Medical Assistance Bulletin Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for September 12

The following is an update of selected state health policy developments in Pennsylvania from September 8- 12 (Some of the language used below is taken directly from state documents).

Budget Update

The state budget impasse continues, more than ten weeks past the constitutional deadline. Senate Majority Leader Pittman told reporters this week that he is “encouraged by the meaningful work at the negotiating table” but there is no agreement on a final budget at this time. Various potential budget-related bills continue to be positioned in order for a completed budget to be passed within a few days of a budget deal being reached. The Senate stands in recess to the call of the President Pro Tempore and the House stands adjourned until Monday, September 22, 2025 unless sooner recalled by the Speaker.

General Assembly

The Senate met for voting session this week. The following is a summary of health care related legislative activity:

The Senate passed SB 381 that would prohibit the use of commonwealth funding for certain animal testing activities in research facilities. The bill will be sent to the House for consideration.

The Senate Consumer Protection and Professional Licensure committee favorably reported SB 507 with amendments. The bill provides for licensure of certified midwives, allows them to prescribe treatment for opioid use disorder, and seeks to modernize the collaborative agreement structure for midwives.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) issued comments on the State Board of Nursing’s proposed regulations for the certified registered nurse anesthetists. See IRRC’s comments in this Pennsylvania Bulletin notice. The nursing board is required to address IRRC’s comments and questions when issuing its final form regulations.

Department of Human Services

The Department of Human Services (DHS) updated its list of Remittance Advices with information on a new ADA claim form that should be used for dental claims with dates of service after November 1, 2025. See the alert here.

DHS issued its 2024 Annual Report from the Bureau of Human Services Licensing, which licenses personal care homes and assisted living residences. The report shows data on the number of facilities, patient census and demographics, and facility incidents and complaints. Click here for the full report.

The Office of Long-Term Living is accepting statements of interest from new and existing Living Independence for the Elderly (LIFE) program operators to serve 12 counties that do not yet have LIFE program services available for seniors age 55 and older. Click here to view the announcement in the Pennsylvania Bulletin with instructions on how to request information about the application and evaluation process.

DHS issued an Medical Assistance Bulletin with updates to the Dental Fee Schedule. These updates include revised frequency and unit limitations for several codes as well as a change in age limits for two codes. These changes are considered effective as of August 1, 2025.

Around the State

An article from the Penn Capital Star explores the ways in which health care providers in Pennsylvania are already responsibly using artificial intelligence (AI) amid discussions from lawmakers to introduce legislation to regulate AI use in health care.
ABC27 describes the geographic split that may be compounding the political split between legislative leaders as the budget impasse wears on. With caucus leaders from opposite sides of the commonwealth and regional transit funding issues at the core of negotiations, “There’s no question geography of the membership and leadership members has played a role,” said Senate Minority Leader Jay Costa (D-Allegheny).
Though it is not an unusual financing move for many school districts, the Philadelphia district this week voted to borrow up to $1.55 billion (WHYY) to support services during the state budget impasse. Because of the lack of state and federal funds, this year’s borrowed amount is $1 billion more compared to previous years, costing millions more in interest payments for the district.

Stakeholder Meetings

Medical Assistance Advisory Committee (MAAC) – Sept. 25

The DHS Medical Assistance Advisory Committee will meet virtually on September 25, 2025, at 10:00am. To register, click here.

Department of Drug and Alcohol Programs Emerging Drug Trends Symposium – Nov. 18

DDAP will host its 2025 Emerging Drug Trends Symposium on November 18 from 7:00am to 4:00pm at the Penn Harris Hotel & Conference Center in Camp Hill, PA. Attendees will discuss the latest drug use and overdose trends in PA, shifting overdose patterns and drug supply, and evidence-based best practices. Click here to register for this free event.

PA Safety Net Admin2025-09-12T21:51:32+00:00September 12th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for September 5

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

Fiscal Year 2025-26 Budget Update

There was no legislative activity surrounding the state budget this week. Governor Shapiro sent a compromise budget proposal to Senate Republican leadership last week, but they have yet to take any action. The Senate is scheduled to return to session next week on September 8, but that date could be pushed back if an agreement is not ready.

The House stands adjourned until September 22.

Department of Health

The Department of Health (DOH) issued interpretative guidance to clarify staffing regulations for hospitals, allowing for flexible physician coverage models while maintaining patient safety and regulatory compliance. It focuses on on-site, on-call, and telemedicine-based physician coverage requirements. Review the full document here.

Department of State

The State Board of Pharmacy met this week and voted to approve four new entities as “competent authorities” to issue guidelines for licensed pharmacists under 49 PA Code § 27.403 on the use of injectable immunizations. This action was taken in anticipation of changes from the Centers for Disease Control’s upcoming vaccine committee meeting and will permit pharmacists to continue providing COVID-19 vaccinations, which had been paused by some providers. Find a news release about the voting meeting here.

Department of Human Services

The Department of Human Services (DHS) updated its list of Remittance Advices with an updated participating drug company list for the Medicaid Drug Rebate Program. Find the updated list here.

The Offices of Long-Term Living and Medical Assistance Programs issued a Medical Assistance bulletin alerting providers that it will begin issuing electronic visit verification (EVV) alerts to providers whose EVV manual entry percentages exceed 15 percent for the previous quarter. These alerts will be sent directly by DHS for fee-for-service claims and the department will transmit a list of noncompliant providers to the appropriate managed care organizations for awareness and follow up.

The Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) Letter jointly developed by CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA). This SHO provides guidance to states on the best practices for implementing the continuum of crisis services. It describes specific Medicaid and CHIP authorities and flexibilities to support the full continuum of crisis response services and suggests strategies for measuring and monitoring crisis response services.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 released a new interactive map displaying access to care in different counties, called MAPPED 2. This resource includes hospitals, ambulatory surgery centers, and nursing homes. It was designed to help patients, legislators, and health care providers learn more about the health care landscape of Pennsylvania.

Around the State

A Philadelphia judge has directed SEPTA to immediately reverse all service cuts imposed last month. WHYY reports on the decision in this article.
The Penn Capital Star reported on the state pharmacy board’s decision this week to permit additional professional organizations to issue guidance for immunizations.
An article from the Altoona Mirror details the financial strain and difficult decisions that are facing county providers and non-profits now that the state budget is two months late.

Stakeholder Meetings

DHS Statewide Positive Approaches & Practices Conference – September 17

This quarterly meeting is jointly hosted by The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP). It aims to provide the most recent research and resources for people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities to live an everyday life. The meeting is held virtually from 10am to 3pm. For details and registration, click here.

Dual Diagnosis Professional Conference Series – September 18

Jointly hosted by OMHSAS and ODP, this presentation will review the clinical clues for identifying the effects of fetal alcohol spectrum disorder, suggestions for screening, current research, and statistics. The meeting is held virtually from 9am to 12:30pm. Click here to register.

PA Safety Net Admin2025-09-05T19:11:23+00:00September 5th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for May 23

The following is an update of selected state health policy developments in Pennsylvania from May 19 – 13. (Some of the language used below is taken directly from state documents).

Primary Election Update

Voters went to the polls on Tuesday, May 20 for Pennsylvania’s 2025 Primary Election. On the ballot there were judicial candidates seeking to fill vacancies on the Commonwealth and Superior Courts, along with municipal races. Find the Department of State’s unofficial election results here.

General Assembly

The state House of Representatives and Senate were recessed this week. Both chambers are scheduled to return to Harrisburg on Monday, June 2.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin with Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix. This bulletin applies to all providers enrolled in the Medical Assistance program who provide EPSDT screens for Medical Assistance (MA) beneficiaries.

Board of Nursing

The State Board of Nursing has announced that it has adopted temporary regulations, which can be found here, necessary to implement the Nurse Licensure Compact. The temporary regulations are effective upon their publication in the Pennsylvania Bulletin. Additional information about the Nurse Licensure Compact is available on the Department of State’s website here.

Insurance Department

The Pennsylvania Insurance Department (PID), along with the Department of Health, the Department of Human Services, and the Department of Drug and Alcohol Programs (DDAP), has announced the launch of a women’s health survey to identify challenges and questions women have about their health insurance benefits, and to remind women about preventive health services that are available to them at no cost through their insurance.

Independent Fiscal Office

The Independent Fiscal Office (IFO) has released its initial revenue estimate for FY 2025-26. The IFO has estimated Pennsylvania’s General Fund revenues will total $47 billion in FY 2025-26. The IFO has also revised the current fiscal year’s deficit to $3.6 billion, an increase of $280 million. Find the full report here and the IFO’s presentation here.

Around the State

The Tribune-Review has published an article about the potential spike in the number of Pennsylvanians without health insurance that will occur if the reconciliation bill passed by the U.S. House this week moves forward.

Spotlight PA has continued to report about state legislative efforts to implement additional oversight of health care facility mergers and acquisitions.

The mayoral elections that featured prominently in Tuesday’s Primary Election were the focus of an article by City & State Pennsylvania.

Spotlight PA has published an article about the Commonwealth and Superior Court candidates advancing to November’s General Election.

Stakeholder Meetings

DHS – Long-Term Services & Supports Subcommittee – June 4

The Long-Term Services and Supports (LTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold its next public meeting on June 4 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

PA Safety Net Admin2025-05-23T20:21:35+00:00May 23rd, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for May 16

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

Election Update

Pennsylvania’s 2025 Primary Election will be held next Tuesday, May 20. On the ballot there are judicial candidates seeking to fill vacancies on the Commonwealth and Superior Courts, along with municipal races. Find additional election information on the Department of State’s website here.

Governor Shapiro

On Thursday, May 15 Governor Shapiro visited Crozer-Chester Medical Center, which is ceasing operations, in Delaware County to highlight efforts to support impacted workers, maintain emergency medical services, and “hold private equity firms accountable.” Find additional information in this press release.

General Assembly

The state House of Representatives and Senate convened for voting session this week. The following is an overview of selected legislative activity that occurred.

The House of Representatives passed an amended House Bill 561, which while still prioritizing non-narcotic medication-assisted treatment (MAT) expands Act 80 to include all FDA-approved MAT. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 79, which establishes uniform hospital-based financial assistance forms and requirements. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 433, which eliminates out-of-pocket costs for diagnostic imaging related to breast cancer. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 309, which amends the Osteopathic Medical Practice Act to allow team physicians traveling internationally with their club or national team to treat their own players on site during games without needing a Pennsylvania medical license. The bill will now be sent to the Senate for consideration.

The House Health Committee met on Wednesday, May 14 and favorably reported House Bill 704, which establishes the “Pennsylvania Neurodegenerative Disease Research Program.” A recording of the hearing is viewable here.

The House Aging & Older Adult Services Committee held a joint hearing with the House Health Committee on Wednesday, May 14 regarding Pennsylvania’s registered nurse aide program. A recording of the hearing is viewable here.

The Senate Banking & Insurance Committee met on Tuesday, May 13 and favorably reported Senate Resolution 27, which directs the Legislative Budget and Finance Committee to study the feasibility of establishing a no-fault catastrophic loss fund to provide payment for claims brought as the result of birth-related neurological injuries. A recording of the hearing is viewable here.

The House Human Services Committee met on Tuesday, May 13 and favorably reported House Bill 1429, which requires a study on the feasibility of implementing chip-enabled electronic benefit cards (EBT) for the Supplemental Nutrition Assistance Program (SNAP). A recording of the hearing is viewable here.

The Senate Veterans Affairs & Emergency Preparedness Committee met on Monday, May 12 and favorably reported, among other bills, Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed.

The House of Representatives and the Senate are now recessed until Monday, June 2.

Department of Human Services

The Department of Human Services (DHS) has announced it will hold a listening session on May 19 from 1:00 – 2:30 p.m. entitled, “Food is Medicine: Screening and Referral.” This is part of DHS’ Keystone of Health Section 1115 demonstration waiver initiative. The listening session is intended for representatives from health care and other settings that interact with consumers that may be eligible for Food is Medicine programs. Find additional information and register here.

DHS has announced that the Office of Mental Health and Substance Abuse Services (OMHSAS) is conducting a survey, which will be the first step to begin the development of one proposed chapter of licensing regulations for inpatient psychiatric services in psychiatric units of general hospitals, private psychiatric hospitals, and extended acute care services located within those inpatient settings. The survey is for all stakeholders, including licensed providers, and will remain open until May 26. Find the survey here.

DHS has issued a Medical Assistance Bulletin with the U.S. Department of Health & Human Services’ (HHS) Centers for Disease Control and Prevention (CDC) 2025 recommended child and adolescent immunization schedule.

DHS has also issued a Medical Assistance Bulletin to advise dental providers enrolled in the Medical Assistance (MA) program that will accept the 2024 American Dental Association (ADA) claim form effective May 1, 2025.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of June. Find the updated calendar here.

DHS has announced the implementation of the 2025 Federal Poverty Income Guidelines (FPIG), which were issued by HHS and published at 90 FR 5917 on January 17, 2025. Find additional information in this Pennsylvania Bulletin notice.

Around the State

Spotlight PA has written an article about private equity, its role in health care companies, and the scrutiny its drawing from critics. Spotlight also wrote an article about health systems’ opposition to initiatives aimed at implementing more stringent health care transaction oversight.

The Pittsburgh Post-Gazette has published an article about Medicaid cuts being contemplated by Congress and their potential impact on providers in Fayette County.

The Associated Press covered Governor Shapiro’s remarks about the potential impact of Medicaid proposals being considered by Congress.

The Philadelphia Inquirer has reported about this what is anticipated to be this year’s biggest election issue, the retention of three sitting Pennsylvania Supreme Court justices.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – May 21

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on May 21 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – May 22

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on May 22 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

DOH – Spinal Cord Research Committee – May 23

The Spinal Cord Research Advisory Committee will hold a public meeting on Friday, May 23 from 10:00 a.m. to 11:00 a.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-05-16T19:25:46+00:00May 16th, 2025|Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for April 18

The following is an update of selected state health policy developments in Pennsylvania from April 14 – 18. (Some of the language used below is taken directly from state documents).

Governor Shapiro

An arsonist attacked the Governor’s Residence in Harrisburg on Sunday, April 13, which forced the Governor and his family, who were present at the time of the attack, to be evacuated. The suspect has been arrested and formally charged with attempted murder, terrorism, and other charges. Find additional details, and the Governor’s statement on political violence, in this press release.

General Assembly

The state House of Representatives and Senate were recessed this week. The House of Representatives will return to Harrisburg on Tuesday, April 22. The Senate will remain recessed until Monday, May 5.

The House Majority Policy Committee held an informational meeting on Monday, April 14 examining the impact of the life science sector on advanced manufacturing and health care workforce development. Find additional details and a recording of the meeting here.

The House Majority Policy Committee also held an informational meeting on Tuesday, April 15 examining midwifery modernization and maternal health deserts in Pennsylvania. Find additional details and a recording of the meeting here.

The House Insurance Committee has scheduled an informational meeting on Wednesday, April 23 at 9:15 a.m. to examine infertility care in Pennsylvania. The meeting will be held in Room 523 of the Irvis Building and livestreamed here.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers enrolled on the Medical Assistance (MA) program of updates to the MA program fee schedule, including the addition of new procedure codes and the end-dating of certain codes based on provider request and clinical review. These changes will take effect May 1.

DHS has issued a Medical Assistance Bulletin to advise federally qualified health centers (FQHCs) and rural health clinics (RHCs) of the procedure codes, modifiers, and places of service to utilize when billing for covered services provided to Medicaid beneficiaries.

DHS Secretary Val Arkoosh along with other health-related cabinet officials participated in the Western Pennsylvania Regional Rural Healthcare Summit to discuss opportunities and challenges communities face accessing health care services. Find more information in this press release.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of May. Find the updated calendar here.

Department of Health

The Department of Health has announced that an individual from another state tested positive for measles while visiting Lancaster County after a trip to Texas, creating a potential for exposure to others. Find additional details and information about measles from DOH here.

The Newborn Screening and Follow-up Technical Advisory Board had voted to recommend the addition of Metachromatic leukodystrophy (MLD), a lysosomal storage disorder, to the commonwealth newborn screening panel effective January 1, 2026. Find additional information in this Pennsylvania Bulletin notice.

DOH has announced it will hold four public comment sessions to provide stakeholders an opportunity to comment on the development of the 2026 State Plan for the Pennsylvania Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

Around the State

Crozer Health’s ongoing challenges, as well as efforts to transition certain service lines were the subject of an article published by The Philadelphia Inquirer.

PA has published an article about measles, the increasing cases nationally, and growing vaccine hesitancy.

Stakeholder Meetings

DHS – Pharmacy & Therapeutics (P&T) Committee – April 23

The Department of Human Services (DHS) has cancelled the April 23 Drug Utilization Board meeting and will instead hold an ad hoc P&T Committee meeting. Find registration information and details here.

DHS – Consumer Sub-MAAC – April 23

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 23 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – April 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 24 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

The Patient Safety Authority – April 29

The Patient Safety Authority board will hold a public meeting on Tuesday, April 29 at 10:30 a.m. The meeting will be held in person and virtually. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – May 2

The Brain Injury Advisory Board will hold a public meeting on Friday, May 2 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 17112 in the Cumberland conference room. Find additional details in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-04-18T17:47:31+00:00April 18th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for April 11

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

General Assembly

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

The House of Representatives passed House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP). The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 409, which requires health care providers to inform patients that they will be receiving their test results in their electronic health record, or that they can request to receive the results in the mail. The bill will now be sent to the Senate for consideration.

The House Aging & Older Adult Services Committee held an informational meeting on Monday, April 7 to examine potential updates to the Older Adult Protective Services Act (OAPSA). A recording of the meeting is viewable here.

The House Human Services Committee met on Tuesday, April 8 and favorably reported House Bill 561, which expands Act 80 to include all FDA-approved medication assisted treatment, and House Bill 1117, which updates language defining DDAP’s duties and responsibilities. A recording of the meeting is viewable here.

The House Insurance Committee met on Tuesday, April 8 and favorably reported House Bill 433, which eliminates out-of-pocket costs for diagnostic imaging related to breast cancer. A recording of the meeting is viewable here.

The House Health Committee met on Wednesday, April 9 and favorably reported, among other legislation, the following pertinent bills. A recording of the meeting is viewable here.

- House Bill 69, which expands the existing Cancer Drug Repository program to other prescription drugs.
- House Bill 79, which establishes uniform hospital-based financial assistance forms and requirements.
- House Bill 1104, which caps the costs of obtaining electronic medical records.

The House of Representatives and the Senate have now recessed. The House will reconvene Tuesday, April 22 and the Senate will reconvene Monday, May 5.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to remind physicians, physician assistants (PAs), and certified registered nurse practitioners (CRNPs) enrolled in Medicaid that they are able render topical fluoride varnish (TFV) services to Medicaid beneficiaries.

DHS has issued a reminder to all participating Medicaid providers of the need to complete a “MA 112 Form” after the birth of a child to a mother enrolled in Medicaid in order to notify the mother’s respective county assistance office (CAO). The “MA 112 Form” should be completed and submitted within three working days of the child’s birth.

DHS has published final notice of its funding allocation for FY 2024-25 for several classes of inpatient disproportionate share hospital (DSH) and supplemental payments to Medicaid-enrolled, qualifying inpatient acute care general hospitals. Find additional information in this Pennsylvania Bulletin notice.

Around the State

CBS News has published an article about the continued challenges facing Crozer Health in Delaware County. An attorney for Prospect Medical Holdings, the parent company of Crozer, indicated Crozer would start transitioning certain service lines to other providers.

Pennsylvania’s home care industry and its need for additional funding was the focus of an article by Politics PA this week.

The Pennsylvania Capital-Star has published an article about increasing measles cases in the state and some counties’ lagging vaccination rates.

Stakeholder Meetings

DOH – WIC State Advisory Board – April 22

The WIC State Advisory Board will hold a public meeting on April 22 from 1:00 p.m. to 2:00 p.m. The purpose of the meeting is to collaborate to gather suggestions of strategies for increasing participation and improving the WIC program to better support participants. The meeting will be held in person and virtually. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

DHS – Pharmacy & Therapeutics (P&T) Committee – April 23

The Department of Human Services (DHS) has cancelled the April 23 Drug Utilization Board meeting and will instead hold an ad hoc P&T Committee meeting. Find registration information and details here.

DHS – Consumer Sub-MAAC – April 23

DHS – Medical Assistance Advisory Committee – April 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 24 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

DOH – Renal Disease Advisory Committee – April 25

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, April 25 from 10:00 a.m. to 12:00 p.m. The purpose of the meeting is to discuss new and ongoing issues relating to treatment of chronic renal disease and the Department of Health’s programs related to care and treatment. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

The Patient Safety Authority – April 29

PA Safety Net Admin2025-04-11T22:36:44+00:00April 11th, 2025|Governments, Medical Assistance Bulletin, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for April 4

The following is an update of selected state health policy developments in Pennsylvania from March 31 – April 4. (Some of the language used below is taken directly from state documents).

Governor Shapiro

The Shapiro administration has announced it joined a multi-state lawsuit against the Trump administration’s decision to cancel more than $500 million in public health grant funding that supported programs in the Department of Health, Department of Human Services, and the Department of Drug & Alcohol Programs. Find a copy of the lawsuit here and additional information in this press release.

General Assembly

The state Senate convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity.

The Senate passed Senate Bill 347, which prohibits the implementation of safe injection sites throughout the commonwealth, by a vote of 38-11. The bill will now be sent to the House of Representatives for consideration.

The Senate Institutional Sustainability & Innovation Committee held an informational hearing on Tuesday, April 1 examining the commonwealth’s life science sector and Pennsylvania’s innovation economy. A recording of the hearing is and testimony offered to the committee is viewable here.

The Senate Health & Human Services Committee held a voting meeting on Tuesday, April 1 and favorably reported, among other bills, Senate Bill 115, which provides skills competency examination opportunities to individuals seeking employment as a direct caregiver in lieu of successfully obtaining a high school diploma or GED equivalency, and Senate Bill 411, which implements a statewide stroke registry.

The Senate has now recessed until Monday, May 5. The state House of Representatives will reconvene Monday, April 7 through Wednesday, April 9.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that DHS is implementing an alternative payment methodology for federally qualified health centers (FQHCs) and rural health clinics (RHCs) for a supplemental payment at the Medicaid fee schedule rate for a long-acting reversible contraceptive (LARC) device and its insertion, or the removal of a LARC device.

DHS has announced a recent audit uncovered recipient date of death discrepancies and a claims recovery was completed to recoup monies paid in error. DHS also reminded providers that it is their responsibility to resubmit a correctly completed claim if they are due payment for services provided prior to the date of death. Find the notice here.

Revenue Collection Update

The Department of Revenue has announced Pennsylvania collected $6.2 billion in General Fund revenue in March, which was $70.0 million, or 1.1 percent, more than anticipated. Fiscal year-to-date General Fund collections total $33.2 billion, which is $34.3 million, or 0.1 percent, below estimate.

Board of Pharmacy ission,

The State Board of Pharmacy has published a notice in the Pennsylvania Bulletin of the current income levels necessary for participation in the Cancer Drug Repository program.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has published a notice in the Pennsylvania Bulletin that it has received the following final form rulemaking which will be considered at its May 15 meeting.

IRRC has also published a notice in the Pennsylvania Bulletin announcing it has issued comments to the State Board of Nursing regarding its proposed rule on nursing education programs issued January 25, 2025. Find IRRC’s comments here.

Around the State

The Philadelphia Inquirer has published an article about Independence Blue Cross’, the largest health insurer in southeastern Pennsylvania, reported financial loss in 2024 due, in part, to Medicare and Medicaid rates.

Governor Shapiro’s decision to join a multi-state lawsuit against the Trump administration’s decision to cancel public health grant funding was reported by the Pennsylvania Capital-Star.

The Pennsylvania Capital-Star also published an article about the potential impact Medicaid cuts at the federal level may have on rural health care access.

Spotlight PA has published an article about the Department of Aging’s decision to revise a policy that previously required the tracking of the cause of death for every adult who died during an active abuse or neglect investigation.

Stakeholder Meetings

DHS – Pharmacy & Therapeutics (P&T) Committee – April 23

The Department of Human Services (DHS) has cancelled the April 23 Drug Utilization Board meeting and will instead hold an ad hoc P&T Committee meeting. Find registration information and details here.

PHC4 – Meeting Schedule

The Pennsylvania Health Care Cost Containment Council (PHC4) has scheduled a Payment Data Advisory Group meeting for April 10 at 1:00 p.m., a Data Systems Committee meeting for April 15 at 10:00 a.m., an Education Committee meeting for April 23 at 10:00 a.m., and a Council meeting for May 1, 2025, at 10:00 a.m. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-04-04T20:41:43+00:00April 4th, 2025|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for February 21

The following is an update of selected state health policy developments in Pennsylvania from February 17 – 21. (Some of the language used below is taken directly from state documents).

General Assembly

The state House of Representatives and Senate began hearings on Governor Shapiro’s FY 2025-26 budget proposal this week. The following are the health-related agency budget hearings that occurred this week.

The Department of Health appeared before the Senate Appropriations Committee on Wednesday, February 19. A recording of that hearing is viewable here.

The Department of Health and the Department of Drug & Alcohol Programs appeared before the House Appropriations Committee on Friday, February 21. A recording of that hearing is viewable here.

The House of Representatives and Senate will continue budget hearings next week. The only health-related agency scheduled to appear is the Department of Aging, which will be before the Senate Appropriations Committee on Tuesday, February 25 at 1:00 p.m. and the House Appropriations Committee on Thursday, February 27 at 1:00 p.m. The House Appropriations Committee’s full hearing schedule is viewable here and the Senate Appropriations Committee’s full hearing schedule is viewable here.

Department of Human Services

The Department of Human Services (DHS) has released a rate and wage study for its long-term services and supports (LTSS) and home and community-based services (HCBS) programs. The study assessed rates paid to LTSS and HCBS providers in order to inform the commonwealth’s budget and rate setting process. The study is viewable here.

DHS has issued a Medical Assistance Bulletin to advise providers that effective February 18, the Medical Assistance (MA) program will cover Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screening and diagnostic services to eligible juveniles in the 30 days prior to release, and targeted case management services, both physical and behavioral health, in the 30 days prior to and for at least 30 days following release from a carceral setting.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has announced it will hold a webinar on March 3 at 10:00 a.m. to discuss the changes to 42 CFR Part 8 (Medications for the Treatment of Opioid Use Disorders) and their practical implications in treatment settings. Find additional information and details on how to participate here.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of a special report on the finances of rural hospitals in Pennsylvania. Find the full report and data visualizations from the report here.

Around the State

The Philadelphia Inquirer’s Harold Brubaker has written an article about Sharon Regional Medical Center and Crozer Health and the financial support provided by the state to help keep them open and serving patients.

Governor Shapiro’s appointment by President Trump to serve a two-year term on the Council of Governors was covered by The Philadelphia Inquirer. Among other things, the council is tasked with improving state-federal partnerships and coordinating national security and disaster response efforts.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – February 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on February 26 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – February 27

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on February 27 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

Pennsylvania Health Care Cost Containment Council – Committee Meetings

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the schedule of various committee meetings for the first quarter of 2025. Find a detailed schedule and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-02-21T21:58:30+00:00February 21st, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for January 10

The following is an update of selected state health policy developments in Pennsylvania January 6 – 10. (Some of the language used below is taken directly from state documents).

General Assembly

The General Assembly convened on Tuesday, January 7 to officially commence the 2025-2026 legislation session. Members of the state House of Representatives and Senate who were newly elected or re-elected were sworn in. In addition, the two chambers elected their respective presiding officers, adopted rules, and established standing committees.

At the conclusion of Tuesday’s legislative business, the House and Senate recessed until Monday, January 27. Following are their respective 2025 session calendars.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) has approved the remainder of the commonwealth’s request for a five-year section 1115 demonstration – Bridges to Success: Keystones of Health for Pennsylvania. You will recall Pennsylvania received approval from CMS back in November to implement multi-year continuous eligibility for Medicaid-eligible children through age six and one year of continuous coverage for Medicaid-eligible citizens returning from a state correctional facility. The Department of Human Services (DHS) has stated it, “will work through the state budget process to determine next steps for potential implementation.” Find CMS’ approval letter to DHS here.

Department of Human Services

The Department of Human Services (DHS) has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of November.

The Office of Mental Health & Substance Abuse Services (OMHSAS) has released the Intensive Behavioral Health Services (IBHS) Regulatory Compliance Guide (RCG) in an effort to provide clear explanations of the regulatory requirements of Title 55 Pa. Code, Chapter 5240, “Intensive Behavioral Health Services” regulations.

DHS has issued updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of prescriptions for Anticonvulsants submitted for prior authorization. Find additional information in this Medical Assistance Bulletin.

DHS has issued a Medical Assistance Bulletin to advise providers that it has updated the Admissions Notice Packet (MA 401) form due to an increase in the personal needs allowance (PNA) deduction amount. This bulletin applies to nursing facilities, intermediate care facilities, and long-term care facilities enrolled in the Medical Assistance program.

Insurance Department

The Pennsylvania Insurance Department (PID) has announced that 259 Pennsylvanians successfully appealed denied health service claims through PID’s new Independent External Review process. Of the total health service denials submitted for review in 2024, 50.1 percent were overturned.

PID has also shared information related to its efforts to increase health insurance transparency through several reports available to the public, including its annual Transparency in Coverage Report for ACA Health Plans, which outlines data on claims, denials, and appeal information, and its inaugural ACA and Qualified Health Plans (QHP) Summary. Find additional information in this press release.

Around the State

WHYY has written about the Pennsylvania Insurance Department’s external review program which received 517 health service denial appeals in 2024. 259 of those denials were overturned.

City & State Pennsylvania has published an article about the General Assembly’s first session day of 2025.

The Pittsburgh Post-Gazette has written an article about a study released by Pennsylvania Partnerships for Children that kids largely stayed insured despite uncertainties during the Medicaid eligibly redetermination process following the conclusion of the COVID-19 public health emergency.

Stakeholder Meetings

DOH – WIC Advisory Board – January 14

The WIC State Advisory Board will hold a meeting on January 14 from 1:00 p.m. to 2:00 p.m. The purpose of the meeting is to collaborate to gather suggestions of strategies for increasing participation and improving the WIC program to better support participants. Find details on how to participate in this Pennsylvania Bulletin notice.

DHS – Consumer Sub-MAAC – January 22

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on January 22 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – January 23

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on January 23 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

DOH – Special Pharmaceutical Benefits Advisory Council – January 30

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a public teleconference meeting on Thursday, January 30 from 10:00 a.m. to 12:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-01-10T20:27:58+00:00January 10th, 2025|Federal Medicaid issues, Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for January 3

The following is an update of selected state health policy developments in Pennsylvania December 23 – January 3. (Some of the language used below is taken directly from state documents).

General Assembly

The state House of Representatives and Senate will convene on Tuesday, January 7 at 12:00 p.m. to swear in newly elected and re-elected members for the 2025-2026 legislative session.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that the department is adding doula services to the Medical Assistance (MA) program fee schedule and will pay enrolled certified perinatal doulas beginning January 1, 2025.

The Office of Mental Health & Substance Abuse Services (OMHSAS) has issued a bulletin announcing the Peer Support Services (PSS) and PSS Provider Handbook has been updated to reflect the requirements for PSS. The revisions better clarify which requirements apply to OMHSAS licensure and which apply to MA payments. Additional updates include staff qualifications and requirements for certified peer specialists and their supervisors and telehealth requirements.

DHS has provided final notice of its intent to adjust the managed care assessment fixed fee. Effective January 1, 2025, the fee will be $30.47 per member per month. The aggregate fiscal impact for this change in FY 2024-2025 will be $208.6 million dollars in additional assessment revenue.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has issued comments to the Department of Human Services (DHS) regarding the transition to the Patient-Driven Payment Model (PDMP) for non-public and county nursing facilities. Find additional information in this Pennsylvania Bulletin notice.

Revenue Collection Update

The Department of Revenue has announced Pennsylvania collected $3.8 billion in General Fund revenue in December, which was $87.2 million, or 2.3 percent, less than anticipated. Fiscal year-to-date General Fund collections total $20.2 billion, which is $97.1 million, or 0.5 percent, below estimate.

Around the State

Spotlight PA has written an article about the scrutiny, and at times, lack of transparency over how counties across Pennsylvania are spending billions of dollars in opioid settlement money.

Writing for The Philadelphia Inquirer, Harold Brubaker has published an article about Pennsylvania’s new law limiting noncompete agreements for health care practitioners. Brubaker also wrote an article about the success and challenges of Pennsylvania-based biopharmaceutical companies in 2024.

The Pittsburgh Post-Gazette has reported that Sharon Regional Medical Center announced an agreement has been made with Tenor Health Partners to take over operations at the hospital, avoiding the anticipated January 6^th closure.

Stakeholder Meetings

DOH – HIV Planning Group – January 15

The Statewide HIV Planning Group will hold a public meeting on Wednesday, January 15 and Thursday, January 16 from 9:00 a.m. to 4:30 p.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – January 17

The Renal Disease Advisory Committee will meet on Friday, January 17 at 10:00 a.m. to discuss new and ongoing issues relating to the treatment of chronic renal disease and the department’s programs related to care and treatment. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Preventive Health Services Block Grant Advisory Committee – January 27

The Preventative Health and Health Services Block Grant Advisory Committee will hold a public meeting on Monday, January 27 from 9:00 a.m. to 11:00 a.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – February 7

The Brain Injury Advisory Board will hold a public meeting on Friday, February 7 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-01-03T18:57:52+00:00January 3rd, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off

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