long-term care Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for December 15

The following is an update of selected state health policy developments in Pennsylvania from December 11 – 15. (Some of the language used below is taken directly from state documents.)

FY 2023-2024 Budget

The General Assembly and Governor Shapiro enacted the remaining pieces of the FY 2023-2024 budget this week, including the Fiscal Code – House Bill 1300. The enactment of the Fiscal Code will enable approximately $1.1 billion that has been delayed since July to begin to be distributed. This includes $50 million for hospital financial relief, tobacco settlement funds, etc. Find a summary of the various provisions in the Fiscal Code here.

Governor Shapiro

Governor Shapiro signed several bills into law this week. Following is a selection of health care-related laws enacted.

Senate Bill 414 (Act 59 of 2023) authorizes the establishment of Sexual Assault Nurse Examiner (SANE) programs by hospitals, mandates the creation of a comprehensive list of such programs, and authorizes a grant program to establish and support SANE services.

Senate Bill 683 (Act 43 of 2023) requires drug screening for fentanyl and xylazine, if a drug screening is conducted in a general acute care hospital to assist in diagnosing a patient’s condition.

Senate Bill 941 (Act 66 of 2023) enables certain flexibilities for addiction treatment providers.

House Bill 1131 (Act 50 of 2023) removes the requirement for counties to operate state health centers in counties establishing their own local health departments.

General Assembly

The state House of Representatives and Senate convened for their final voting session of 2023 this week. In addition to the bills noted above that were enacted by the General Assembly and the governor, following is an overview of selected health care-related legislative activity from this week.

The House of Representatives passed House Bill 1585, which establishes access and coverage for tele-dentistry in Pennsylvania, by a vote of 163-40. The bill will now be sent to the Seante for consideration.

The House of Representatives amended House Bill 181, known as the Family Medical Leave Act, on second consideration. The bill was subsequently referred to Appropriations and re-reported as amended. The bill still needs to be passed on third and final consideration before heading to the Senate.

The House Health Subcommittee on Health Care met on Wednesday, December 13 for an informational meeting on the “cannabis regulatory landscape.” Find a recording of the proceeding here.

Department of Human Services

The Department of Human Services (DHS) has announced the addition of interprofessional consultation services to the Medical Assistance (MA) program fee schedule. These changes are effective for dates of services on and after January 1, 2024. Find additional information in this Pennsylvania Bulletin notice.

The public comment period for Pennsylvania’s proposed 1115 waiver application – Bridges to Success: Keystones of Health for Pennsylvania – is open through January 2, 2024. During this period, interested stakeholders can review the draft waiver application and provide comments online, in writing via mail, during multiple advisory and stakeholder meetings, or through three upcoming virtual forums. Those details can be found here.

DHS has issued a Medical Assistance Bulletin to inform providers about updates to the Medical Assistance (MA) program fee schedule related to the administration of COVID-19 vaccines.

DHS has published revisions to the participating drug company list for the Medicaid Drug Rebate Program. These changes are effective January 1, 2024.

DHS has released its report on Medicaid managed care enrollment in Pennsylvania for the month of October.

DHS has published an updated Medicaid Managed Care Organization (MCO) Directory.

Department of Health

The Department of Health (DOH) has sent a message to long-term care facilities regarding the methodology for calculating staffing ratios for licensed practical nurses (LPNs) and nurse aides. The new methodology will go into effect January 1, 2024.

DOH has published an addendum to its solicitation for substance use disorder navigation services to increase emergency department capacity. Find the addendum and additional information regarding the solicitation here.

DOH has asked health care providers to report individuals with blood lead levels of 3.5 μg/dL or higher detected through venous, capillary or unspecified testing within three months after consuming a WanaBana, Schnucks, or Weis brand cinnamon applesauce or apple purée product containing cinnamon by securely emailing the following information to RA-DHBOE-RESPONSE@pa.gov or by fax: 717-772-6975. Find additional information in this Health Advisory issued by DOH.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has published its 2022 Hospital Performance Report. The report includes risk-adjusted, hospital-specific mortality and readmission ratings as well as volume of cases and average charges for patients discharged from Pennsylvania’s acute care hospitals between October 1, 2021, through September 30, 2022

State Board of Medicine

The State Board of Medicine has published proposed rulemaking submitted by the Board of Medicine effectuating Act 79 of 2021, which among other things, enables physician assistant written agreements to be effective upon being filed rather than approved. Find additional information in this Pennsylvania Bulletin notice.

Department of Labor & Industry

The Department of Labor & Industry has determined the maximum compensation payable under the Workers Compensation Act shall be $1,325 per week for injuries occurring on or after January 1, 2024. Find additional information in this Pennsylvania Bulleton notice.

Medicaid Continuous Coverage Unwinding

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.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

Stakeholder Events

Pharmaceutical Assistance Board – December 18

The Department of Aging Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, December 18 from 1 p.m. to 2:30 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-12-18T16:30:15+00:00December 16th, 2023|long-term care, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for September 29

The following is an update of selected state health policy developments in Pennsylvania from September 25 – 29. (Some of the language used below is taken directly from state documents.)

Governor Shapiro

Governor Shapiro announced the launch of a new economic development strategy this week that aims to make Pennsylvania a leader in job creation and innovation. Tuesday’s announcement was the first step in creating the state’s first comprehensive economic growth strategy in almost two decades. The strategy will be an assessment of the areas of strength, an analysis of barriers to growth, and concrete goals and initiatives to guide policymaking and investment decisions moving forward.

General Assembly

The state House of Representatives convened in Harrisburg this week. The following is an overview of selected health care focused legislative activity.

- The Health Committee met on Wednesday, September 27 and favorably reported, among other bills and resolutions, House Resolution 143, which directs the Joint State Government Commission to study Pennsylvania’s response to COVID-19. Find a recording of the hearing here.

- The Aging & Older Adult Services Committee met on Wednesday, September 27 and favorably reported, among other bills, House Bill 1527, which increases the personal needs allowance for Medical Assistance-eligible residents living in nursing facilities, and House Resolution 165, which directs the Legislative Budget and Finance Committee to examine the effect of workforce shortages on state-supported Medicaid home and community-based services waiver programs. Find a recording of the hearing here.

The state House of Representatives and Senate will convene in Harrisburg next Monday, October 2 through Wednesday, October 4 for voting session.

The House Health Subcommittee on Health Facilities will hold an informational meeting on Wednesday, October 4 at 9:00 a.m. to examine hospital closures and consolidation.

The House Human Services Committee and Aging & Older Adult Services Committee will hold a joint informational meeting on Wednesday, October 4 at 9:00 a.m. on personal care homes and assisted living facilities.

Department of Human Services

The Department of Human Services (DHS) has published a notice in the Pennsylvania Bulletin announcing the addition of new procedures codes to the Medical Assistance (MA) program for vaccine administration.

DHS has issued a Medical Assistance Bulletin to notify dental providers of updates to the 2023 Pediatric Dental Periodicity Schedule.

Insurance Department

The Pennsylvania Insurance Department has announced the 2024 individual and small group Affordable Care Act (ACA) health insurance rates. The open enrollment period for Pennsylvania’s state-based insurance exchange, Pennie, will be November 1 to December 15.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has published its annual list of 35 diseases, procedures, and medical conditions for which data shall be required. Find the comprehensive list in this Pennsylvania Bulletin notice.

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.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

Stakeholder Events

Pharmaceutical Assistance Advisory Board – October 2

The Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, October 2 from 10:00 a.m. to 11:30 a.m. Find information on how to participate in this Pennsylvania Bulletin notice.

Interstate Commission of Nurse Licensure Compact Administrators – October 17

The Interstate Commission of Nurse Licensure Compact Administrators will host a free webinar on October 17 from 3:00 – 4:00 p.m. to discuss the nurse licensure compact and new rules taking effect in 2024, answer questions nurse employers often have, and explain Nursys.com and Nursys e-Notify. Find additional details and instructions on how to participate here.

DOH – Traumatic Brain Injury Advisory Board Meeting – November 3

The Traumatic Brain Injury Advisory Board will hold a public meeting on Friday, November 3 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person at the Pennsylvania Training and Technical Assistance Network, 6340 Flank Drive, Harrisburg, PA in the Cambria conference room. Find additional information in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-09-29T19:55:37+00:00September 29th, 2023|long-term care, Medicaid Eligibility Redetermination , Meetings and notices, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for August 11

The following is an update of selected state health policy developments in Pennsylvania from August 7 – 11. (Some of the language used below is taken directly from state documents.)

General Assembly

The House Professional Licensure Committee held a public hearing Monday, August 7 on HB 1000, which seeks to provide prescription authority to psychologists who complete specialized training. A recording of the hearing can be viewed here.

Department of Human Services

The Department of Human Services (DHS) has issued Provider Quick Tip #263 with updated information regarding the electronic submission process for Office of Medical Assistance Fee-for-Service (FFS), Office of Long-Term Living (OLTL), and long-term care 180-day exception requests requiring documentation.

The Office of Mental Health & Substance Abuse Services (OMHSAS) has reminded stakeholders that its application is still open for qualified entities to request funding to invest in technology and training for behavioral health telehealth providers. Organizations with 51 or more employees are ineligible. The application deadline is December 31, 2023. Learn more about this funding opportunity here.

Department of Health

The Department of Health (DOH) and the Department of Drug and Alcohol Programs (DDAP) have requested that organizations who plan to request fentanyl and xylazine test strips complete “pre-order” information here. DOH, DDAP, and the Commission on Crime and Delinquency are working to establish a new program that can provide organizations with a supply of test strips at no cost. Organizations that make a request through the pre-order form will be contacted when orders can be filled.

DOH has issued a Health Advisory (PAHAN – 714) notifying clinicians of recently identified variant influenza viruses (A H1N2v and A H3v) in the U.S. The advisory also contains diagnosis and reporting guidance for clinicians.

Department of Aging

The Department of Aging has announced the state’s 52 Area Agencies on Aging (AAAs) will be hosting in-person listening sessions in all 67 counties to gather input on Pennsylvania’s Master Plan for Older Adults – a 10-year strategic plan designed to transform infrastructure and coordination of services for older Pennsylvanians.

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.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

PA Safety Net Admin2023-08-11T18:45:22+00:00August 11th, 2023|long-term care, Medicaid Eligibility Redetermination , Pennsylvania Medicaid|Comments Off

PA Health Policy Update for April 28

The following is an update of selected state health policy developments in Pennsylvania from April 24 -28. (Some of the language used below is taken directly from state documents.)

Medicaid Eligibility Redetermination

Medicaid unwinding has officially begun, and recipients will begin to receive their renewal packets and additional communications from the Department of Human Services 90 days prior to their individual renewal date. Individuals can view their renewal dates in COMPASS and can begin the renewal application online up to 60 days early. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

General Assembly

The state House and Senate returned to Harrisburg on April 24 for voting session. Below is coverage of selected health-related committee proceedings.

- The Senate Consumer Protection and Professional Licensure Committee held a public hearing Monday, April 24 at 10:00am on professional licensing delays in health care. A recording of the hearing can be viewed here.

- The House Insurance Committee held a voting meeting on Monday, April 24 to consider, among other bills, SB 8 which 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. The bill advanced from committee and received a unanimous vote on final passage in the House. SB 8 will move to the Governor’s desk for his consideration upon signature in the Senate.

- The Senate Veteran Affairs and Emergency Preparedness Committee held a voting meeting to consider SB 81, which codifies the ability for EMS providers to leave a dose of Naloxone with an on-scene caregiver. The bill now moves to the full Senate for consideration. A recording of the meeting can be viewed here.

- The House Health Committee held an informational meeting Wednesday, April 26 on unregulated intoxicants and psychoactive substances. A recording of the hearing can be viewed here.

- The House Human Services Committee held a voting meeting Wednesday, April 26 to consider the following bills.
  - HB 409, which would establish a mental health care services clearinghouse. The bill was reported without amendment.
  - HB 754, which would provide a standard notice to each nursing home resident and their designated representatives at the time of their admission that they have the option of having legal representation to assist with the application for Medicaid benefits. The bill was re-referred to the House Health Committee.

A recording of the meeting can be viewed here.

- The House Professional Licensure Committee held an informational meeting on the Bureau of Professional and Occupational Affairs. A recording of the meeting can be viewed here.

The state House and Senate will return to Harrisburg for voting session Monday, May 1. Following are selected health-related proceedings.

- The House Health Committee will hold a public hearing Tuesday, May 2 at 9:30am on HB 106, the Patient Safety Act, which sets nursing ratios. The hearing will be held in Room 523 of the Irvis Office Building and can be live streamed here.

- The Senate Health and Human Services Committee is holding a voting meeting on Tuesday, May 2 at 11:00 to consider among other bills:
  - SB 100, Establishing the Lyme Disease and Related Tick-Borne Illness Diagnosis and Treatment Act.
  - SB 262, Amends the Maternal Mortality Review Committee Act regarding reportable events.
  - SB 414, Expanding access to Sexual Assault Nurse Examiners (SANE).
  - SB 500, Provides for Medicaid Coverage for Pasteurized Donor Human Milk.
  - SB 549, Requires consent for pelvic, rectal, and prostate exams.
  - SB 555, Reducing the loaded mileage requirements for EMS Medicaid reimbursement.

The meeting will be held in Room 8E of the East Wing and will be livestreamed here.

Department of Health

The Department of Health issued a Health Alert (PAHAN – 693-04-28) with updated recommendations regarding the Monovalent and Bivalent mRNA COVID-19 vaccines.

Department of Human Services

The Department of Human Services (DHS) issued a press release highlighting how the Shapiro administration has reduced the backlog for Medicaid provider enrollment from 34,682 applicants waiting more than 30 days to less than 8,500. The press release notes the backlog has been reduced by 75 percent in the administration’s first 100 days.

DHS has shared the following presentations used at the Medical Assistance Consumer Subcommittee meeting on April 26

DHS has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of April.

DHS has issued Provider Quick Tip (#263) with an update notifying providers that the electronic submission process for Office of Medical Assistance Fee-for-Service (FFS) and the Office of Long Term Living’s 180-day exception requests and other claims requiring documentation is available in the PROMISe Portal.

DHS has shared the following presentations used at the Medical Assistance Advisory Committee (MAAC) meeting on April 27

Stakeholder Events

PHC4 –Executive Committee & Council Meeting – May 4

The Pennsylvania Health Care Cost Containment Council (PHC4) has scheduled an executive committee meeting at 9:30 a.m. and a council meeting at 10:00 a.m. on May 4, 2023. Go here for additional information and details on how to register to participate.

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.

PA Safety Net Admin2023-04-28T20:48:32+00:00April 28th, 2023|long-term care, Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Uncategorized|Comments Off

PA Health Policy Update for February 17

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

General Assembly

The state House of Representatives will convene for session on Tuesday, February 21 at 12:00 p.m. The state Senate is scheduled to return on Monday, February 27.

Department of Human Services

The fee-for-service subcommittee of the Department of Human Services (DHS) Medical Assistance Advisory Committee met on Wednesday, February 8. See the presentation made by Office of Medical Assistance officials during that meeting.
DHS’s Office of Long-Term Living offered a presentation during the February 14 meeting of the Medical Assistance Advisory Committee’s long-term services and supports subcommittee. Find that presentation here.
DHS has published a notice of its funding allocation for FY 2023 inpatient disproportionate share hospital (DSH) payments to qualifying inpatient acute-care general, psychiatric, and rehabilitation hospitals and qualifying psychiatric and rehabilitation units of acute-care general hospitals; outpatient supplemental payments to qualifying inpatient acute-care general hospitals; direct medical education payments to qualifying inpatient acute-care general hospitals; and certain DSH and supplemental payments to new hospitals. It is not otherwise changing the qualifying criteria or payment methodology for these payments. These payments will amount to $257.76 million in total funds. Learn more from this Pennsylvania Bulletin notice.
DHS has published a notice of its funding allocation for DSH payments to qualifying acute-care general hospital burn centers, to qualifying acute-care general hospitals providing obstetrical and neonatal services, to critical access and qualifying rural hospitals, and to qualifying acute-care general hospitals that treat a high percentage of Medical Assistance patients under 18 years of age. Together, the payments amount to $107.655 million in total state and federal funds. Learn more from this Pennsylvania Bulletin notice.
DHS has published procedure codes and payment rates for the administration of the Pfizer and Moderna bivalent booster dose of the COVID-19 vaccines. Find the codes, the rates, and their effective dates in this Pennsylvania Bulletin notice.
DHS’s Office of Long-Term Living has informed stakeholders that the Centers for Medicare & Medicaid Services has approved renewal of the Community HealthChoices waiver, effective January 1, 2023, for five years. See the DHS message here.
DHS has published a notice announcing that it will increase fees in the Medical Assistance Program for certain ambulance transportation services in both the fee-for-service and managed care delivery systems, effective with dates of service on and after January 1, 2023. Those fees will be not less than $325 for basic life support ambulance transportation services, not less than $400 for advanced life support ambulance transportation services, and not less than $4 per loaded mile for each loaded mile beyond 20 loaded miles for ground ambulance transportation. Learn more from this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has issued a health alert to providers advising them about a possible nation-wide increase in invasive group A streptococcal (iGAS) infections in children. This increase, however, reflects only a return to pre-pandemic levels. The alert includes information about the condition and offers guidance for clinicians and laboratories. Find the alert here.
DOH has published information about its Medical Care Availability and Reduction Error (MCARE) Act surcharge for FY 2023, a per unit assessment of approximately $156.56 payable by June 1. Learn more about the surcharge and the providers to which it applies from this Pennsylvania Bulletin notice.
DOH has published information about its Nursing Home Patient Safety Trust Fund surcharge for FY 2023. That surcharge will be $13.83 per nursing facility bed. Learn more from this Pennsylvania Bulletin notice.
DOH has published a list, as required by regulation, of hospitals that have chosen to exercise their religious or moral beliefs regarding the provision of certain contraception-related emergency services and will instead refer patients to other hospitals to receive such services. Learn more from this Pennsylvania Bulletin notice.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania and the number of new daily deaths in the past week remained at the same levels as last week.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and on ventilators held steady over the past week while the number in hospital ICUs declined 25 percent.
The CDC reports a six percent decline in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19.
For the week ending February 15, five Pennsylvania counties experienced a moderate rate of community transmission of COVID-19; 16 counties experienced a substantial rate of community transmission; and the remaining 46 counties experienced a high rate of community transmission – all the same numbers as last week.

Department of Drug and Alcohol Programs

In response to the continuing challenge health care providers are having maintaining an adequate workforce, the Department of Drug and Alcohol Programs is conducting a workforce climate survey among drug and alcohol service providers to learn about which jobs and positions are in short supply or understaffed, the challenges these providers face, what they are doing to address them, and how they think the state can help them address those challenges. Find that survey here.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission has issued comments in response to regulations proposed by the State Board of Nursing that address licensure by endorsement and reactivation. Find those comments in this Pennsylvania Bulletin notice.

Stakeholder Events

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

The consumer subcommittee of the Medical Assistance Advisory Committee will meet virtually on Wednesday, February 22 at 1:00. Learn more from the meeting’s agenda and go here to register to participate.

DHS – Medical Assistance Advisory Committee Meeting – February 23

The Medical Assistance Advisory Committee will meet virtually on Thursday, February 23 at 10:00. For the meeting agenda go here and to register to participate go here.

DHS – Managed Long-Term Services and Supports Subcommittee Meeting – March 1

The Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee will meet in Harrisburg on Wednesday, March 1 at 10:00. For information on the location of the meeting or how to participate virtually, see this DHS notice.

Department of Aging – Pennsylvania Long-Term Care Council – March 9

The Department of Aging’s Long-Term Care Council will meet in Harrisburg on Thursday, March 9 at 10:00. For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates: March 9 and May 16, both at 8:30. This training on adolescent ASAM criteria, to be delivered virtually, is designed 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. 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 the March 9 and May 16 sessions will be identical.

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.

jsteinbock2023-02-17T21:42:53+00:00February 17th, 2023|COVID-19, DSH hospitals, long-term care, Medicaid supplemental payments, Meetings and notices, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for January 27

The following is an update of selected state health policy developments in Pennsylvania from January 21-27. (Some of the language used below is taken directly from state documents.)

General Assembly

The Legislative Budget and Finance Committee (LBFC) met this week and approved the release of a report entitled “Prescription Drug Pricing Under the Medical Assistance Managed Care Program.” Act 120 of 2020 directed LBFC to conduct a study analyzing prescription drug pricing in the Medical Assistance managed care program; review reimbursement practices by PBMs (pharmacy benefit managers) to pharmacies and to PBMs by MCOs; investigate and compare reimbursement rates by PBMs to independent pharmacies and to chain pharmacies; and study state laws and best practices adopted by other states regarding PBMs and pharmacy reimbursement. Find the report here.
Although the House has not adopted a rules package or formally established standing committees for the 2023-2024 legislation session, the Republican caucus announced its selections for committee chairs this week. Representatives Kathy Rapp and Tina Pickett will remain Republican chairs of the Health Committee and the Insurance Committee, respectively, while Doyle Heffley will be the new Republican chair of the Human Services Committee. In addition, Representative Carl Metzger will be the Republican chair of the Professional Licensure Committee, Steven Mentzer will be the Republican chair of the Aging & Older Adult Services Committee, and Linda Schlegel Culver will be the Republican chair of the Children & Youth Committee. Find the full list of Republican committee chairs here.
The state House Democratic Policy Committee convened in Pittsburgh for an informational hearing examining the health care staffing crisis. Find the meeting agenda and testimony offered during the hearing here.

Department of Human Services

The Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) has issued a bulletin providing guidance for the implementation of Act 65 of 2020, which governs who can provide consent for voluntary mental health treatment of minors who are 14 years of age and less than 18 years of age in both inpatient and outpatient settings. Act 65 also addresses which individuals may grant consent for the release of a minor’s medical records. Find that bulletin here.
DHS has issued a Medical Assistance Bulletin informing providers that it has increased fees for certain ambulance transportation services on the Medical Assistance fee schedule effective with dates of service on or after January 1, 2023. Find that bulletin here.
DHS has published final notice of the assessment amount, the assessment methodology, and the estimated aggregate impact on nursing facilities that will be subject to the Nursing Facility Assessment Program for FY 2023. Learn more about which types of facilities to which the assessment applies and how much their 2023 assessment will be from this Pennsylvania Bulletin notice.
At the January 26 meeting of the Medical Assistance Advisory Committee, DHS’s Office of Long-Term Living offered a presentation on the efforts of the managed care plans that serve Community HealthChoices members to redetermine the eligibility of their current participants in the wake of the upcoming end of continuous Medicaid eligibility and vaccination rates among Community HealthChoices participants. Find that presentation here.
DHS has updated its physical health managed care enrollment report.

Department of Health

Pennsylvania’s Executive Board has approved a reorganization of the Department of Health. Find an organizational chart that reflects this reorganization in this Pennsylvania Bulletin notice.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania held steady over the past week, remaining higher than prior to Thanksgiving, and the number of new daily deaths rose more than 50 percent over the past week after a decline of 50 percent the week before.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined seven percent last week after a 14 percent decline the previous week; the number on a ventilator because of the virus remained steady; and the number in hospital ICUs fell 15 percent after a six percent decline the week before.
The CDC reports a slight decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
As of January 25, four Pennsylvania counties are experiencing a moderate rate of community transmission of COVID-19; 15 counties are experiencing a substantial rate of community transmission; and the remaining 48 counties are experiencing high rates of community transmission.

Stakeholder Events

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.

Department of Health – Organ Donation Advisory Committee Meeting – February 2

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting on Thursday, February 2 at 10:00. The purpose of the meeting is to review progress in the area of organ and tissue donation in Pennsylvania, recommend education and awareness activities, recommend priorities in expenditures from the Organ and Tissue Donation Awareness Fund, and advise the Department of Health on matters involving administration of that fund. Interested parties may attend in person or virtually. For further information about the meeting and how to attend, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – February 3

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Harrisburg on Friday, February 3 at 10:00. Meeting materials will be sent out before the meeting and will also be available on the board’s web and at the meeting location. For further information about the meeting and its location, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates: March 9 and May 16, both at 8:30. This training on adolescent ASAM criteria, to be delivered virtually, is designed 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. 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 the March 9 and May 16 sessions will be identical.

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.

jsteinbock2023-01-27T21:38:47+00:00January 27th, 2023|COVID-19, long-term care, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for January 20

The following is an update of selected state health policy developments in Pennsylvania from January 14-20. (Some of the language used below is taken directly from state documents.)

Governor Shapiro

Josh Shapiro was sworn in as Pennsylvania’s 48^th governor on Tuesday. Much of the governor’s inaugural speech focused on preserving democracy. He also highlighted the need for unity and emphasized bringing people together. Find a transcript of the governor’s speech here.
On Wednesday Governor Shapiro issued his first executive order, which prioritizes work experience, skill, and competency for state jobs and highlights that 92 percent of the state’s jobs do not require a four-year college degree.
Information about the Shapiro administration’s health-related agency nominees can be found here and a complete list of the Shapiro administration appointments made to date can be found here.

General Assembly

The state Senate convened for voting session this week and the House briefly convened for non-voting session. Both chambers are now recessed. The Senate is scheduled to return on Monday, February 27 while the House has yet to release a session calendar.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin rescinding Medical Assistance Bulletin 01-22-78, titled “340B Drug Pricing Program – Dispensing 340B Purchased Drugs,” which was issued on December 22, 2022. Instead, Medical Assistance Bulletin 99-13-08, titled “340B Drug Pricing Program Provider Requirements and Billing Instructions – Pharmacy Services,” remains in effect. Go here to see the new bulletin rescinding the December 22 version.
DHS has extended its calendar for Remittance Advice (RA) notifications and the delivery of electronic payments and checks into early March. Find the updated calendar here.
DHS has issued a Medical Assistance Bulletin informing providers that it has added CPT codes 0124A, 0154A (Pfizer) and 0134A, 0144A (Moderna) to its fee schedule for the administration of a bivalent booster dose COVID-19 vaccine. Find the bulletin here.
DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has written to stakeholders informing them that it has extended until March 31 its requirement that providers capture consent to treat, service verifications, and approval of treatment plans for Medicaid-funded behavioral health services delivered via telehealth. At the end of this period providers must have an electronic capability to secure auditable electronic signatures for consent and service verification. Learn more from OMHSAS’s message to stakeholders.
DHS has informed stakeholders that Jennifer (Jen) Smith has joined the department as deputy secretary for OMHSAS. Smith previously served as Secretary of the Department of Drug and Alcohol Programs. Learn more from DHS’s message to stakeholders.
DHS has posted information about an electronic submission process for Medicaid fee-for-service 180-day exception requests and other claims requiring documentation that will soon be available in the PROMISE portal. Find that information here.
DHS has updated its Medicaid managed care organization directory.
DHS has published its peer groups, peer group medians, and peer group prices for non-public nursing facilities, including hospital-based nursing facilities and special rehabilitation facilities. DHS used these peer groups, peer group medians, and peer group prices to determine case-mix rates for non-public nursing facilities for FY 2023. Learn more from this Pennsylvania Bulletin notice.
DHS has published its final annual case-mix per diem payment rates for FY 2023 for non-public and county nursing facilities that participate in the Medical Assistance program. Learn about those rates from this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has updated its telemedicine interpretive guidance for hospitals. Find the updated guidance here.
DOH has updated its FAQ on innovative care models for hospitals. Find the updated FAQ here. The changes, which address critical access hospitals and small rural hospitals, are highlighted in red.
DOH has updated its criteria and guidance for establishing an outpatient emergency department. The changes, which address critical access hospitals, small rural hospitals, and rural emergency hospitals, are highlighted in red. Find the updated guidance here.
DOH also has updated its matrix on how facilities can qualify as an innovative hospital model. Find the updated matrix here. Changes again are highlighted in red.
DOH has issued guidance requiring prospective new owners of skilled nursing facilities to inform facility residents, representatives, and employees of the possibility of a change of ownership of the facility. Learn more from this DOH guidance.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania declined 27 percent over the past week and the number of new daily deaths, after a 50 percent increase a week ago, returned this week to its level of recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined nearly 14 percent last week after an 11 percent decline the previous week; the number on a ventilator because of the virus rose nine percent; and the number in hospital ICUs fell six percent.
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 18, four Pennsylvania counties are experiencing a moderate rate of community transmission of COVID-19; eight counties are experiencing a substantial rate of community transmission; and the remaining 55 counties are experiencing high rates of community transmission.

Health Care Cost Containment Council (PHC4)

PHC4 is beginning the verification process for hospital self-pay records for fiscal year 2021. Its self-pay data reconciliation web application on the PHC4 portal enables hospitals to reconcile their self-pay records, which eventually will be provided to DHS to be used as a part of its calculation of the extraordinary expense portion under Act 77 (the state’s 2001 tobacco settlement law). Find PHC4’s letter to hospitals here and the portal for self-pay records here.

Stakeholder Events

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.