Federal Medicaid issues Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for June 16

The following is an update of selected state health policy developments in Pennsylvania from June 12 – 16. (Some of the language used below is taken directly from state documents.)

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

U.S. Health & Human Services (HHS) Secretary Xavier Becerra has sent a letter to governors urging states to adopt all options that HHS has offered to help eligible individuals and families maintain their health coverage during the redetermination process and leverage all partners to support individuals and families to complete renewal forms.

Governor Shapiro

Governor Shapiro signed House Bill 739 (Act 2 of 2023) into law on Wednesday. Act 2 creates new cyber security-related requirements for health insurers and allows the Insurance Commissioner to adopt National Association of Insurance Commissioners (NAIC) Valuation Manual exemptions by notice in the Pennsylvania Bulletin.

General Assembly

The state House returned to Harrisburg for voting session Monday, June 12. The following are selected health-related proceedings.

The House Insurance Committee held a voting meeting Monday, June 12 at 11:00am to consider HB 1050, requiring health insurers to cover preventive health care services without cost-sharing. The bill was reported as amended. A recording of the meeting can be viewed here. The Insurance Committee was expected reconvene on Wednesday, June 14 to consider HB 1140; however, the meeting was cancelled.

The House Health Committee held a voting meeting Wednesday, June 14 to consider the following bills:
- HB 78, establishing the Medical Debt Relief Program. The bill was reported as amended by a vote of 18-3.
- HB 807, providing for perimenopause and menopause education. The bill was reported as committed by a vote of 20-1.
- HB 817, amends the Pharmacy Act to provide education on drug take back programs. The bill was reported as committed by a vote of 20-1
- HB 818, creates the Pharmaceutical Collection Sites Educational Program within the Department of State. The bill was reported as amended by a vote of 18-2.
- HB 1209 and HB 1407, add two enforcement mechanisms to the Tobacco Product Manufacturer Directory Act and the Tobacco Settlement Agreement Act, which resolved legal claims between the commonwealth and participating manufacturers relating to health care costs for treating smoking-related illnesses. The bills were unanimously reported as committed.
- HB 1351, which makes changes to the Pennsylvania Rural Health Redesign Center Authority (RHRCA) Act, including financing of the authority and board membership.
- SB 262, amends the Maternal Mortality Review Act to would add “severe maternal morbidity” to the list of reportable events within the Pennsylvania Department of Health. The bill was unanimously reported as committed.

A recording of the meeting can be viewed here.

The Senate will return to Harrisburg Monday, June 19 and the House will return Tuesday, June 20 for voting session. The following are selected health-related proceedings.

The Senate Health & Human Services Committee will hold a voting meeting on Tuesday, June 20 at 10:30 a.m. to consider the following bills.
- SB 683, which require an acute-care hospital to include testing for fentanyl if the hospital conducts a urine drug screening to assist in the diagnosis of a patient’s condition.
- SB 768, which makes changes to the Pennsylvania Rural Health Redesign Center Authority (RHRCA) Act, including financing of the authority and board membership.
- SB 817, which creates a primary care workforce initiative for our Federally Qualified Health Centers (FQHCs).

Immediately following, the Senate Health & Human Services Committee will hold a public hearing to consider the nomination of Dr. Latika Davis-Jones for Secretary of the Department of Drug and Alcohol Programs (DDAP).

Both meetings will be held in Room 8E-A East Wing and will be live streamed here.

Department of Health

The Department of Health (DOH) has issued a Health Advisory (2023 – PAHAN – 704) notifying providers of an anticipated increase in Legionellosis cases due to seasonality.

Department of Human Services

The Department of Human Services (DHS) has shared the agenda for the June 22 Medical Assistance Advisory Committee (MAAC) meeting. In advance of the meeting, DHS has also shared the public input it received regarding the Drug Utilization Review (DUR) Board prior authorization guideline briefing documents discussed at the May 25 meeting.

DHS has issued a Medical Assistance Bulletin informing providers the department has rescinded the statement of policy codified at § 1101.51a, which clarified the term “within a provider’s office” and updated the process for the enrollment or revalidation of providers that are in co-located arrangements. Effective January 14, 2023, providers who are in co-location arrangements no longer need to complete the attestation form during enrollment or revalidation in the MA Program.

The Executive Board approved a reorganization of DHS. Additional information and a revised organizational chart is available in this Pennsylvania Bulletin notice.

DHS has announced the addition of a procedure code to the Medical Assistance (MA) Program Fee Schedule for the administration of an additional bivalent dose of the COVID-19 vaccine manufactured by Pfizer, Inc. The effective date and MA Fee for the code is indicated in this Pennsylvania Bulletin notice.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has issued Licensing Alert 04-2023 to provide clarification on how to calculate client to counselor ratios for inpatient, non-hospital treatment and rehabilitation facilities for regulatory compliance.

Department of Aging

The Department of Aging held its first regional town hall in southeastern Pennsylvania to seek input on Pennsylvania’s Master Plan for Older Adults, which will be a 10-year, state-led strategic plan designed to transform the infrastructure and coordination of services for older Pennsylvanians. Governor Shapiro’s executive order directing the department to develop the plan is available here.

Stakeholder Events

DHS – Medical Assistance Advisory Committee Meeting – June 22

The Medical Assistance Advisory Committee (MAAC) will meet on June 22, 2023 at 10:00 a.m. Individuals interested in participating may register here.

DOH – Medical Marijuana Advisory Board – June 28

The Medical Marijuana Advisory Board will meet on June 28 from 10:30 a.m. to 12:30 p.m. to discuss Medical Marijuana Program updates. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PID – 1332 Waiver Reinsurance Program Public Forum – June 28

The Pennsylvania Insurance Department (PID) has announced it is accepting public comment on its 1332 State Innovation Waiver Reinsurance Program beginning June 1 and ending June 30. PID will also hold an in-person forum for public comment on Thursday, June 28 from 1:00 p.m. to 2:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-06-17T00:10:13+00:00June 16th, 2023|Federal Medicaid issues, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for May 5

The following is an update of selected state health policy developments in Pennsylvania from May 1 – 5. (Some of the language used below is taken directly from state documents.)

Medicaid Eligibility Redetermination

The Department of Human Services (DHS) published the first section of an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code.

Additional updates and resources about the Medicaid eligibility renewal process may be found here.

Governor Shapiro

Governor Shapiro signed the first bill of his administration on Monday. Act 1, formerly Senate Bill 8, requires insurers to cover all costs associated with 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, and also requires insurers to cover all costs associated with a supplemental breast screening by MRI or Ultrasound for women at increased risk of breast cancer. View this press release for additional information.

The Shapiro administration announced today that all commonwealth agencies completed a comprehensive review of their respective licensing, certification, and permitting processes as directed in the governor’s January 31 executive order. The administration will now work to establish “efficient processing times” for all permits and licenses.

General Assembly

The state House and Senate returned to Harrisburg on May 1 for voting session. Below is coverage of selected health-related proceedings.

- The House Health Committee held a public hearing Tuesday, May 2 on HB 106, the Patient Safety Act, which sets nursing staffing ratios. A recording of the hearing can be viewed here.

- Representative Jennifer O’Mara (D-Delaware), Representative Eddie Day Pashinski (D-Luzerne) and Senator Carolyn Comitta (D-Chester) held a press conference Wednesday on hospital closure reform. More information can be found here.

- The House Republican Policy Committee held a public hearing Thursday, May 4 on hospital pricing transparency. A recording of the hearing can be viewed here.

- The Senate voted to confirm Governor Josh Shapiro’s nominee for the Secretary of Aging, Jason Kavulich, this week. A recording of the confirmation hearing in the Senate Aging and Youth Committee can be viewed here.

- The Senate Health and Human Services Committee held a voting meeting on Tuesday, May 2 to consider among other bills:
  - SB 100, Establishing the Lyme Disease and Related Tick-Borne Illness Diagnosis and Treatment Act. The bill was unanimously reported as committed.
  - SB 262, Amends the Maternal Mortality Review Committee Act regarding reportable events. The bill was unanimously reported as committed.
  - SB 414, Expanding access to Sexual Assault Nurse Examiners (SANE). The bill was unanimously reported as committed.
  - SB 500, Provides for Medicaid Coverage for Pasteurized Donor Human Milk. The bill was unanimously reported as committed.
  - SB 549, Requires consent for pelvic, rectal, and prostate exams. The bill was unanimously reported as amended.
  - SB 555, Reducing the loaded mileage requirements for EMS Medicaid reimbursement. The bill was unanimously reported as committed.

A recording of the meeting can be viewed here.

The state Senate will return to Harrisburg for voting session Monday, May 8. The state House is recessed and will return to Harrisburg for voting session Monday, May 22. The following are selected health-related proceedings.

- The House Aging and Older Adult Services Committee will hold an information meeting Wednesday, May 10 at 10:00am to receive updates from local Area Agencies on Aging and to discuss scams targeting older adults. The meeting will be held in Room G-50 of the Irvis Office Building and will be livestreamed here.

Office of the Attorney General

Attorney General Michelle Henry issued the following Frequently Asked Questions (FAQ) document regarding medication abortion and mifepristone access in Pennsylvania.

Department of Health

The Department of Health’s (DOH) Division of Newborn Screening and Genetics, with support of the Newborn Screening and Follow-up Technical Advisory Board, is proposing that Guanidinoacetate Methyltransferase (GAMT) deficiency screening be added effective January 1, 2024 to the supplemental conditions mandated for screening. Additional information can be viewed in this Pennsylvania Bulletin notice.

Department of Human Services

The Department of Human Services (DHS) has announced its intent to increase the funding and amend the payment methodology for the COVID-19 disproportionate share hospital (DSH) payments for qualifying acute care general hospitals for FY 2022-23. Learn more from this Pennsylvania Bulletin notice.

DHS published final notice of its intent to allocate funding and amend the qualifying criteria and payment methodology allocation for DSH payments to acute-care general hospital trauma centers. These payments will amount to $18.034 million in total funds. Learn more from this Pennsylvania Bulletin notice.

DHS published final notice of its funding allocation for FY 2022-23 supplemental payments to promote the continuation of quality medical services to individuals enrolled in the Pennsylvania Medical Assistance (MA) Program, and to provide financial relief to hospitals during the COVID-19 pandemic. Learn more from this Pennsylvania Bulletin notice.

DHS published updates to the Medical Assistance (MA) Program Fee Schedule for administration of a booster dose of the SARS-CoV-2 vaccine manufactured by Novavax. Learn more from this Pennsylvania Bulletin notice.

DHS has announced the temporary extension of the Alternative Payment Methodology (APM) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) for the administration of COVID-19 vaccines administered during a COVID-19 vaccine-only visit. The APM will be extended beyond the end of the federal PHE to September 30, 2024. Learn more from this Pennsylvania Bulletin notice.

The Office of Mental Health and Substance Abuse Services (OMHSAS) shared a notice issued by the U.S. Department of Health and Human Services’ Office of Civil Rights (OCR) informing stakeholders there will be a 90-day transition period following the conclusion of the federal PHE for covered health care providers to come into compliance with HIPAA rules for telehealth. The transition period will be in effect from May 12, 2023 to 11:59 p.m. on August 9, 2023.

DHS has issued an updated Provider Quick Tip (#263) regarding the electronic submission process in the PROMISe Portal for Office of Medical Assistance Fee-for-Service (FFS) and Office of Long Term Living (OLTL) 180-day exception requests and other claims requiring documentation.

DHS issued a corrected April Medical Assistance Bulletin (MAB) list. A prior version was shared with the Medical Assistance Advisory Committee (MAAC) at its April 27 meeting.

Revenue Collection Update

The Department of Revenue announced Pennsylvania collected $5.7 billion in General Fund revenue in April, which was $51.1 million, or 0.9 percent, more than anticipated. Fiscal year-to-date General Fund collections total $37.9 billion, which is $1.2 billion, or 3.3 percent, above estimate.

Stakeholder Events

DOH – WIC Advisory Board – May 10

The WIC Program Advisory will meet on May 10 from 1:00 p.m. – 2:00 p.m. Additional information and details on how to participate can be viewed in this Pennsylvania Bulletin notice.

DHS – Managed Long-Term Services and Supports Subcommittee – May 12

The Managed Long-Term Services and Supports (MLTSS) Subcommittee will hold a meeting on Friday, May 12 from 10:00 a.m. – 1:00 p.m. in the Department of Education Building’s Honors Suite, 1st floor, at 333 Market Street in Harrisburg, or via webinar. You may register for the webinar here.

DOH – HIV Community Prevention Planning Committee – May 18

The Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will hold a public meeting on Wednesday, May 17 and Thursday, May 18. For information on how to participate, review this Pennsylvania Bulletin notice.

DHS – Medical Assistance Consumer Subcommittee – May 24

The Consumer Subcommittee of the Medical Assistance Advisory Committee is scheduled to meet on Wednesday, May 24 at 1:00 pm. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – May 25

The Medical Assistance Advisory Committee is scheduled to meet on Thursday, May 25 at 10:00 a.m. Go here to register to participate.

PA Safety Net Admin2023-05-05T21:19:20+00:00May 5th, 2023|Federal Medicaid issues, Medicaid Eligibility Redetermination , Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medical Assistance|Comments Off

PA Health Policy Update for March 17

The following is an update of selected state health policy developments in Pennsylvania from March 11 to March 17. (Some of the language used below is taken directly from state documents.)

General Assembly

The General Assembly will begin hearings examining Governor Shapiro’s FY 2023-24 budget proposal next week. A complete schedule for the House Appropriations Committee can be viewed here and a complete schedule for the Senate Appropriations Committee can be found here. The following are the schedules for the Department of Health and the Department of Human Services budget hearings.
- Tuesday, March 28: Department of Health – House Appropriations Committee
- Tuesday, April 11: Department of Human Services – House Appropriations Committee
- Wednesday, April 12: Department of Human Services – Senate Appropriations Committee
- Thursday, April 13: Department of Health – Senate Appropriations Committee

The House and Senate are currently recessed. They will return to Harrisburg on Monday, April 24 following the conclusion of budget hearings.

Department of Health

The federal Centers for Medicare & Medicaid Services has informed the Department of Health that the approved CMS waiver extending the deadline for temporary nurse aides to complete required examinations is in effect until May 11, 2023. Learn more about the implications of the expiration of this waiver and how nurse aide candidates can continue to work while pursuing certification from this Department of Health notice.

The Department of Health’s Medical Marijuana Advisory Board will add chronic hepatitis C as a qualifying serious medical condition for medical marijuana use in Pennsylvania. Learn more from this Pennsylvania Bulletin notice.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania fell 19 percent last week after a similar 19 percent decline last week and 17 percent the previous week. The number of daily deaths is holding steady.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 fell 14 percent last week after a 16 percent decline the previous week and a nine percent decline the week before that. The number of COVID-19 patients on ventilators and in hospital ICUs held steady over the past two weeks.
The CDC reports a 10 percent decline in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19 after an 18 percent decline the previous week and a 13 percent decline the week before that.
For the week ending March 15, 24 Pennsylvania counties experienced a moderate rate of community transmission of COVID-19; 20 counties experienced a substantial rate of community transmission; and the remaining 33 counties experienced a high rate of community transmission.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – March 22

The consumer subcommittee of the Medical Assistance Advisory Committee will meet virtually on Wednesday March 22 at 1:00. Go here to register to participate.

March 22 – Medicaid and CHIP Continuous Enrollment Unwinding Webinar – March 22

CMS will hold a webinar on the unwinding of Medicaid and CHIP continuous enrollment and what providers need to know and how to prepare for that unwinding on Wednesday, March 22 at noon (eastern). During the webinar, CMS officials will review recently released CMS unwinding resources to help partners with their outreach efforts and respond to questions about Medicaid renewals and terminations, Medicaid to marketplace transitions, Medicaid to Medicare transitions, communication and outreach strategies, and more. Go here to register to participate. CMS will offer the same webinar on April 26, May 24, and June 28. Go here and scroll down for materials from previous webinars on Medicaid unwinding.

DHS – Medical Assistance Advisory Committee – March 23

The Medical Assistance Advisory Committee will hold its next public meeting virtually on Thursday, March 23 at 10:00. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee Meeting April 5

The Medical Assistance Advisory Committee’s managed long-term services and support subcommittee will hold a public meeting on Wednesday, April 5 at 10:00 in Harrisburg. For information about how to join the meeting in person or participate remotely, see this DHS notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria. The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies. The program will be held on May 16 at 8:30. Continuing education credits are available. Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice. Please note that this program is identical to one offered on March 9.

jsteinbock2023-03-17T19:46:43+00:00March 17th, 2023|COVID-19, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2024 budget|Comments Off

PA Faces Major Challenge Reviewing Medicaid Eligibility

As many as 30 percent of Pennsylvanians currently on the state’s Medicaid rolls may soon become ineligible for the program, according to a new report.

When the COVID-19 pandemic began, Congress temporarily expanded Medicaid eligibility and directed additional money to states for their Medicaid programs. The catch? Once deemed eligible, participating states were prohibited from dropping those Medicaid participants from their programs for the duration of the public health emergency.

Health Benefits Claim Form That continuous Medicaid eligibility, however, will end on April 1 and states have one year to redetermine Medicaid eligibility for everyone currently enrolled in the program. In Pennsylvania, the state estimates that nearly 600,000 of the 3.6 million people now participating in the program will lose their eligibility and another nearly 600,000 may be in danger of doing so.

The implications of reduced Medicaid enrollment for the state’s safety-net hospitals are serious: hundreds of thousands of people who have health insurance today may soon be without health insurance but will continue turning to hospitals – and especially, to safety-net hospitals – for care.

Learn more about the challenge Pennsylvania faces today and how the state plans to address it from the AP article “Resuming Medicaid case checks confronts 3.6M in Pennsylvania.”

jsteinbock2023-02-15T22:31:50+00:00February 16th, 2023|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19|Comments Off

PA Health Policy Update for January 13

The following is an update of selected state health policy developments in Pennsylvania from January 7-13. (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-Elect Josh Shapiro announced the nomination of several cabinet-level officials this week, including Dr. Valerie Arkoosh as Secretary of the Department of Human Services, Dr. Debra Bogen as Secretary of the Department of Health, Dr. Latika Davis-Jones as Secretary of the Department of Drug and Alcohol Programs, Mr. Jason Kavulich as Secretary of the Department of Aging, and Mr. Michael Humphreys as Insurance Commissioner. All of these nominees are subject to confirmation by the state Senate. Find additional information about the health-related agency nominees’ respective backgrounds here and a complete list of the Shapiro-Davis administration appointments made to date here.

Governor-Elect Josh Shapiro and Lieutenant Governor-Elect Austin Davis will be sworn into office next Tuesday, January 17 at 12:00 p.m.

General Assembly

The state House and Senate both convened this week for a special session to consider a constitutional amendment extending the statute of limitations for victims of sexual abuse to file civil claims. The Senate passed Senate Bill 1 by a vote of 28-20; the bill includes three proposed constitutional amendments. In addition to extending the statute of limitations, Senate Bill 1 also requires voters to present a valid form of ID before voting in an election and prevents the governor from vetoing the General Assembly’s disapproval of a regulation. After convening on Monday, the House recessed without agreement. Speaker Rozzi subsequently appointed a committee of six House members (three Republicans and three Democrats) to negotiate a path forward.

The state Senate is scheduled to return to session Tuesday, January 17 at 10:00 a.m.

Department of Human Services

The Department of Human Services (DHS) has updated its web page addressing the unwinding of continuous Medicaid and CHIP eligibility established by the Families First Coronavirus Response Act to reflect federal legislation that will launch a path toward bringing that continuous eligibility to an end: specifically, the federal Consolidated Appropriations Act of 2023 set April 1, 2023 as the end of continuous coverage for Medical Assistance and CHIP. After April 1, DHS will return to normal eligibility processes. This means that all Medical Assistance and CHIP recipients must complete an annual renewal to see if they are still eligible for coverage. Learn more from DHS’s web page addressing the unwinding of continuous Medicaid and CHIP eligibility.
DHS will hold a COMPASS Community Partner technical assistance call on Tuesday, January 24 at 1:00 that may address this subject, among other matters. Go here to register (the registration deadline is January 17) and to submit questions to be addressed during the meeting.
DHS has published a co-location regulatory change that has been under development since 2021. The purpose of change is to eliminate a prohibition against providers leasing or renting space, shelves, or equipment within a provider’s office to another provider or from allowing the paid or unpaid staff of a provider to be placed in another provider’s office. As the published announcement explains, “Developments in the health care industry have emphasized the need for integrated health care. The Department recognizes the benefits of integrated care and deletes this subsection to support the enrollment in the Medical Assistance (MA) Program of providers that share space (co-locating providers). By expanding provider qualifications to include co-locating providers, the Department seeks to support more coordinated and integrated care within the MA Program.” Learn more from this Pennsylvania Bulletin notice.
DHS has released quarterly licensing and enforcement activity data for its five licensing offices that oversee providers of long-term care, child care, behavioral health care, day activity programs, and residential care for individuals with intellectual disabilities and autism. Learn more about the outcome of these licensing and enforcement efforts from this DHS news release.

Centers for Medicare & Medicaid Services

CMS has shared a presentation with states addressing how they can work with Medicaid managed care plans to review the eligibility of current Medicaid beneficiaries once the continuous eligibility requirement for current Medicaid participants ends on April 1. Learn more from the CMS presentation “Strategic Approaches to Engaging Managed Care Plans to Maximize Continuity of Coverage as States Resume Normal Eligibility and Enrollment Operations.”

Department of Health

The Department of Health (DOH) has issued a health advisory informing providers that as of January 1 it has introduced a new surveillance case definition for multisystem inflammatory syndrome in children (MIS-C) for reporting cases of MIS-C. Providers are required to report cases that meet the new criteria to their local health department. Learn more from this health advisory.

DOH and Berks County will be the nation’s first to test a new federal COVID-19 Home Test to Treat Pilot Program run by the National Institute of Health (NIH) and HHS’s Administration for Strategic Preparedness and Response (ASPR). Learn more about the program from this DOH news release.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania declined slightly over the past week but the number of new daily deaths rose nearly 50 percent over the high end of the death rate in recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined nearly 11 percent over the past week; the number on a ventilator because of the virus fell 20 percent; and the number in hospital ICUs held steady.
The CDC reports a five percent decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
As of January 11, four Pennsylvania counties – Forest, McKean, Potter, and Sullivan – are experiencing a low rate of community transmission of COVID-19; nine counties are experiencing a substantial rate of community transmission; and the remaining 54 counties are experiencing high rates of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs (DDAP) has removed a number of inactive bulletins that were formerly listed in its Publications Library because the information contained in them has been superseded by changes in regulation, legislation, subsequent editions of DDAP’s manuals, or the end of an executive order. Policy and information bulletins currently listed on DDAP’s Publications page are still considered active. The information contained in several of the removed bulletins is still relevant under other current active policy bulletins or has been clarified in active licensing alerts. The policy bulletins that have been removed are:

Information bulletins that have been removed are:

DDAP has announced the availability of more than $4 million in grant funding for the establishment of regional recovery hubs to enhance recovery supports and promote recovery within communities across Pennsylvania. Grants of up to $500,000 each will be awarded to department-licensed treatment providers that are non-profit organizations for a 15-month period beginning July 1, 2023 through September 29, 2024. Learn more about the purpose of the grants and how to apply for them from this department news release; this grant funding notice; and this department guide to submitting grant requests. The deadline for submitting applications is February 24.
DDAP has announced a grant funding program “Services to BIPOC Communities” for organizations to establish or expand substance use disorder services, community outreach, and education to Black, Indigenous, and People of Color (BIPOC) communities. The program will award $4 billion in grants, with individual grants ranging up to $400,000 each for one year. Learn more about the grant program, eligibility criteria, and more from this DDAP notice and more about DDAP competitive grant processes here. The deadline for applications is March 10.

Stakeholder Events

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – January 18

The Department of Health’s Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will hold a public meeting on Wednesday, January 18 at 9:00. Interested parties may attend in person or virtually. Learn more about the committee, where the meeting will be held, and how to participate virtually from this Pennsylvania Bulletin notice.

Department of Health – Renal Disease Advisory Committee – January 20

The Department of Health’s Renal Disease Advisory Committee will meet in Harrisburg on Friday, January 20 at 10:00. To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Department of Human Services – COMPASS Community Partner Technical Assistance Call – January 24

DHS will hold a COMPASS Community Partner technical assistance call on Tuesday, January 24 at 1:00. Go here to register (the registration deadline is January 17) and to submit questions to be addressed during the meeting.

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00. Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, January 26 at 10:00. To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – January 26

The Patient Safety Authority will meet virtually on Thursday, January 26 at 1:00. For information about how to participate in this meeting, see this Pennsylvania Bulletin notice. Registration is required.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30. For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00. Interested parties may attend in person or virtually. Go here for further information about the meeting, its location, and how to participate virtually.

jsteinbock2023-01-13T20:52:23+00:00January 13th, 2023|COVID-19, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for January 6

The following is an update of selected state health policy developments in Pennsylvania from December 23 through January 6. (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Josh Shapiro announced the appointment of his first cabinet-level officials this week, including Akbar Hossain, who will serve as Secretary of Policy and Planning, and Mike Vereb, who will be Secretary of Legislative Affairs. Hossain is currently the transition team’s executive director and prior to that served as the Shapiro campaign’s policy director. Vereb, a long-time advisor to Shapiro, previously worked as legislative affairs director for the Office of the Attorney General. Governor-elect Shapiro also announced the appointment of his deputy chiefs of staff. Lindsey Mauldin, who currently works for Planned Parenthood Pennsylvania, will be Deputy Chief of Staff for Health and Human Services. Prior to joining Planned Parenthood, Mauldin coordinated Pennsylvania’s COVID-19 pandemic response efforts. A complete list of the Shapiro-Davis administration appointments made to date may be viewed here.

General Assembly

The General Assembly convened on Tuesday, January 3 to swear in members of the House and Senate and the respective chambers’ presiding officers. The Senate made history by electing Senator Kim Ward (R-Westmoreland) President Pro Tempore; she is the first woman to hold the position. Senator Ward also was sworn in as Lieutenant Governor, a position she will hold until Lieutenant Governor-Elect Austin Davis is sworn in on January 17. After what appeared to be an impasse choosing a Speaker of the state House, Representative Mark Rozzi (D-Berks) was elected by a vote of 115 to 85 to serve as Speaker. Sixteen Republicans joined Democrats in voting for Rozzi, who committed to being an independent Speaker and not to caucus with either party.

Revenue Collection Update

The Department of Revenue has released its monthly revenue update for December. General Fund revenue collections were $319.9 million, or 8.6 percent, above estimate for the month. Fiscal year-to-date General Fund collections total $19.7 billion, which is $503.1 million, or 2.6 percent, above estimate.

Centers for Medicare & Medicaid Services

CMS has issued guidance on a way for states to address unmet health-related social needs for Medicaid beneficiaries. This option will help states offer alternative benefits, such as housing and nutrition assistance, through the use of a service or setting that is provided to an enrollee in lieu of a service or setting covered under their state’s Medicaid plan to address a range of unmet health-related social needs to help enrollees maintain their coverage and improve their health outcomes. Learn more from this CMS news release and this letter from CMS to state Medicaid directors.
CMS has issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. For the first time, state Medicaid and CHIP programs will be able to pay specialists directly when a beneficiary’s primary health care provider asks for advice. For example, if a pediatrician consults with a specialty behavioral health provider about a specific patient’s needs, both providers may be reimbursed for their care – even if the patient is not present. This move to pay for interprofessional consultations seeks to link routine care with specialty care, enabling more people to benefit from practitioners with specialized knowledge. Learn more from this CMS news release and the guidance letter CMS sent to state Medicaid directors about this subject.
CMS has sent a letter to state Medicaid programs that provides a detailed description of the configuration/implementation plan, testing plan, and testing results that states will need to submit to the federal government when the public health emergency and continuous Medicaid enrollment condition end. This document seeks to help states understand systems readiness artifacts that are routinely submitted to CMS’s state systems team during IT project and certification reviews. See the CMS letter here.

Department of Human Services

The Department of Human Services (DHS) has published a Medical Assistance Bulletin to inform providers that it will reinstate provider enrollment requirements that were in place prior to the COVID-19 public health emergency, including an enrollment application fee, fingerprint-based background checks, and site visits for providers. Providers temporarily enrolled in the program during the public health emergency who did not satisfy enrollment requirements that were suspended at the time now must satisfy those requirements. This policy takes effect on February 27. Find the bulletin here.
DHS has published a Medical Assistance Bulletin to inform providers about the procedures for dispensing 340B drugs to Medical Assistance beneficiaries and about implementation of the Medical Assistance program’s 340B drug exclusion list. The policies took effect on January 1. Find the bulletin here.
DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has issued a bulletin to inform peer support service providers and Medicaid behavioral health managed care organizations that peer support services identified in beneficiaries’ individual service plans may be provided during transit. The policy took effect on December 28. The bulletin also includes revised provider handbook pages. Find the bulletin here.
DHS has updated its COMPASS Community Partners web page with new information about steps that can be taken to help people retain health care coverage after the COVID-19 public health emergency ends, including a new FAQ and an updated public health emergency toolkit. Learn more about COMPASS Community Partners and these new developments from this message from DHS.
DHS has added a new procedure code to the Medical Assistance program fee schedule for a second nurse to shadow a nurse providing private duty/shift nursing to beneficiaries under 21 years of age, effective with dates of service on and after January 1. Learn more from this Pennsylvania Bulletin notice.
DHS has published a summary of the December 8 meeting of the Medical Assistance Advisory Committee. Find it here.
DHS has updated its telephone directory for those seeking assistance with different Medical Assistance-related issues. Find the updated directory here.
DHS has updated its Medicaid managed care organization directory.
DHS has published its physical health Medicaid managed care enrollment report for November.

Department of Health

The Department of Health has written to long-term-care facilities to inform them that it will no longer provide short-term crisis staffing support or staffing support for test swabbing missions as of January 14. It also encourages those facilities to engage with their local LTC RISE partner, which will continue to provide COVID-19 outbreak response consultative support. Learn more from the department’s letter to long-term-care facilities.
The Childhood Blood Lead Test Act signed into law on November 3 took effect on January 2. The act provides for blood lead assessment and testing of certain children and pregnant women by health care providers; imposes duties on the Department of Health; and requires certain health insurance policies to cover blood lead tests. Learn more about the new law from this Pennsylvania Bulletin notice.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania rose 21 percent over the past week. 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 is the highest it has been since last February 22; the number on a ventilator because of the virus is the highest it has been since March 9; and the number in hospital ICUs is greater than it has been since March 4.
The CDC reports a 15 percent increase in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 since December 21.
As of January 5, one Pennsylvania county – Cameron – is experiencing a low rate of community transmission; 12 counties are experiencing a substantial rate of community transition; and the remaining 54 counties are experiencing high rates of community transmission of COVID-19.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued an information bulletin informing single- county authorities, substance use disorder treatment providers, and other substance use disorder treatment-related organizations that they may be asked to serve on a death review team and that they may be asked to provide records as part of a death review team’s duties. Find the bulletin here.

The Department of Drug and Alcohol Programs announced an open enrollment period last October 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. This open enrollment period has been extended, and will now continue through January 13. Go here to see the original notice of the open enrollment period and here to see the department’s recent communication on this subject.

Insurance Department

An Insurance Department examination of Capital Blue Cross has identified concerns with claims processing, including claims being denied for lack of prior authorization when prior authorization had already been obtained, and a coordination of benefits issue that has since been updated. The examination also reported additional Unfair Insurance Practices Act violations involving unclear communication with members. The exam also found mental health parity violations. Learn more about why the department conducted the review, what it found, and how it is addressing the problems it identified from this news release.

Stakeholder Events

Pennsylvania Health Care Cost Containment Council – January 12

The Pennsylvania Health Care Cost Containment Council (PHC4) will hold a public meeting on Thursday, January 12 at 10:00. For additional information about the session, see this Pennsylvania Bulletin notice.

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – January 18

Department of Health – Renal Disease Advisory Committee – January 20

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00. Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

jsteinbock2023-01-06T21:54:53+00:00January 6th, 2023|340b, COVID-19, Federal Medicaid issues, health equity, Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|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

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.

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 – 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.

jsteinbock2022-10-14T19:19:31+00:00October 14th, 2022|COVID-19, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for Friday, October 7

The following is an update of selected state health policy developments in Pennsylvania for the week of October 3-7, 2022. (Some of the language used below is taken directly from state documents.)

Behavioral Health Commission for Adult Behavioral Health

The Wolf administration has released the recommendations of its Behavioral Health Commission for Adult Behavioral Health, which was created to advise the General Assembly on how to spend $100 million in one-time federal American Rescue Plan Act funding, including to support adult behavioral health needs addressed in the state’s 2022-2023 fiscal code. The commission recommended that the $100 million be used in the following manner:

$37 million to stabilize, strengthen, and expand the workforce
$23.5 million to improve the criminal justice and public safety systems
$39 million to expand capacity for services and supports
$500,000 for a future study of the impact of this spending

The commission’s recommendations are only advisory; the General Assembly will consider its recommendations in the coming weeks and decide if and how to appropriate the $100 million.

Find a Wolf administration news release about the report here and the report itself here.

Department of Human Services

The Department of Human Services has announced its intent to allocate funds for FY 2023 supplemental payments to promote the continuation of quality medical services to individuals enrolled in the Medical Assistance program and to provide financial relief to hospitals during the COVID-19 pandemic. It does not intend to otherwise change the qualifying criteria or payment methodology for these payments. Learn more from this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has updated its interim infection prevention and control recommendations for health care settings to reflect recent changes in federal CDC recommendations.
DOH has shared information on severe manifestations of monkeypox among patients who are immunocompromised due to HIV or other conditions. This is the same alert issued last week by the CDC.
DOH has added to its naloxone standing orders that enable residents and first responders to obtain naloxone products to help combat the rise of overdoses in Pennsylvania a non-prefilled syringe with two single-dose vials of liquid naloxone that is injectable. Residents can present a copy of the state’s standing order, which can be found here, at their local pharmacy to obtain the naloxone. The medication also is available for free for personal use through a statewide mail-based naloxone program.
DOH has issued an advisory about lead exposure in adults.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases in Pennsylvania over the past week was down 20 percent from the previous week and the number of deaths fell 10 percent.
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 seven percent increase in the seven-day rolling average of new daily COVID-19 hospital admissions.
For the first time in several months, all, or almost all, of Pennsylvania’s 67 counties are not experiencing a high rate of community transmission. Currently, 60 counties are still experiencing a high rate of community transmission while six counties – Forest, Centre, Lycoming, Union, Snyder, and Delaware – are experiencing “only” a substantial rate of community transmission and Philadelphia’s rate is now classified as moderate.

Monkeypox

The CDC has posted an updated map showing the distribution of 26,385 confirmed cases of monkeypox in the U.S. as of October 6, up only slightly from 25,613 cases on September 29. 789 of those cases were in Pennsylvania, up from 713 a week ago.
As of October 3, 495 of those Pennsylvania monkeypox cases were in Philadelphia, up from 475 on September 25. Learn more about monkeypox in Philadelphia from the city Department of Public Health’s monkeypox web page.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has issued the research brief “Hospitalizations for Opioid Overdose, 2016 – 2021” that looks at trends among state residents, ages 15 and older, who have been admitted to Pennsylvania acute-care hospitals for opioid overdoses. Find a news release about the report here and the report itself here.

Centers for Medicare & Medicaid Services

CMS’s Center for Medicare and Medicaid Innovation has released materials presenting its evaluation of year two of the Pennsylvania Rural Health Model, which seeks to improve access to hospital services and improve population health in underserved rural communities. New evaluation materials include a summary of the evaluation of the program’s second year; the full report; the report’s executive summary; and an appendix to the report. Learn more about the Pennsylvania Rural Health Model, including a list of its participating hospitals, from the program’s web page.

Stakeholder Events

DHS – Long-Term Care Workforce Motivation – October 13

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 how to express appreciation for long-term-care workers. The webinar will be held on Thursday, October 13 at 2:00. Learn more, including how to participate, from this notice.

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

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

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

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

jsteinbock2022-10-07T21:24:30+00:00October 7th, 2022|COVID-19, DSH hospitals, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid policy, Uncategorized|Comments Off

PA Health Policy Update for Friday, July 1

The following is an update of selected state health policy developments in Pennsylvania for the week of June 27 to July 1, 2022. (Some of the language used below is taken directly from state documents.)

FY 2023 Budget Update

As of 2:00 p.m. on Friday, July 1, Governor Wolf and the General Assembly continue to work on finalizing Pennsylvania’s FY 2023 budget. Despite indications that a framework for a budget agreement has been reached, the state missed its June 30 deadline to enact a spending plan. The General Assembly is scheduled to return to session next Tuesday, July 5 to continue its work. The short-term impact of not having a budget by July 1 will be minimal; the state is obligated to maintain essential operations and cover Medicaid expenditures, state employee payroll, and debt payments.

General Assembly

The state House and Senate cancelled session this weekend and are schedule to return to session on Tuesday, July 5. Depending on the outcome of budget negotiations and the progress of budget-related legislation, they may have to add additional session days next week.

The Senate passed House Bill 1561 and House Bill 1563 on third and final consideration. These bills amend the Mental Health Procedures Act and the Drug and Alcohol Abuse Control Act, respectively, to align them with HIPAA and give providers, facilities, and insurers the ability to share more easily patient mental health and substance use disorder treatment information. Both pieces of legislation were presented to Governor Wolf for his signature.
The Senate passed Senate Bill 225 on third and final consideration. The bill seeks to streamline and standardize the process for prior authorization of medical services. The bill was sent to the House and referred to the Insurance Committee for consideration.
The House passed Senate Bill 861, which enters Pennsylvania into the EMS compact, on third and final consideration. The bill has been presented to Governor Wolf for his signature.
The House passed Senate Bill 818, which aligns the procedures permitted in ambulatory surgery centers in Pennsylvania with those permitted by the federal Centers for Medicare & Medicaid Services (CMS), on third and final consideration. Since the bill was amended, it was sent back to the Senate for concurrence.
The House passed House Bill 2679 on third and final consideration. The bill, which was subsequently sent to the Senate for consideration, authorizes pharmacists and pharmacy interns to administer influenza and COVID-19 vaccines to individuals five years of age and older.
The House unanimously voted to concur with Senate amendments to House Bill 2097, which makes permanent a COVID-19 regulatory waiver that permits certified emergency personnel, such as firefighters with specific first-aid, CPR, and emergency vehicle training, to drive ambulances with an EMT on board. The bill will now be sent to the governor for his signature.
The House passed House Bill 2293 on third consideration and final passage and sent it to the Senate for consideration. This bill requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.

Governor Wolf

Governor Wolf has signed into law House Bill 2401, which extends regulatory waivers that went into effect over the course of the COVID-19 pandemic. This extension will permit many waivers to remain in place until October 31, 2022 unless the waivers are related to federal exemptions. Waivers related to federal exemptions will remain in place until the last day of the federal public health emergency or the last day the federal exemptions are authorized, whichever is later. House Bill 2401 also makes permanent two COVID-19 waivers that permit non-physician practitioners to order and oversee orders for home health care services and permits the continued use of remote supervisory visits by registered nurses. Learn more from this Wolf administration news release.

Governor Wolf has signed Senate Bill 709, which establishes the CMV Education and Newborn Screening Act and requires the Department of Health to make available on its website certain information regarding cytomegalovirus (CMV), one of the most common viral infections that infants are born with in this country. Health care providers will be required to provide parents or guardians of newborns with information on CMV and to offer a screening or referral within 21 days if the newborn child fails the initial newborn hearing screening. Learn more from this Wolf administration news release and Senate Bill 709 (now Act 29).

Department of Human Services

In response to the COVID-19 emergency, the federal Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) in April of 2020 issued an exemption to opioid treatment programs from the requirement to perform an in-person physical evaluation for any patient who will be treated by such programs with buprenorphine if a program physician, primary care physician, or an authorized health care professional under the supervision of a program physician determines that an adequate evaluation of the patient can be accomplished via telehealth. Based on positive response to this practice, SAMHSA is extending this flexibility for one year from the formal end of the COVID-19 public health emergency. Learn more from SAMHSA’s guidance.
The Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services has issued a bulletin to update its guidelines for payment of behavioral health services delivered using telehealth technology. Find the bulletin here and attachments here and here. The new guidelines take effect immediately.
DHS’s Breast & Cervical Cancer Prevention & Treatment Program provides eligible individuals treatment for confirmed cases of breast and cervical cancer or pre-cancerous conditions of the breast or cervix. DHS has posted a notice to providers reminding them how to determine whether patients may be eligible for services under the program and, if they are, how they can enroll in the program. Find that notice here.
DHS has issued a Medical Assistance Bulletin informing providers that as of November 1 it will reinstate the prior authorization requirements for shift care services provided to beneficiaries under the age of 21 in the Medical Assistance fee-for-service program. Medical Assistance managed care organizations may reinstate the prior authorization requirements for these services provided to children under the age of 21. Providers rendering services in the managed care delivery system should contact the appropriate managed care organization regarding any questions about prior authorization requirements. Learn more from this Medical Assistance Bulletin.
DHS has announced a funding opportunity for home and community-based service (HCBS) providers to improve and strengthen HCBS programs and services to better serve HCBS participants. Under the program DHS will provide up to $40,000 for each approved request to help HCBS providers implement a series of specific types of service improvement projects. Funding is limited to providers of services through the Community HealthChoices and OBRA 1915(c) waivers for activities that supplement HCBS services rather than supplant existing services. Learn more about the funding program and the specific types of projects DHS is interested in supporting from this DHS news release. For more detailed information, see this DHS description of the program, the funding guidelines, and how to apply. Applications will be accepted until December 31 or whenever the $38 million allocated for this purpose has been committed. All awarded funds must be spent by July 1, 2023.
DHS is seeking partners to help it through the public health emergency unwinding process during which people will need to re-establish their eligibility for Medical Assistance benefits. Specifically, it seeks individuals and organizations that will help guide current Medical Assistance beneficiaries through the eligibility renewal process or direct them to other resources for possible health care coverage. Learn more about what DHS seeks and how to participate in this undertaking from this DHS message.
DHS has decreased from 90 to 30 days the period of time individuals have to request a hearing appealing a Medicaid termination or denial. The time limit previously was 30 days, was extended to 90 days at the start of the COVID-19 public health emergency, and has now been restored to 30 days. Find the notice in this DHS memo (on page 7, in red).
DHS and the Department of Transportation have been awarded a $750,000 grant from the Federal Transit Administration to expand its Find My Ride online tool, Pennsylvania’s “one-stop shop” for access to human services transportation. The program was developed collaboratively with transit agencies and streamlines the application process for the five largest transportation assistance programs in the state, including the Senior Share Ride program, the Medical Assistance Transportation Program, ADA complementary paratransit, the Persons with Disabilities Program, and the Free Transit Program. The program enables third parties, such as family members or health care providers, to apply for services on behalf of riders. Learn more from this Wolf administration news release.

Insurance Department

The Insurance Department has received a federal grant as part of the State Flexibility to Stabilize the Market Grant Program Cycle II. One of the proposed projects includes studying the availability of providers in various specialties and geographic areas. The goal of this study is to understand areas of need based on the current availability of providers to accept new patients and the amount of time it takes to get an appointment with these providers and to assess network adequacy considerations based on the findings. The Insurance Department is seeking public comment from organizations, consumer advocates, providers, and consumers about their experience with getting appointments or finding available specialists. Learn more about the project and the areas of medical specialty the analysis may consider, and on which the department is interested in comments, in this Pennsylvania Bulletin notice. Comments are due by August 5.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has announced the availability of $3 million in funding for entities to provide pregnancy support services to address the needs of pregnant and postpartum women with substance use disorder. Last year the program awarded $599,000 to 12 organizations and this year the Department of Drug and Alcohol Programs plans to award approximately three to five grants of up to $600,000 each to help provide services, streamline care, and assure that this population is connected with the most appropriate resources to reach long-term recovery. Learn more about this funding opportunity from this department news release and a program overview that describes eligible applicants and outlines the application process. Applications are due by July 29 for projects that begin on October 1 and end by September 30, 2023.

COVID-19: By the Numbers

After four weeks of falling case counts the number of new reported COVID-19 cases rose over the past week.
During this past week, Pennsylvania’s total of COVID-19 cases since the beginning of the pandemic rose past three million.
COVID-19-related deaths rose slightly during the week.
The number of Pennsylvanians hospitalized with COVID-19 remained steady over the past week but the number in hospital intensive care units and on ventilators declined.
Thirty-five of Pennsylvania’s 67 counties are currently experiencing high rates of community transmission of COVID-19, down from 55 counties last week. Four counties experienced a moderate rate of community transmission and the remaining 18 experienced a substantial rate.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee Meeting – July 6

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, July 6 at 10:00; the meeting also will be available virtually. For further information about the location of the meeting and how to participate virtually, see this announcement.

Pennsylvania Health Care Cost Containment Council – July 7

The Pennsylvania Health Care Cost Containment Council (PHC4) will meet virtually on Thursday, July 7 at 10:00. For access to the meeting agenda and information about how to participate, see this Pennsylvania Bulletin notice.

Department of Human Services – Long-Term Care Learning Network/Nursing Facilities – July 7

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 to help nursing facility staff recognize expressions of behavior among residents living with dementia. The webinar will be held on Thursday, July 7 at 2:00. Learn more about the webinar and how to participate from this notice.

Department of Health – COVID-19 Therapeutics – July 12

The Department of Health, Department of Human Services, and Pennsylvania Emergency Management Agency will hold a webinar on COVID-19 therapeutics on Tuesday, July 12 at 4:00. The webinar is intended for providers and facility administrators and will cover why, when, and
how to prescribe and obtain outpatient COVID-19 treatment and preventive therapies. Learn more about the webinar and how to register to participate in this notice.

Department of Health – Newborn Screening and Follow-Up Technical Advisory Board – July 14

The Department of Health’s Newborn Screening and Follow-Up Technical Advisory Board will meet virtually on Thursday, July 14 from 10 a.m. until 1 p.m. The agenda will include discussions about board member terms; updates from the Bureau of Family Health; payment options for additional conditions; research on dried blood spot specimens; a discussion on metachromatic leukodystrophy; and updates from the ethics, lysosomal storage disorders/X-ALD, cystic fibrosis, hemoglobinopathy, and critical congenital heart defects subcommittees. For information about how to join the meeting, see this Pennsylvania Bulletin notice.

jsteinbock2022-07-01T20:16:07+00:00July 1st, 2022|COVID-19, Federal Medicaid issues, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2023 budget|Comments Off

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