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SNAP Responds to RFI on Medicaid Coverage and Access

SNAP has submitted formal comments to the Centers for Medicare & Medicaid Services in response to that agency’s February request for information on access to care and coverage for people enrolled in Medicaid and CHIP.

Safety-Net Association of Pennsylvania logoSNAP’s response focuses on three areas:

  • the adequacy of Medicaid payments to providers as a means of fostering greater access to care and health equity for vulnerable populations
  • monitoring the adequacy of access to care for Medicaid beneficiaries
  • improving the Medicaid eligibility redetermination process

Learn more about the CMS RFI here;  find the questions posed in the RFI here; and see SNAP’s submission in response to the RFI here.

2022-04-20T15:36:35+00:00April 20th, 2022|Federal Medicaid issues, health equity|Comments Off on SNAP Responds to RFI on Medicaid Coverage and Access
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PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its March 2022 newsletter Health Law News.

Included in this month’s issue are articles about:

  • State planning for the use of federal American Rescue Plan money to address the nurse shortage.
  • The governor’s proposed FY 2023 Medicaid budget.
  • The Community HealthChoices transition to a new system for paying participant-directed care workers.
  • Medicaid payment of Medicare Part A premiums for those who meet certain eligibility requirements.

Read about these subjects and more in the Pennsylvania Health Law Project’s March 2022 newsletter.

2022-04-04T15:23:18+00:00April 5th, 2022|Federal Medicaid issues, long-term care, Pennsylvania proposed FY 2023 budget, Pennsylvania state budget issues|Comments Off on PA Health Law Project Newsletter
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PA Health Policy Update for the Week of March 28-April 1

The following is an update of selected state health policy developments in Pennsylvania for the week of March 28-April 1, 2022.  (Some of the language used below is taken directly from state documents.)

Bookshelf with law booksGovernor Wolf

Governor Wolf has signed into law Senate Bill 1019, which temporarily extends certain suspensions of regulations and statutes that were issued by agencies under the COVID-19 disaster declaration through June 30, 2022.

General Assembly

  • The House Health Committee convened on Tuesday, March 29 and favorably reported House Bill 2357, which prohibits the preparation, manufacture, sale, or distribution of unsafe kratom products, and House Bill 2401, which 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.
  • The House Insurance Committee met on Tuesday and favorably reported House Bill 2419, which expands access to outpatient psychiatric care via telemedicine.
  • The state Senate will be in session next Monday (4/4), Tuesday (4/5), and Wednesday (4/6). The House will be in recess next week.

Revenue Collection Update

The Independent Fiscal Office has released its March 2022 Revenue Update.  General Fund collections for March were $579.2 million or 11.6 percent above estimate.  Year-to-date General Fund revenue is $3.04 billion or 9.8 percent more than projected.

Department of Human Services

  • The Department of Human Services (DHS) has informed providers that effective Friday, April 1 at 12:00 a.m. the current Medical Assistance Provider Forms webpage will no longer be accessible.  Instead, providers may order and receive Medical Assistance provider forms here.  Find updated instructions here.  DHS also offered the following explanation to stakeholders:

Over the next few months, the Department of Human Services (DHS) is transitioning web-based forms to a new enterprise solution. While we strive to provide a seamless transition, we understand there may be issues along the way. If you have any bookmarked links, they may no longer work. If you are trying to access an old link that no longer works, please go to https://www.dhs.pa.gov/docs/Publications/Pages/Express-Forms-Transition.aspx for a list of affected forms.

We understand that there may be confusion and issues that arise during this transition, and we appreciate your patience. If you identify a problem following the transition, please reach out to DHS’s Digital Communications Team at RA-PWDHSSOCIALMEDIA@pa.gov and we will assist you as we are able.

  • DHS has issued a Medical Assistance Bulletin advising providers that the Medical Assistance program is extending postpartum coverage from 60 days to 12 months beginning on April 1 and that this applies to all providers enrolled in the Medical Assistance program.  Find the bulletin here.
  • As part of the response to the COVID-19 emergency, numerous state regulatory requirements were suspended by the legislature and DHS to facilitate an effective, timely response to the pandemic.  Over time, some of those suspended requirements have been restored.  DHS has updated its collection of regulatory requirements to reflect which suspensions remain in effect and which have been lifted.  Find that compendium here.
  • DHS has posted a notice informing providers that the Provider Electronic Solutions software they may have used to submit HIPAA-ready transactions to the PROMISe system will not be supported after June 15 and urging them to use the PROMISe Provider Portal to submit claims, validate eligibility, conduct claim inquiries, and view their weekly remittance advice.  Find that notice here.
  • DHS has posted a notice reminding Medical Assistance billing entities that federal law requires physicians and other practitioners who order, refer, or prescribe items or services for Medicaid beneficiaries to be enrolled in the Medical Assistance program and suggesting that billing entities remind unenrolled billing providers about this requirement.  Find the notice here.
  • DHS has posted a notice reminding providers that the two percent Medicare sequestration imposed in 2013 and suspended in 2020 in response to the COVID-19 pandemic will be restored partially on April 1 and fully after July 1.  Find that notice here.
  • DHS has updated its “Monthly Physical Health Managed Care Program Enrollment Report” to include January 2022 data.
  • DHS has posted presentations delivered at the March 24 meeting of its Medical Assistance Advisory Committee (MAAC).  See the presentations from:
  • The federal Centers for Medicare & Medicaid Services (CMS) has released an informational bulletin informing state Medicaid agencies that CMS is exercising enforcement discretion during the COVID-19 public health emergency regarding state submissions of updated Medicaid access monitoring review plans.  CMS is delaying enforcement of the updated plans that are due by October 1, 2022 until October 1, 2024.  Find the CMS informational bulletin here.

COVID-19:  By the Numbers

  • Daily COVID-19 case counts climbed slightly over the past week.  On Wednesday, March 23 the state’s seven-day average of new cases was 574 cases a day; on March 31 it was 585 cases a day.
  • The number of new COVID-19-related deaths, on the other hand, fell by more than half over the past week, with the March 24 seven-day average of 37 deaths falling to 18 on March 31.
  • For the third consecutive week, no Pennsylvania counties are experiencing a high rate of community transmission.  For the second consecutive week, just eight counties experienced a substantial rate of community transmission.  Three counties – down from four last week – are experiencing a low rate of community transmission.  The rest of the state – 56 counties – is experiencing a moderate rate of community transmission of COVID-19.
  • The number of Pennsylvanians receiving hospital care for COVID-19 fell significantly during March:  the number hospitalized declined from 1356 on March 1 to 481 on March 31; the number being treated on a ventilator from 163 on March 1 to 54 on March 31; and the number in hospital ICUs from 252 on March 1 to 75 on March 31.

Department of Drug and Alcohol Programs

The departments of Drug and Alcohol Programs (DDAP) and Community and Economic Development have announced the availability of more than $1 million in grant funding for recovery houses to provide safe housing for individuals in recovery from a substance use disorder.  The grants are designed to help existing recovery house facilities with physical upgrades to comply with all federal, state, and local laws and ordinances, including the Americans with Disabilities Act of 1990.  Grants of up to $50,000 for a 12-month period beginning July 1, 2022 will be awarded to between 22 and 25 eligible applicants for health and safety upgrades including demolition, debris removal, rehabilitation improvements, environmental remediation costs, and construction and inspections to comply with DDAP’s regulations.  Learn more from this Department of Drug and Alcohol Programs news release and go here for additional information about the grant program and the application process.  There is no application deadline; applications will be accepted until all of the available money is spent.

In September of 2021, Governor Wolf signed into law Act 73, which extended three of DDAP’s temporary regulatory suspensions through March 31, 2022 in response to the COVID-19 pandemic.  This week Governor Wolf signed Senate Bill 1019, which further extends DDAP’s regulatory suspensions that are “related to federal exemptions granted under the federal public health emergency declaration” until “the last day federal exemptions granted under the federal public health emergency declaration are authorized.”  Three DDAP regulatory suspensions and a relevant Department of State regulation are included in this chart and also remain suspended.  In November of 2021, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) announced that methadone take-home flexibilities will be extended for one year after the eventual expiration of the federal COVID-19 public health emergency.  DDAP has submitted its written concurrence with this exemption.  SAMHSA also has indicated that it is considering mechanisms to make this flexibility permanent.  Narcotic treatment programs do not need to do anything additional at this time to continue taking advantage of this flexibility. Similarly, the U.S. Drug Enforcement Administration (DEA) also has announced that it is working to make its tele-prescribing regulations permanent.

Stakeholder Events

Department of Health – Health Research Advisory Committee – April 4

The Department of Health’s Health Research Advisory Committee will meet virtually on Monday, April 4 at 10:00 a.m. to review the committee’s work, confirm its 2022 priorities, plan future health research priorities, and address emerging issues.  To learn more about the meeting and how to participate, see this Pennsylvania Bulletin notice.

Department of Human Services – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports subcommittee – April 5

The Medical Assistance Advisory Committee’s managed long-term services and supports committee will meet virtually on Tuesday, April 5 at 10:00 a.m.  Public comments will be taken after each presentation.  Questions can be entered into the meeting’s chat box during the presentations and will be asked at the end of each presentation.  There will be an additional period at the end of the meeting for additional public comments.  Go here to register to participate.

Pennsylvania Long-Term Care Learning Network – Strategies to Reduce Hospitalizations and Emergency Room Visits – April 7

The Pennsylvania Long-Term Care Learning Network, part of DHS’s Quality Strategy for Nursing
Facilities, is holding a virtual webinar “Strategies to Reduce Hospitalizations and Emergency Room Visits” on Thursday, April 7 at 2:00 p.m.  Go here to register to participate.

Department of Aging – Pharmaceutical Assistance Advisory Board Virtual Meeting – April 13

The Department of Aging’s Pharmaceutical Assistance Advisory Board will meet virtually on Wednesday, April 13 at 8:30 a.m.  For information about how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Spinal Cord Research Advisory Committee – April 21

The Department of Health’s Spinal Cord Research Advisory Committee will meet virtually on Thursday, April 21 at 10:30 a.m.  The purpose of this meeting is to review the committee’s work, review the status and progress of the current request for applications, reaffirm priorities, evaluate and refine the process to review the next spinal cord research applications, and address emerging issues.  For information about how to join the meeting, see this Pennsylvania Bulletin notice.

Department of Human Services – Medical Assistance Advisory Committee – Consumer Subcommittee – April 27

The Medical Assistance Advisory Committee’s consumer subcommittee will meet virtually on Wednesday, April 27 at 1:00.  Go here to register to participate.

Department of Human Services – Medical Assistance Advisory Committee – April 28

The Medical Assistance Advisory Committee will meet virtually on Thursday, April 28 at 10:00.  Go here to register to participate.

 

2022-04-01T20:56:41+00:00April 1st, 2022|Coronavirus, COVID-19, Federal Medicaid issues, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for the Week of March 28-April 1
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PA Health Policy Update for the Week of February 28-March 4

The following is an update of selected state health policy developments in Pennsylvania for the week of February 28-March 4, 2022.  (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf announced that Pennsylvania’s state-based health insurance marketplace, known as Pennie, has added a new “qualifying life event” to enable low-income Pennsylvanians to enroll in health insurance throughout the year.  Under this new qualifying life event, Pennsylvanians with an annual household income equal to or below 150 percent of the federal poverty level will be permitted to shop and enroll in health insurance through Pennie, with financial assistance available to those who qualify.  Until now, this opportunity was only available for those not already receiving coverage through Pennie.  Beginning in June, existing Pennie customers whose income is lower than or equal to the 150 percent federal poverty level can update their application and change their plan using this qualifying life event.  Learn more from this Wolf administration news release.

General Assembly

The Department of Health and the Department of Drug and Alcohol Programs appeared before the House Appropriations Committee on Thursday, March 3 to discuss their FY 2023 budget proposals.  A recording of their budget hearing can be viewed here.

Among the health-related budget hearings to be held the week of March 7 are:

  • Department of Human Services (Senate Appropriations Committee) – Tuesday, March 8 at 10:00 a.m.
  • Department of Health (Senate Appropriations Committee) – Wednesday, March 9 at 10:00 a.m.
  • Department of Human Services (House Appropriations Committee) – Wednesday, March 9 at 10:00 a.m.

Find a complete schedule of the budget hearings here.

In addition,

  • The legislative Rare Disease Caucus held a press conference on Monday, February 28 to recognize February 28 as Rare Disease Day.  In addition to announcing that Senator Maria Collett (D-Bucks/Montgomery) will serve as co-chair of the Rare Disease Caucus, Senator  Kim Ward (R-Westmoreland) and her colleagues highlighted Senate Bill 196/House Bill 1664 and the Pennsylvania Rare Disease Advisory Council’s “Rare Disease Needs Assessment.”
  • The House Human Services Committee held an informational hearing this week focused on traumatic brain injury care.  A recording of the hearing can be viewed here.

State Revenue Collection

The Department of Revenue reported this week that Pennsylvania’s General Fund revenue collections for February were $155.7 million, or 6.8 percent, above the official estimate.  Fiscal year-to-date collections are $28.6 billion, which is $2 billion, or 7.5 percent, more than projected.

Centers for Medicare & Medicaid Services

CMS has issued guidance to state Medicaid programs to ensure that they are prepared to initiate eligibility renewals for all individuals enrolled in Medicaid and CHIP within 12 months of the eventual end of the public health emergency and to complete renewals within 14 months.  To help consumers maintain coverage, the guidance emphasizes current rules requiring states to provide a smooth transition to other options for those who may no longer be eligible for Medicaid or CHIP.  This letter is part of a series of guidance and tools that outline how states may address the large volume of pending eligibility and enrollment actions that will need to be addressed when they restore routine operations, including terminations of coverage.  It describes how states may distribute eligibility and enrollment work in the post-public health emergency period, mitigate churn for eligible beneficiaries who lose coverage and later reenroll, and smoothly transition individuals between coverage programs.  It reiterates options for states to align work on pending eligibility and enrollment actions after the public health ends and provides that states must initiate, rather than complete, all pending actions during the 12-month unwinding period.  In addition, it informs states that they are at risk of inappropriately terminating coverage for eligible individuals if they plan to initiate a high volume of renewals in a given month and that CMS intends to collect information on all states’ plans to adopt strategies that will promote continuity of coverage and guard against inappropriate terminations.  Learn more from this CMS letter to state Medicaid officials.

Department of Health

  • The Department of Health (DOH) has unveiled what it is calling “innovative delivery models” that it hopes will “…provide options that will preserve and increase access to high quality care in areas that may be medically underserved” and “… give rural hospitals flexibility to address historic challenges so they can maintain emergency care in local communities.”  The three models DOH introduced are:
  • Outpatient emergency departments, which DOH defines as “…an outpatient location of a hospital that offers only emergency services and is not located on the grounds of the main licensed hospital.”  Go here for criteria and guidance for implementing outpatient emergency departments.
  • Micro-hospitals, which DOH defines as “…an acute care hospital that offers emergency services and maintains facilities for at least 10 inpatient beds with a narrow scope of inpatient acute care services, such as no surgical services.”  Go here for DOH guidance on operating micro-hospitals.
  • Tele-emergency departments, or tele-EDs, which DOH defines as “…an emergency department in an acute care or critical access hospital that is staffed by Advanced Practice Providers (APP) 24 hours per day/7 days per week with a physician available at all times through telecommunications but not physically present in the emergency department.”  DOH provides guidance on operating tele-EDs here.

Learn more about DOH’s innovative delivery models from the following resources:

In addition, DOH has established a web page for its innovative delivery models.

Department of Human Services

  • The Department of Human Services (DHS) has published the minutes of the February 24 meeting of its Medical Assistance Advisory Committee.  Find them here.
  • DHS has added a procedure code to the Medical Assistance fee schedule for over-the-counter COVID-19 tests.  Learn about the code, its intended use, and its effective date in this Pennsylvania Bulletin notice.
  • DHS has posted a notice informing presumptive eligibility providers that the income guidelines used to determine presumptive eligibility have been updated effective January 12, 2022 and reminding them that they can make presumptive eligibility decisions for pregnant women.  Find the notice here.
  • DHS has posted a reminder that all enrolled physicians, audiologists, pharmacies, medical suppliers, and outpatient hospital clinics that dispense hearing aid supplies to Medicaid beneficiaries must submit a copy of their renewed DOH certification to MA Provider Enrollment by March 16 to provide and bill DHS for hearing aid supplies.  Find the notice here.
  • DHS has updated its list of participating providers in its Healthy Beginnings Plus program.
  • DHS has updated its Medicaid managed care organization directory.

COVID-19:  By the Numbers

  • Daily COVID-19 case counts have fallen significantly over the past month.  On February 1 the state’s seven-day average of new cases was 5685 cases a day; on March 1 it was 1677 cases a day.
  • The number of new COVID-19-related deaths follows the same downward trend:  Pennsylvania’s seven-day average of deaths was 155 deaths a day on February 1 but was just half that, 78 cases a day, on March 1.
  • The Department of Health also reports that approximately 7.5 percent of all staffed adult ICU beds in the state are occupied by COVID-19 patients this week, down from 9.9 percent last week, and that 24 percent of all ventilators in the state are currently in use, down from 25.8 percent last week.
  • The decline in the number of Pennsylvania counties experiencing a substantial rate of community transmission of COVID-19 – the highest rate – continues.  This past week, Delaware, Lehigh, and Perry counties were all in moderate states of community transmission and 26 other counties – Allegheny, Berks, Bucks, Butler, Carbon, Chester, Cumberland, Dauphin, Erie, Juniata, Lancaster, Lawrence, Lebanon, Luzerne, Lycoming, Mercer, Monroe, Montgomery, Montour, Northampton, Northumberland, Snyder, Sullivan, Venango, Washington, Wyoming – were experiencing “only” substantial rates of community transmission.
  • The decline in the number of new COVID-19 cases is reflected in a 70 percent decline from February 1 to March 1 in the number of Pennsylvanians hospitalized with the virus; a 66 percent decline in the number of patients on ventilators during that same period of time; and a 67 percent month-to-month decline in the number of COVID-19 patients in hospital ICUs.

Stakeholder Events

Department of Health – Advisory Health Board – March 16

The Department of Health’s Advisory Health Board will meet virtually on Wednesday, March 16 at 2:00 p.m. to discuss programmatic and departmental activities.  For information about how to participate, see this Pennsylvania Bulletin notice.

Patient Safety Authority – March 17

The Patient Safety Authority will hold a virtual public meeting on Thursday, March 17 at 1:00 p.m.  Learn how to join the meeting from this Pennsylvania Bulletin notice.

Department of Health – Newborn Screening and Follow-Up Technical Advisory Board – March 30

The Department of Health’s Newborn Screening and Follow-Up Technical Advisory Board will hold a virtual public meeting on Wednesday, March 30, 2022 at 10:00 a.m.  The agenda will include discussions about board member terms; updates from the Bureau of Family Health and the RUSP workgroup; a discussion on pyruvate dehydrogenase; and updates from the Ethics, Lysosomal Storage Disorders/X-ALD, Cystic Fibrosis, Hemoglobinopathy and Critical Congenital Heart Defects subcommittees.  Learn how to join the meeting in this Pennsylvania Bulletin notice.

2022-03-04T22:18:59+00:00March 4th, 2022|Coronavirus, COVID-19, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2023 budget|Comments Off on PA Health Policy Update for the Week of February 28-March 4
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PA Health Policy Update for the Week of December 6-10

The following is an update of selected state health policy developments in Pennsylvania for the week of December 6-10, 2021.  (Some of the language used below is taken directly from state documents.)

Harrisburg, PA capital buildingGeneral Assembly

The Senate Democratic Policy Committee held an informational hearing this week on substance use disorder treatment facilities.  The hearing was co-hosted by senators Schwank, Tartaglione, and Muth.  Panelists included individuals affected by the addiction crisis, treatment providers, and the Department of Drug and Alcohol Programs.  Testimony offered at the hearing and a video recording may be found here.

The state House and Senate will return to session next week.  The following are the relevant health committee hearings currently scheduled.

  • The House Health Committee has scheduled a hearing on Monday, December 13 at 9:00 a.m. to discuss COVID-19 treatment options.  Chairman Kathy Rapp has indicated the committee will examine House Bill 1741, which allows for the prescribing and dispensing of off-label drugs approved by the FDA to treat COVID-19.
  • The Senate Health & Human Services Committee is scheduled to convene on Tuesday, December 14 at 11:00 a.m. to consider, among other bills, Senate Bill 358, which categorizes maternal deaths and severe maternal morbidity complications as reportable events within the Department of Health and requires the Maternal Mortality Review Committee to submit a report including each reportable event to the Department of Health; Senate Bill 522, which requires all pregnant women and children in Pennsylvania to receive blood tests to detect lead poisoning; Senate Bill 848, which creates a chief nursing officer position in the Department of Health; Senate Bill 967, which establishes the Women, Infants, and Children State Advisory Board; and Senate Bill 970, which implements certain measures to verify that child protective services or law enforcement are notified of children age 13 or younger who receive treatment for sexually transmitted diseases, pregnancy, abortions, or contraception.  The committee also will consider House Bill 118, which establishes requirements for the final disposition of fetal remains.
  • The House Human Services Committee has scheduled an information hearing on House Bill 1644 for next Thursday, December 16 at 9:30 a.m.  House Bill 1644 directs the Department of Human Services to develop a state-wide process to place patients enrolled in Medicaid and who have behavioral health or other long-term-care needs in appropriate care settings in a timely manner.  The Human Services Committee also has scheduled an 11:00 a.m. hearing to examine community participation supports during COVID-19 pandemic.

Department of Human Services

  • The Department of Human Services (DHS) has updated its list of regulations that have been suspended to facilitate the state’s response to the COVID-19 emergency.  Find the updated list here.
  • The federal Centers for Medicare & Medicaid Services (CMS) has written to state Medicaid directors to encourage them to take advantage of a provision in the American Rescue Plan that authorizes their programs, beginning on April 1, 2022, to provide 12 months of postpartum Medicaid coverage to pregnant women enrolled in either their Medicaid or CHIP programs.  Learn more from the CMS letter to state Medicaid directors.  Pennsylvania announced in August that it would extend this coverage.
  • CMS has sent a letter to state Medicaid directors to help them understand provisions in the Consolidated Appropriations Act of 2021 that include new reporting requirements for non-disproportionate share hospitals (DSH) supplemental payments and a change in the methodology for calculating hospital-specific DSH limits.  See that letter here.
  • DHS has issued a news release elaborating on Pennsylvania’s spending plan for approximately $1.2 billion in enhanced federal Medicaid funding made available to states through the American Rescue Plan Act.  This funding will support Medicaid’s home and community-based services system throughout the state.  Learn more from this DHS news release.

Department of Health

  • The Department of Health (DOH) has issued a seasonal influenza update urging providers to encourage their patients to receive flu vaccines, offering treatment recommendations, and reminding providers that they are required to report flu cases to the state.  Learn more in this department influenza update and reminder health alert.
  • DOH has updated two health alerts, PA-HAN-609 and PA-HAN-610, to clarify that the visitation guidance from the department applies only to skilled nursing facilities and that other types of facilities, such as personal care homes, assisted living facilities, and intermediate-care facilities, should seek guidance from their licensing agencies when it comes to COVID-19 visitation policies.
  • DOH has distributed communication that it received from the Centers for Medicare & Medicaid Services informing states that the federal government will not be enforcing the health care provider vaccination mandate while federal litigation is pending.

COVID-19:  By the Numbers

  • Daily COVID-19 case counts remain near their highest levels since the beginning of the pandemic.  To date, more than 1.8 million Pennsylvanians have contracted COVID-19.
  • The number of new COVID-19-related deaths also remains high.
  • All 67 Pennsylvania counties continue to experience a high rate of COVID-19 transmission.
  • The number of Pennsylvanians hospitalized because of COVID-19, in hospital ICUs because of COVID-19, and on ventilators because of the virus all rose sharply in the past week.
  • These numbers reflect the growing rate of occupancy in the state’s hospitals.  There currently are only 481 unoccupied adult ICU beds – 13.5 percent of the total of such beds in the state; 2019 unoccupied medical/surgical beds – 10 percent of such beds in the state; 29 pediatric ICU beds (7.7 percent); 234 pediatric beds (20.8 percent); and 919 airborne isolation beds (29.1).
  • Media reports confirm the challenges some communities and hospitals are facing, including this report on the situation at the nine hospitals that constitute Geisinger Health; this report on the situation in Allegheny County; this report on the situation in the Erie area; and this report on the situation throughout Pennsylvania.
  • The Department of Health reports that 6.7 million Pennsylvanians, excluding those in Philadelphia, are now fully vaccinated; it appears likely, although not certain, that this figure reflects the original concept of “fully vaccinated” and not whether such individuals have received boosters.  Philadelphia’s Department of Public Health reports slightly more than one million people fully vaccinated and that nearly 170,000 boosters have been administered to city residents since August 13.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has established minimum qualifications for the positions of project director, facility director, clinical supervisor, counselor, and counselor assistant but these regulations permit persons to meet those qualifications with a degree in an “other related field.”  In Licensing Alert 03-2021 the department lists “other related fields” that meet qualifications and notes that this list is not necessarily all-inclusive and that the department will review those degrees on a case-by-case basis.  Find the licensing alert here.

The Department of Drug and Alcohol Programs has published its long-delayed, much discussed final standards for drug and alcohol recovery house licensure.  Find them in this Pennsylvania Bulletin notice.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has published its annual report on the financial performance of the state’s non-general acute-care hospitals, including rehabilitation hospitals, psychiatric hospitals, long-term acute-care hospitals, and specialty hospitals.  Learn more from this PHC4 news release and the report itself.  PHC4 also offers download data from the report in Excel format.

2021-12-10T21:44:43+00:00December 10th, 2021|Coronavirus, COVID-19, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off on PA Health Policy Update for the Week of December 6-10
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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.

House Chamber of the State HouseLegislative 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

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

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:

 

 

2021-07-06T03:16:48+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 on PA Health Policy Update for the Week of June 28-July 2
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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.

2021-03-23T06:00:52+00:00March 23rd, 2021|Federal Medicaid issues|Comments Off on MACPAC Issues Recommendations to Congress
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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 logoThe 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.

2021-02-05T17:20:29+00:00February 5th, 2021|Coronavirus, COVID-19, Federal Medicaid issues, Medicare|Comments Off on SNAP Asks PA Delegation for Help From COVID-19 Relief Bill
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MACPAC Meets

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

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

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

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

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

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

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

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

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

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

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

Supporting the discussion were the following briefing papers:

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

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

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

 

2021-02-02T06:00:35+00:00February 2nd, 2021|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off on MACPAC Meets
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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.”

2020-12-15T06:00:16+00:00December 15th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on GAO: CMS Should Pay More Attention to States’ Financing of Medicaid
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Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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