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PA Health Policy Update for the Week of June 28-July 2

The following is an update of selected state health policy developments in Pennsylvania for the week of June 28-July 2, 2021. (Some of the language used below is taken directly from state documents.)

FY 2021-2022 Budget

On Wednesday Governor Wolf signed into law Pennsylvania’s FY 2021-2022 General Fund appropriations bill and related code bills. The governor partially vetoed Senate Bill 255, the General Appropriations Act, to remove the funds appropriated by the General Assembly for the establishment and operation of a new Bureau of Election Audits. The full package of budget-related bills passed by the legislature and signed by the governor includes the FY 2022 General Appropriations Act – Senate Bill 255; the Fiscal Code – House Bill 1348; the Administrative Code – House Bill 336, and the Tax Code – House Bill 952.

Legislative Update

The legislature has passed, and Governor Wolf has signed, the following health care-related bills:

House Bill 649 (Act 67) – requires the Department of Health, in consultation with the Department of Human Services, to establish protocols to permit an essential caregiver to provide in-person physical and emotional support to a congregate care facility resident during a declaration of disaster emergency.
House Bill 1024 (Act 44) – revises to the state’s Medical Marijuana Act, including caregiver, dispensing, and criminal background check provisions.
House Bill 1429 (Act 48) – adds a new section to the state Crimes Code providing for the offense of financial exploitation of an older adult or care-dependent person. It also clarifies that district attorneys have the right to investigate and institute criminal proceedings for any violation of this new section.
House Bill 1431 (Act 49) – adds a new section to the Crimes Code that defines as abuse and establishes as a misdemeanor the use of social media by employees who post pictures of care-dependent individuals without permission.
Senate Bill 108 (Act 56) – provides for a $130 supplemental per diem payment for ventilator or tracheostomy care provided by qualified skilled nursing facilities that meet certain criteria based on the volume and proportion of Medicaid patients they serve.
Senate Bill 115 (Act 68) – establishes the Nurse Licensure Compact Act, which makes the state a party to the Nurse Licensure Compact with all other states that have joined the compact.
Senate Bill 416 (Act 60) – establishes the certified registered nurse anesthetist (CRNA) designation in the commonwealth. The legislation grants an individual licensed to practice professional nursing and who meets the requirements of this act the right to use the CRNA designation.
Senate Bill 425 (Act 61) – amends the Medical Care Availability and Reduction of Error (MCARE) Act to permit a physician to fulfill their duty to obtain a patient’s or the patient’s authorized representative’s consent by a qualified practitioner prior to conducting surgery or administering radiation or chemotherapy blood transfusions or medications and devices.
Senate Bill 445 (Act 23) – permits a person renewing a driver’s license, identification card, or vehicle registration electronically through the Department of Transportation’s web site to contribute $5 to the Pennsylvania Breast Cancer Coalition for breast cancer research.
Senate Bill 484 (Act 63) – adds the chair of the State Veterans Commission or a designee to the Pennsylvania Long-term Care Council.

Governor Wolf vetoed Senate Bill 618, which would have prohibited the use of vaccine passports by government entities and prevented institutions of higher education from requiring proof of vaccination against COVID-19. The bill also sought to restrict the Secretary of Health’s ability to implement certain disease control measures. See the governor’s veto message here.

The General Assembly has now adjourned until September.

Department of Human Services

DHS has updated the Medical Assistance fee schedule to reflect 2020 HCPCS codes. The update is retroactive to December 21, 2020. Learn more in this Medical Assistance Bulletin.
DHS has issued a Medical Assistance Bulletin with the 2021 recommended child and adolescent immunization schedule. The bulletin applies to all providers enrolled in the Medicaid program who administer immunizations and provide services in the fee-for-service and managed care delivery systems.
DHS has updated its requirements for enrolling in Pennsylvania’s Medicaid program as a mental health substance abuse (Type 11) provider.
DHS has updated its requirements for enrolling in Pennsylvania’s Medicaid program as a case manager (Type 21).
DHS has updated its list of drug companies participating in the Medicaid drug rebate program.
DHS has published installment #254 in its “Provider Quick Tips” series. The subject: “Payment Error Rate Measurement (PERM) Initiative for RY 2022.” Find it here.
DHS has published a notice in the Pennsylvania Bulletin reminding hospitals that, as it informed them last fall, the assessment percentage of the state’s Quality Care Assessment for FY 2021-2022 and FY 2022-2023 will return to 3.32 percent of net inpatient revenue and 1.73 percent of net outpatient revenue for affected hospitals. See the notice here.

Department of Health

The departments of Health and Human Services have extended to September 30 the period during which the Regional Congregate Care Assistance Teams (RCAT) will remain available to help long-term-care facilities prevent and respond to COVID-19. See the announcement here and updated call center information here.

COVID-19: By the Numbers

The daily number of new COVID-19 cases continues to decline and the number of COVID-19 deaths continues to decline significantly.

For the week from June 18 through June 24 the state’s overall COVID-19 test positivity rate was 1.2 percent, down from 1.4 percent last week and 1.9 percent the week before.
Sixty-five counties had a positivity rate lower than five percent, up from 64 last week, and no counties had a positivity rate greater than 20 percent for the ninth consecutive week.

Fifty-five counties are currently experiencing low levels of community transmission of COVID-19, up from 37 last week; the remaining 12 Pennsylvania counties are experiencing moderate levels of community transmission and no counties are experiencing a high level of community transmission.
On July 1 the number of Pennsylvanians hospitalized with COVID-19 was less than one-third of what it was on June 1; the number on ventilators was 30 percent of what it was on June 1; and the number in hospital ICUs was 25 percent of what it was on June 1.
5.4 million Pennsylvanians have been fully vaccinated against COVID-19, according to the state’s COVID-19 dashboard. Growth in this number has slowed significantly over the past month, with fewer than 100,000 new, complete vaccinations reported in the past week. Another 760,000 people have been vaccinated in Philadelphia. According to the state, 60.3 percent of Pennsylvanians 18 years of age and older are now fully vaccinated and 62.9 percent of the entire population has now received at least the first dose of a vaccine.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued a memo establishing a procedure for drug and alcohol treatment providers to request additional time beyond July 1 to reach substantial alignment with service delivery conditions under The ASAM Criteria, 2013.

Around the State

While Pennsylvania is among the nation’s leaders in the percentage of its residents receiving their first dose of a COVID-19 vaccine it is the fifth-worst state when it comes to getting those first shot recipients their second dose. The Philadelphia Inquirer lays out the situation and explores why.
Following a 2018 fire at the U.S. Steel Clairton Coke Works site the number of asthma-related visits to doctors’ offices and hospital emergency departments nearly doubled, according to a new study. WESA Pittsburgh tells the story.
According to the Philadelphia Business Journal, “A partnership involving an Allentown-based health system and a recently formed hospital turnaround company has emerged as a bidder for the financially struggling Tower Health.” Learn more here.
After today Lancaster County closes its COVID-19 mass vaccination site. Lancaster Online recounts some of the site’s accomplishments and experiences.
With people spending more time at home, HIV testing at non-health care sites in Philadelphia fell 75 percent in 2020, according to the Pennsylvania Capital-Star.

Stakeholder Events

Managed Long-Term Services and Supports Subcommittee Meeting

July 7 at 10:00 a.m.

This meeting will be held via webinar. Public comments will be taken after each presentation and questions can be entered in the chat box. Interested parties can participate in the following ways:

- Webinar registration – go here
- Dial in: 1-914-614-3221, access code 716-025-613
- Remote captioning and streaming link – go here

Health Research Advisory Committee Meeting

July 12 at 10:00 a.m.

The public meeting will be held virtually by means of Microsoft Teams at (267) 332-8737 with Conference ID: 689 378 043#.

Newborn Screening and Follow-Up Technical Advisory Board

July 15 at 10:00

The virtual public meeting will be conducted as a teleconference Skype meeting. The dial-in number is (267) 332-8737 and the conference access ID is 63145728#.

Special Pharmaceutical Benefits Program

July 29, 2021 at 10:00

This is a telephone meeting.

Join on your computer or mobile app

Click here to join the meeting

Or call in (audio only)

+1 412-648-8888,,785376728# United States, Pittsburgh

(866) 588-4789,,785376728# United States (Toll-free)

Phone Conference ID: 785 376 728#

Stakeholder Event Report

Financial Management Services Meeting – June 28

At the most recent Financial Management Services stakeholder meeting on June 28, 2021the Community HealthChoices managed care organizations announced that Tempus Unlimited, Inc. will be the new statewide Vendor Fiscal/Employer Agent, with HHA eXchange as the software solution, supporting FMS in the Community HealthChoices program.

Stakeholder Events Materials

DHS has shared materials presented at the June 28 meeting of its Financial Management Services stakeholder meeting. This public meeting discussed the upcoming changes for the administration of financial management services under the Community HealthChoices, OBRA Waiver, and Act 150 programs. Representatives from the Office of Long-Term Living and Community HealthChoices managed care organizations participated in the meeting. Those presentations are:

jsteinbock2021-07-06T03:16:48+00:00July 6th, 2021|Coronavirus, COVID-19, Federal Medicaid issues, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania proposed FY 2022 budget|Comments Off

MACPAC Issues Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has submitted its annual report to Congress on Medicaid and the Children’s Health Insurance Program.

The report includes recommendations for:

improving Medicaid’s responsiveness during economic downturns
addressing concerns about high rates of maternal morbidity and mortality;
reexamining Medicaid’s estate recovery policies
integrating care for people who are dually eligible for Medicaid and Medicare
improving hospital payment policy for the nation’s 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 array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).” Its mandate calls for it to address matters such as Medicaid and CHIP payment, eligibility, enrollment and retention, coverage, access to care, quality of care, and the programs’ interaction with Medicare and the health care system generally.

Because Pennsylvania safety-net hospitals care for so many more Medicaid and CHIP participants than the typical community hospital, MACPAC’s deliberations are especially important to them.

Learn more about MACPAC’s recommendations in its Report to Congress on Medicaid and CHIP.

PA Safety Net Admin2021-03-23T06:00:52+00:00March 23rd, 2021|Federal Medicaid issues|Comments Off

SNAP Asks PA Delegation for Help From COVID-19 Relief Bill

The next federal COVID-19 relief bill should include more resources for the Provider Relief Fund, SNAP has told members of Pennsylvania’s congressional delegation.

Safety-Net Association of Pennsylvania logo The bill also should include additional targeted funding for safety-net hospitals, help with staffing, an extension of the current moratorium on the Medicare sequestration, and forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program.

This was the message the Safety-Net Association of Pennsylvania conveyed last week in a letter to members of Pennsylvania’s congressional delegation. See that letter here.

PA Safety Net Admin2021-02-05T17:20:29+00:00February 5th, 2021|Coronavirus, COVID-19, Federal Medicaid issues, Medicare|Comments Off

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:

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.

PA Safety Net Admin2021-02-02T06:00:35+00:00February 2nd, 2021|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

GAO: CMS Should Pay More Attention to States’ Financing of Medicaid

The federal government does not adequately monitor how states finance their Medicaid programs.

It also lacks a sufficiently clear understanding of how they pay providers of Medicaid-covered services.

These are among the conclusions in a new study on Medicaid financing and payments by the U.S. Government Accountability Office.

According to the GAO report,

GAO estimated that states’ reliance on provider taxes and local government funds decreased states’ share of net Medicaid payments (total state and federal payments) and effectively increased the federal share of net Medicaid payments by 5 percentage points in state fiscal year 2018. It also resulted in smaller net payments to some providers after the taxes and local government funds they contribute to their payments are taken into account. While net payments are smaller, the federal government’s contribution does not change. This effectively shifts responsibility for a larger portion of Medicaid payments to the federal government and away from states.

To address this challenge, the GAO urged CMS to collect more complete and consistent information about both state financing of their Medicaid programs and the manner in which states pay Medicaid providers. CMS neither agreed nor disagreed with the GAO’s recommendation.

Such a study could have implications for Pennsylvania safety-net hospitals because of the state’s growing dependence on provider taxes to fund its Medicaid programs in recent years.

Learn more about what the GAO found and recommended in its new report “Medicaid: CMS Needs More Information on States’ Financing and Payment Arrangements to Improve Oversight.”

PA Safety Net Admin2020-12-15T06:00:16+00:00December 15th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

SNAP Asks PA Delegation for COVID-19 Aid

SNAP has written to Pennsylvania’s congressional delegation to request additional COVID-19 legislation between now and the end of the year to help Pennsylvania safety-net hospitals respond to the health care and financial challenges posed by the pandemic.

In its letter, SNAP asked Congress for:

additional funding for the Provider Relief Fund for assistance to hospitals;
extension of the temporary moratorium on continued implementation of the 2011 Budget Control Act’s Medicare sequestration; and
the suspension of any other federal cuts for health care providers, such as the scheduled reduction of Medicaid disproportionate share (Medicaid DSH) allocations to the states.

Read SNAP’s message to Congress.

PA Safety Net Admin2020-12-08T06:00:24+00:00December 8th, 2020|Coronavirus, COVID-19, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

SNAP Seeks Help From End-of-Year Federal Legislation

Eliminate Medicaid disproportionate share hospital cuts (Medicaid DSH), appropriate additional resources for the Provider Relief Fund, and extend the current suspension of the two percent sequestration of Medicare spending, the Safety-Net Association of Pennsylvania asked members of Pennsylvania’s congressional delegation in a letter SNAP sent earlier this week.

The request comes as Congress returns to Washington to take up the funding of the federal government at a time when authorization for spending under a continuing resolution ends on December 11. In addition to addressing federal funding, Congress also may consider COVID-19 legislation.

PA Safety Net Admin2020-11-19T06:00:26+00:00November 19th, 2020|COVID-19, DSH hospitals, Federal Medicaid issues, Safety-Net Association of Pennsylvania|Comments Off

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.

The October 2020 MACPAC meeting opened with a panel discussion on restarting Medicaid eligibility redeterminations when the public health emergency ends. It included Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities; René Mollow, deputy director for health care benefits and eligibility at the California Department of Health Care Services; and Lee Guice, director of policy and operations at the Department for Medicaid Services, Kentucky Cabinet for Health and Family Services.

After a break, Commissioners heard a panel discussion with Kevin Prindiville, executive director at Justice in Aging; Mark Miller, executive vice president of healthcare at Arnold Ventures; and Charlene Frizzera, senior advisor at Leavitt Partners, on creating a new program for dually eligible beneficiaries. Later, staff presented preliminary findings from a mandated report on non-emergency medical transportation. The day concluded with a report on nursing facility acuity adjustment methods.

On Friday, the day began with a session on access to mental health services for adults in Medicaid. It was followed by a related panel discussion on mental health services with Sandra Wilkniss, director of complex care policy and senior fellow at Families USA; Melisa Byrd, senior deputy director for the District of Columbia Department of Health Care Finance; and Dorn Schuffman, director of the CCBHC Demonstration Project at the Missouri Department of Mental Health.

Next, the Commission considered the merits of extending Medicaid coverage for pregnant women beyond 60 days postpartum. Staff then provided an update on a statutorily required analysis of disproportionate share hospital (DSH) allotments, as well as an analysis of addressing high-cost drugs and the challenges they present to Medicaid.

The meeting concluded with comment on the Secretary’s report to Congress on Reducing Barriers to Furnishing Substance Use Disorder (SUD) Services Using Telehealth and Remote Patient Monitoring for Pediatric Populations under Medicaid. The Commission decided to send a letter to Congress and the Secretary commenting on this report.

Supporting the discussion were the following briefing papers:

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.

PA Safety Net Admin2020-11-17T15:00:47+00:00November 5th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Congress Gives Hospitals Medicaid DSH Relief

Medicaid DSH allocations to states will not be reduced right away thanks to a new continuing resolution to fund the federal government through December 11.

The Medicare disproportionate share allocation cuts to the states, mandated by the Affordable Care Act but delayed by Congress several times, were delayed again earlier this year but scheduled to take effect on November 11. With the latest continuing resolution, the cuts will be delayed yet another month.

SNAP worked hard to encourage Congress to include the Medicaid DSH delay in the continuing resolution, doing so most recently in this September 14 letter to members of Pennsylvania’s congressional delegation. Medicaid DSH payments are an important tool in helping Pennsylvania safety-net hospitals serve their predominantly low-income communities, so SNAP also is urging Congress to eliminate the Medicaid DSH cut entirely.

Learn more about the delay of Medicaid DSH cuts and other aspects of the continuing resolution that affect hospitals in the Healthcare Dive article “Providers win Medicare loan extension, DSH relief but lose other asks in stop-gap spending law.”

PA Safety Net Admin2020-10-08T13:00:02+00:00October 8th, 2020|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MFAR is Dead

At least for now.

The controversial Medicaid Fiscal Accountability Regulation, slated for implementation this fall over the objections of many health care stakeholders, will not move forward at this time.

In a tweet earlier this week, Centers for Medicare & Medicaid Services Administrator Seema Verma wrote that

We’ve listened closely to concerns that have been raised by our state and provider partners about potential unintended consequences of the proposed rule, which require further study. Therefore, CMS is withdrawing the rule from the regulatory agenda.

If implemented, opponents maintained, the regulation would have:

Deprived states of important, established policy-making prerogatives.
Created major new administrative burdens for state governments and hospitals.
Inappropriately regulated financing of the state share of Medicaid spending.
Introduced new, unspecified standards for state Medicaid programs.

While CMS maintained that MFAR would have enhanced the transparency of state Medicaid programs, the rule’s opponents maintained that it could lead to a major reduction of resources for serving the Medicaid population.

SNAP was among those opponents, arguing that the regulation could have hurt Pennsylvania safety-net hospitals and others that serve low-income communities by inappropriately regulating how states can finance their Medicaid programs. CMS proposed the rule last November; SNAP submitted formal comments expressing its opposition in January; and SNAP rallied Pennsylvania’s congressional delegation to oppose the rule in February, March, and July.

It is worth noting that in “withdrawing the rule from the regulatory agenda,” Verma did not preclude the possibility of reintroducing MFAR at some point in the future.

Learn more from article “Trump administration backing off Medicaid rule that states warned would lead to cuts” in the online publication The Hill.

PA Safety Net Admin2020-09-17T06:00:46+00:00September 17th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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