage in hospitals in the state’s Keystone health care coalition region (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, and York counties).  In that region, 41 percent of the region’s hospitals anticipate a staffing shortage in the coming week – more than the 33 percent level that the state believes poses a potential problem.  The overall situation in the Keystone region, however, has not reached a point where the state would direct hospitals in this region to reduce or eliminate their elective surgeries.  This situation has remained the same for the past two weeks.
  • As of January 19 the state’s vaccine dashboard shows that 340,000 COVID-19 Pennsylvanians have received their first dose of a COVID-19 vaccine and more than 42,000 Pennsylvanians have received both doses of vaccine.
  • The vaccine dashboard shows vaccine totals by county both on a map and in lists.
  • A spreadsheet of facilities that have received vaccine can be found here.
  • As ordered by the Department of Health in late 2020, health care institutions – hospitals, FQHCs, and others – must reserve 10 percent of the doses of COVID-19 vaccines they received for non-hospital health care providers.  Now, the vaccine page on the department’s web site features a map of locations where non-hospital providers can obtain vaccines.  The map includes contact information for non-hospital providers identifying whom they can contact to schedule their vaccines.  State officials say more sites will be added to this map as more doses of COVID-19 vaccine become available.
  • Every week the White House Coronavirus Task Force provides a profile to the administration with data and recommendations for each state.  Go here to see the latest (January 10) report for Pennsylvania.

Department of Human Services

  • DHS’s Office of Long-Term Living has issued a transition plan to phase out temporary changes in Pennsylvania’s OBRA 1915(c) waiver.  The Centers for Medicare & Medicaid Services (CMS) approved temporary changes in that waiver beginning March 6, 2020 in response to the COVID-19 pandemic.  These changes addressed potential staffing shortages and the need for service provision not included in approved service descriptions.  OLTL has now obtained another waiver from CMS to extend the effective date of the temporary changes, permitting some flexibilities to continue until March 5, 2021; to provide additional flexibilities for Adult Daily Living Services to be provided remotely; and for waiver services to be provided in alternate settings as approved by OLTL.  OLTL now publishes new guidance that rescinds and replaces its OBRA guidance dated May 8, 2020.  This guidance also clarifies flexibilities that remain available through March 5, 2021 or another date determined by OLTL.  See the revised guidance here and find additional information here, including a list of flexibilities that remain in effect until March 5.
  • OLTL has updated its guidance on COVID-19-related temporary changes in the state’s Act 150 program.  The Act 150 program provides assistance to adults 18 through 59 years of age who are mentally alert and have physical disabilities to perform activities of daily living.
  • HHS’s Office of Development Programs has issued updated guidance for adult daily living providers delivering services remotely or by telephone during the COVID-19 emergency.
  • HHS’s Office of Development Programs has issued guidance to supports coordination organizations, administrative entities, providers, and other interested parties regarding services included in Individual Support Plans that are effective through June 30, 2021 for individuals enrolled in the Consolidated, Community Living, Person/Family Directed Support (P/FDS), or Adult Autism waivers.

Department of State

Pennsylvania’s Department of State has issued a waiver permitting pharmacists who hold a valid Authorization to Administer Injectables to order and administer COVID-19 vaccines without the need for an order from a licensed prescriber or a protocol approved/authorized by a physician or the medical staff of an institution, subject to certain terms and conditions.  The order applies only to administering COVID-19 vaccines and expires 90 days after the termination of the governor’s declaration of the COVID-19 emergency.

Pennsylvania Health Care Cost Containment Council

PHC4 has released its initial “COVID-19 Disaster Emergency Report.”  According to the report, the state’s hospitals and health systems had $4.93 billion in COVID-19-related expenses and lost revenue from January through September 2020; this figure does reflect federal funding provided under the CARES Act and other measures.

Around the State

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

2021-01-20T06:00:14+00:00January 20th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Tuesday, January 19
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PA Hospitals Out $5 Billion From COVID-19

Pennsylvania hospitals reported a combined $5 billion in additional expenses and lost revenue associated with the COVID-19 public health emergency during the nine-month period from January through September, according to a new report from the Pennsylvania Health Care Cost Containment Council.

The report breaks down the additional costs and lost revenue as follows:

  • staffing expenses – $379 million
  • testing expenses – $81 million
  • supplies and equipment: $258 million
  • construction – $21 million
  • housing care – $500,000
  • other expenses – $88 million
  • lost revenue – $4.1 billion

These figures, the report notes, do not reflect emergency funds hospitals received through the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), or the Paycheck Protection Program and Health Care Enhancement Act.

Learn more about how COVID-19 has affected the financial performance of Pennsylvania’s hospitals in the PHC4 analysis “COVID-19 Disaster Emergency Report.”

 

2021-01-18T06:00:13+00:00January 18th, 2021|Coronavirus, COVID-19|Comments Off on PA Hospitals Out $5 Billion From COVID-19
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COVID-19 Update: Wednesday, January 13

The following is the latest COVID-19 information from the state and federal governments as of 4:30 p.m. on Wednesday, January 13.

Pennsylvania Update

The Wolf Administration

The Wolf administration has announced that the state is transitioning from the Regional Response Health Care Collaboration program (RRHC) created last year to a Long-Term Care Task Force that includes Regional Congregate Care Assistance Teams (RCATs) to continue supporting those facilities.  The ten health systems that participated in the RRHC will continue to work with the RCATs, with some previous RRHC functions to be performed by separate contractors.  The program has been allocated $12 million for January and February.  Learn more about the transition, the new program, and the contractors in this Wolf administration news release.

Governor Wolf and Secretary Levine

On Monday, January 11 Department of Health Secretary Rachel Levine held a news briefing and the following day she participated in a separate briefing led by Governor Wolf.  Highlights from the January 11 briefing:

  • As of January 11, when this briefing was held, the state has received 827,000 doses of vaccine and 285,000 of them have been administered.  This latter total may not include some administered by CVS and Walgreens, which are serving long-term-care facilities.  They take as long as 72 hours to report on how many vaccines have administered.
  • Operation Warp Speed says Pennsylvania will receive 138,000 new doses this week.
  • It will take several months before there is enough vaccine for everyone, Secretary Levine said.
  • Doses are going directly from federal sources to hospitals and other providers and those providers are often receiving them with very little advance notice.  Notification comes from Operation Warp Speed, not the state.
  • The state expects more than $100 million to help administer vaccines; this money comes from the end-of-the-year COVID-19 relief/stimulus bill.
  • The perception that the state has been slow to administer vaccines is largely a function of unrealistic projections from the federal government, especially during the holiday season, Secretary Levine said.
  • Pennsylvania is considering expanding access to vaccines to Phase 1-B individuals (seniors).
  • In response to concerns about people choosing not to be vaccinated, Secretary Levine said that the federal government needs a better plan for communicating the importance and effectiveness of the vaccines and the state will be doing the same.
  • Pennsylvanians should not expect to see the impact of vaccinations on new COVID-19 case levels for several months.
  • Secretary Levine said she has received no reports of hospitals discarding unused vaccines.
  • In response to questions about new guidance from Washington about vaccination priorities, Secretary Levine said that she and the Department of Health have not yet seen that guidance and will review it before making any changes in the state’s current approach, although she supports vaccinating additional elderly individuals when programs are in progress and there is serum available.

Highlights of the joint January 12 news briefing:

  • 311,000 vaccines have now been administered, including to more than 52,000 skilled nursing facility residents and staff.
  • Special testing is needed for the new (UK) strain of COVID-19.  Based on the genetic content of current test results, the state is directing that some samples be sent to the CDC or CDC-designated labs for further analysis to ascertain whether they are the UK strain.  The state hopes to develop the capacity to do these tests itself at its Exton lab sometime next month.
  • About two percent of Pennsylvanians have received the vaccine, Secretary Levine said.  That roughly tracks the current vaccination rate nation-wide, she said.
  • There have been no reports of people trying to jump the line to get vaccines, Secretary Levine said.
  • In response to a question, Secretary Levine said that while rural areas did not receive doses of the Pfizer vaccine because they lack facilities to store it, those areas have received, and will continue to receive, the Moderna vaccine and others as they become available.
  • The state’s partnership with rural pharmacies to administer vaccines should begin the next few weeks.

Department of Health – by the numbers

  • After several days of its highest new case counts in several weeks, the number of new COVID-19 cases reported in Pennsylvania has declined significantly in recent days.
  • The death toll remains high, however, and yesterday the state surpassed 18,000 deaths since the pandemic began.
  • For the week from January 1 through January 7 the state’s overall COVID-19 test positivity rate fell to 14.4 percent; it was 15 percent the week before that.  This marked the third consecutive week the rate fell slightly.
  • Despite this modest decline, all 67 Pennsylvania counties remain in “substantial level of community transmission,” as has been the case the past several weeks.
  • Fourteen of those counties have positivity rates greater than 20 percent, down from 27 such counties the previous week.
  • The numbers of Pennsylvanians hospitalized with COVID-19, in hospital ICUs, and on ventilators remain very high but are at their lowest levels since early December.
  • Nearly 21,000 health care workers in the state have contracted COVID-19.
  • More than 68,000 long-term-care facility residents and employees have contracted COVID-19 in 1500 facilities in all 67 Pennsylvania counties.
  • Currently, 16 percent of adult ICU beds in the state are unoccupied, as are 14 percent of medical/surgical beds, 14 percent of pediatric ICU beds 28 percent of pediatric beds, and 32 percent of airborne isolation units.
  • In its “Reduction of Elective Procedures” dashboard that tracks the criteria the state is using to determine whether to order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients, the state continues to flag a growing staffing shortage in hospitals in the state’s Keystone health care coalition region (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, and York counties).  In that region, 41 percent of the region’s hospitals anticipate a staffing shortage in the coming week – more than the 33 percent level that the state believes poses a potential problem.  The overall situation in the Keystone region, however, has not reached a point where the state would direct hospitals in this region to reduce or eliminate their elective surgeries.
  • As of January 13 the state’s vaccine dashboard shows that 300,000 COVID-19 vaccines have been administered so far and more than 42,000 Pennsylvanians have received both doses of vaccine.
  • The vaccine dashboard shows vaccine totals by county both on a map and in lists.
  • As ordered by the Department of Health in late 2020, health care institutions – hospitals, FQHCs, and others – must reserve 10 percent of the doses of COVID-19 vaccines they received for non-hospital health care providers.  Now, the vaccine page on the department’s web site features a map of locations where non-hospital providers can obtain vaccines.  The map includes contact information for non-hospital providers identifying whom they can contact to schedule their vaccines.  State officials say more sites will be added to this map as more doses of COVID-19 vaccine become available.
  • Every week the White House Coronavirus Task Force provides a profile to the administration with data and recommendations for each state.  Go here to see the latest (January 3) report for Pennsylvania.

Department of Human Services

DHS’s Office of Long-Term Living has issued vaccination information for its home and community-based providers.

House Chamber of the State HouseGeneral Assembly

  • House Bill 55 was favorably reported from the State Government Committee earlier today. This legislation would amend Pennsylvania’s constitution to limit gubernatorial emergency declarations to no more than 21 days unless the General Assembly agrees to extend it in whole or part.  In addition, once a disaster emergency expires, the governor would not be able to declare a new one based on “the same or substantially similar facts” without approval from the General Assembly.  Further, the bill would clarify that the General Assembly, through a concurrent resolution, could vote to terminate a disaster declaration without having to present it to the governor.  Similar legislation was passed by both chambers in the previous legislative session.  If it is passed by both chambers this session, it could be placed on the ballot as early as this spring for voter approval.

Around the State

Federal Update

Provider Relief Fund

  • HHS has updated its Provider Relief Fund FAQ with nine new or modified questions on pages 12-13, 13, 15 (three questions), 40-41, 41, and 56.  The new and modified questions address
    • how changes of ownership affect providers’ ability to receive Provider Relief Fund grants and nursing home quality incentive payments;
    • answer questions about audit deadlines and extensions;
    • and describe the methodology for calculating Phase 3 distributions and the timing and size of those distributions.

Providers that have received past distributions and that believe they are eligible for Phase 3 distributions should review the updated FAQ carefully.

Department of Defense

  • The Department of Defense, which is playing a leading role in the distribution of COVID-19 vaccines, has posted a brief document titled “Officials Discuss COVID-19 Vaccine Deliveries and Prioritization Criteria.”  The document outlines the status of vaccine distribution efforts to date, offers data on the number of vaccines that have been distributed and administered, and notes the expansion of vaccine administration to individuals beyond those considered to be the highest priority for receiving vaccines.

Department of Health and Human Services

Centers for Medicare & Medicaid Services

CMS COVID-19 Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Calls

Tuesday, February 2  at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  4956655

Audio Webcast link:  go here.

Tuesday, February 23 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2528725

Audio Webcast link:  go here.

Centers for Disease Control and Prevention

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

2021-01-14T09:52:50+00:00January 14th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Wednesday, January 13
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COVID-19 Update: Friday, January 8

The following is the latest COVID-19 information from the state government as 2:00 p.m. on Friday, January 8.

Department of Health

Department of Health – by the numbers

  • Pennsylvania’s daily new case count generally remains at the high level it has been since mid-December but today was the state’s worst day since December 12.  Yesterday the state’s total number of COVID-19 cases since the pandemic began surpassed 700,000.
  • Yesterday the state’s overall death toll since the pandemic began passed 17,000.
  • The numbers of Pennsylvanians hospitalized with COVID-19, in hospital ICUs, and on ventilators remain very high but are at their lowest levels since early December.
  • More than 20,000 health care workers in the state have contracted COVID-19.
  • More than 66,000 long-term-care facility residents and employees have contracted COVID-19 in 1491 facilities in all 67 Pennsylvania counties.
  • Currently, 13 percent of adult ICU beds in the state are unoccupied, as are 13 percent of medical/surgical beds, 16 percent of pediatric ICU beds, 23 percent of pediatric beds, and 30 percent of airborne isolation units.  The proportion of unoccupied medical/surgical beds, pediatric ICU beds, and pediatric beds has declined considerably over the past three days.
  • In its “Reduction of Elective Procedures” dashboard that tracks the criteria the state is using to determine whether to order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients, the state has flagged a growing staffing shortage in hospitals in the state’s Keystone health care coalition region (Adams, Bedford, Blair, Centre, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, and York counties).  In that region, 41 percent of the region’s hospitals anticipate a staffing shortage in the coming week – more than the 33 percent level that the state identifies as a potential problem.  The overall situation in the Keystone region, however, has not reached a point where the state would direct hospitals in this region to reduce or eliminate their elective surgeries.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

2021-01-11T06:00:05+00:00January 11th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Friday, January 8
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COVID-19 Update: Tuesday, January 5, 2021

The following is the latest COVID-19 information from the state government as 2:00 p.m. on Tuesday, January 5.

Secretary Levine’s News Briefing

Department of Health Secretary Rachel Levine briefed the press yesterday about the state of Pennsylvania’s response to the COVID-19 crisis and took questions from reporters.  Among the highlights of her briefing are the following points:

  • Secretary Levine discussed the new state policy that hospitals that receive shipments of vaccine doses must set aside 10 percent of their supply to vaccinate non-hospital health care workers, such as EMS personnel.  This policy takes effect on Wednesday, January 6.  Every hospital that has receive doses must designate a contact whom non-hospital health care workers can contact to schedule their vaccinations.
  • Within their own organizations, hospitals should give priority to vaccinating frontline health care workers, beginning with those who come into contact with patients who have been diagnosed with or are suspected of having COVID-19.
  • Pennsylvania expects 166,000 doses of Pfizer vaccine this week.  99,000 will be for second doses to health care workers who already received the first dose; 32,000 will be for first doses for additional health care workers; and 39,000 will be for vaccinations at skilled nursing facilities.
  • The state also will receive 80,000 doses of the Moderna vaccine this week.
  • The number of vaccine doses the state receives from the federal government will fluctuate from week to week so the delivery schedule will fluctuate as well.
  • CVS and Walgreens have started to visit long-term-care facilities to administer vaccines.  The state is waiting for a report from the companies on which facilities they visited and how many vaccines they gave.
  • The slow roll-out of the vaccines nation-wide, Secretary Levine says, is the product of overly optimistic projections for the holiday season.
  • It will take months for all Pennsylvanians to be vaccinated.
  • Providers and the state will need to hire additional health care professionals to administer vaccines.  The additional funding provided by Congress at the end of last year should help with this.
  • When the time comes, the state will have ways for people to sign up for appointments to receive their vaccines.  It does not want people waiting in long lines to get their shots.
  • While the state has received reports of health care workers and long-term-care personnel declining to get vaccinated, it has no numbers on how prevalent this has been.

Department of Health

Department of Health – by the numbers

  • Pennsylvania continues to experience between 7000 and 9000 new COVID-19 cases a day, as it generally has since mid-December.  The overall total of cases in the state now approaches 675,000 since the pandemic began.
  • Daily death toll figures generally have ranged between 200 and 300 a day since mid-December but have declined in recent days.  The total death count rose past 16,500 today.
  • The number of Pennsylvanians hospitalized with COVID-19 has been fairly constant since Christmas, as has the number of COVID-19 patients in hospital ICUs.  The number of COVID-19 patients on ventilators has declined modestly from its pre-Christmas high.
  • More than 19,700 health care workers in the state have contracted COVID-19.
  • Nearly 65,000 long-term-care facility residents and employees have contracted COVID-19 in 1479 facilities in all 67 Pennsylvania counties.
  • Currently, 13 percent of adult ICU beds in the state are unoccupied, as are 14 percent of medical/surgical beds, 21 percent of pediatric ICU beds, 34 percent of pediatric beds, and 30 percent of airborne isolation units.
  • The weekly Pennsylvania COVID-19 Early Warning Monitoring Dashboard, issued by the Department of Health and Governor Wolf, shows that the state’s positivity rate for COVID-19 tests fell from 15.1 percent two weeks ago to 15 percent last week.  This is the third consecutive week the rate has declined.
  • Despite this, all 67 Pennsylvania counties remain, according to Pennsylvania’s criteria, in “substantial transmission status.”
  • Every county in the state has a positivity rate greater than five percent, which is generally considered a “concern,” and 21 of the state’s 67 counties have positivity rates of more than 20 percent.
  • The state also reports that it has experienced a “…significant decrease” in people willing to cooperate with contract tracing investigations.
  • The Department of Health’s “COVID-19 Data for Pennsylvania” web page has several features of potential interest to health care providers and stakeholders.
    • Its “Reduction of Elective Procedures” dashboard tracks the criteria the state is using – staffing, surge percentage, and bed availability – to determine whether it will order hospitals to reduce or eliminate elective procedures to ensure their ability to handle possible influxes of COVID-19 patients.  Organized according to the state’s seven health coalition regions, the latest dashboard shows only one potential problem area:  staffing shortages among southwestern Pennsylvania hospitals.  Despite this, the dashboard shows no need for hospitals in any part of the state to curtail or suspend elective procedures at this time.
    • Another feature on the COVID-19 Data for Pennsylvania page is a “Vaccine Dashboard” that shows the number of vaccines administered in the state on a county-by-county basis.  As of January 4, more than 135,000 vaccines have been administered.  These vaccines are all categorized as “partial” because complete vaccination requires two doses and not the one dose that has been administered so far.

Department of Human Services

Department of Revenue

Pennsylvania collected $3.7 billion in General Fund revenue in December, which was $465.8 million, or 14.5 percent, more than anticipated, Revenue Secretary Dan Hassell reported on Monday. Fiscal year-to-date General Fund collections total $18.5 billion, which is $467.1 million, or 2.6 percent, above estimate.

Around the State

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

 

 

2021-01-06T06:00:47+00:00January 6th, 2021|Coronavirus, COVID-19|Comments Off on COVID-19 Update: Tuesday, January 5, 2021
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  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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