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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.

2025-02-21T21:58:30+00:00February 21st, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off on PA Health Policy Update for February 21
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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 

  • 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.

2025-01-10T20:27:58+00:00January 10th, 2025|Federal Medicaid issues, Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for January 10
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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 6th 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.

 

2025-01-03T18:57:52+00:00January 3rd, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for January 3
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PA Health Policy Update for November 15

The following is an update of selected state health policy developments in Pennsylvania November 4 – 15.  (Some of the language used below is taken directly from state documents). 

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) has announced that it approved an amendment to Pennsylvania’s section 1115 Medicaid demonstration waiver to provide continuous Medicaid eligibility for children until the age of six, and 12 months of continuous eligibility for individuals aged 19 through 64 leaving incarceration, who meet certain high-risk criteria. Find additional information about Pennsylvania’s section 1115 demonstration amendment approval here. 

General Assembly

The state House of Representatives and Senate briefly convened for voting session this week to conclude legislative business for the 2023-2024 session and elect caucus leadership for the upcoming 2025-2026 legislative session. Following is the comprehensive list of each caucus’ leadership team.

* Denotes majority party.  

Department of Human Services

  • The Office of Mental Health and Substance Abuse Services (OMHSAS) has announced it released an updated Psychiatric Outpatient Clinic Regulatory Compliance Guide (RCG). The changes made were primarily to language and updates based on comments received from stakeholders on the original document issued in 2021. OMHSAS has been working on developing RCGs for each licensed level of care. The RCG is designed to be a tool for providers, OMHSAS staff, and the public to better understand pertinent regulations. The guide is a companion piece to 55 Pa. Code Chapter 5200.
  • DHS has issued several Medical Assistance bulletins with updated handbook pages that include the requirements for prior authorization for various pharmacy services. Following is a comprehensive list of prior authorization bulletins recently issued by DHS.

Department of Health 

The Department of Health (DOH) has published notice of the Secretary of Health’s decision not to effectuate the recommendation of the Medical Marijuana Advisory Board that certified registered nurse practitioners (CRNPs) and podiatrists be eligible to apply for inclusion in the registry of practitioners who can certify patients for medical marijuana. Find the notice regarding CRNPs here and podiatrists here. 

Insurance Department

The Pennsylvania Insurance Department (PID) has released a comprehensive study of the accuracy of health insurer provider directories. The report highlights persistent inaccuracies in health insurer provider directories that can delay care, hinder scheduling, or result in surprise out-of-network charges. PID is planning to initiate stakeholder outreach to gather input and develop solutions that reduce inaccuracies in provider directories. Find additional information in this press release. 

Independent Fiscal Office 

The Independent Fiscal Office (IFO) has released its Economic and Budget Outlooks for FYs 2024-2025 to 2029-2030. This annual fiscal outlook report, which includes projections of state revenues and expenditures, also considers economic and demographic trends that will impact tax revenues and expenditures over the next five fiscal years. Find the IFO’s presentation here and its full report here. 

Office of Administration 

The Office of Administration has recently announced the launch of a new resource page on PA.gov that makes it easier for residents, businesses, non-profits, and local government entities to find and apply to various grant programs from state agencies. Find additional information in this press release. 

Around the State  

  • The Hill has published an article about Governor Shapiro’s national political prospects following the 2024 election. 
  • WHYY has written an article about this year’s open enrollment for health insurance coverage in 2025.  The Pittsburgh Post-Gazette has also written about open enrollment and the potential for premiums to increase. 
  • An article published by the Patriot-News highlights the continued partisan split in Harrisburg for the upcoming 2025-2026 legislative session.  The Pennsylvania Capital-Star also wrote about this dynamic but noted House Democrats’ hope for greater cooperation with the Republican Senate. 

Stakeholder Events 

DOH – Newborn Screening Advisory Committee – November 21

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, November 21 from 10:00 a.m. until 1:00 p.m. The meeting will be conducted both in person and as a virtual conference. Find additional information in this Pennsylvania Bulletin notice.

2024-11-15T20:57:21+00:00November 15th, 2024|Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for November 15
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PA Health Policy Update for November 1

The following is an update of selected state health policy developments in Pennsylvania October 28 – November 1.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

Governor Shapiro signed the following bills into law this week.

  • House Bill 1608, now known as Act 115 of 2024, which extends Medicaid coverage to doula services and creates a doula advisory board.
  • House Bill 2185, now known as Act 117 of 2024, which requires the Department of Health to develop type 1 diabetes informational materials for parents and guardians.
  • House Bill 2381, now known as Act 119 of 2024, which enables the licensing boards or commissions under Department of State to promulgate one-time, temporary regulations necessary for the implementation of each licensure compact enacted by the General Assembly.
  • Senate Bill 365, now known as Act 121 of 2024, which amends the Workers’ Compensation Act to provide first responders with post-traumatic stress injury (PTSI) coverage.
  • Senate Bill 920, now known as Act 122 of 2024, which establishes a statewide sexual assault evidence tracking system.
  • Senate Bill 267, now known as Act 134 of 2024, which adds urgent care centers to the list of safe haven locations for newborn children.
  • Senate Bill 1080, now known as Act 137 of 2024, which allows licensed practical nurses to make death pronouncements in the hospice setting. 

General Assembly

The state House of Representatives and Senate are currently recessed until after the November 5 General Election. 

Department of Human Services

  • The Department of Human Services (DHS) has announced its intent to allocate funds in FY 2024-2025 for several classes of inpatient disproportionate share hospital (DSH) payments and supplemental payments to Medical Assistance enrolled, qualifying inpatient general acute care hospitals. DHS does not intend to change the qualifying criteria or payment methodology for these payments. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has published its proposed Psychiatric Residential Treatment regulations in the Pennsylvania Bulletin. These proposed regulations codify the minimum licensing standards, Medical Assistance participation requirements, and payment conditions for psychiatric residential treatment facilities which treat certain children, youth, or young adults under 21 years of age.
  • DHS has published a Medical Assistance Bulletin with updates to the PROMISe™ Provider Handbook 837 for Medical Assistance enrolled federally qualified health centers (FQHCs) and rural health clinics (RHCs).
  • The Office of Medical Assistance Programs (OMAP) has announced it will be hosting several upcoming community health worker (CHW) listening sessions throughout November and December in order to gather information that will help DHS’ strategic plan for CHWs. Find a schedule of the listening sessions as well as details on how to participate here.
  • 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 beneficiaries.

Insurance Department

The Pennsylvania Insurance Department has published a notice in the Pennsylvania Bulletin that the Medical Care Availability and Reduction of Error (MCARE) assessment for all basic insurance coverage and self-insured participating health care providers for calendar year 2025 will be 29 percent applied to the prevailing primary premium for each participating health care provider.  

Board of Medicine 

The State Board of Medicine has published its final-form rulemaking related to licensure by endorsement. The regulations are effective upon publication in the Pennsylvania Bulletin. Find the final-form regulations here. 

Office of the Attorney General

The Office of the Attorney General (OAG) has filed a civil suit against Prospect Medical Holdings, which owns Crozer Health System, over breach of contract. OAG has alleged Prospect has broken its 2016 court-approved “asset purchase agreement” by closing facilities and diverting funding from the sale of real estate to shareholders and investors. The lawsuit seeks a preliminary injunction to preserve Crozer’s existing services, and the appointment of a receiver to manage the Crozer Health System until another buyer can be identified. Find additional details in this press release. 

Revenue Collection Update 

The Department of Revenue has announced Pennsylvania collected $4.2 billion in General Fund revenue in September, which was $33.7 million, or 0.8 percent, less than anticipated. Fiscal year-to-date General Fund collections total $10.1 billion, which is $20.2 million, or 0.2 percent, above estimate. 

Around the State  

  • Spotlight PA has published an article written by Stephen Caruso about a slate of bills to improve maternal health care in Pennsylvania.
  • WHYY has written an article about Attorney General Michelle Henry’s decision to sue Prospect Medical Holdings over Crozer Health System. 
  • City & State Pennsylvania has published an article about Pennsylvania’s health insurance marketplace, Pennie, as the open enrollment period nears. 

Stakeholder Events 

Pennsylvania Health Care Cost Containment Council – November 7

The Pennsylvania Health Care Cost Containment Council (PHC4) will hold a public meeting on Thursday, November 7. Find additional details on how to participate in this Pennsylvania Bulletin notice. 

DOH – Organ Donation Advisory Committee – November 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, November 7 from 10:00 a.m. to 1:30 p.m. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – HIV Planning Committee – November 20

The Statewide HIV Planning Committee will hold public meetings at the Hilton Harrisburg (One North 2nd Street, Harrisburg, PA 17101) on Wednesday, November 20 from 9:00 a.m. to 5:00 p.m. and on Thursday, November 21 from 9:00 a.m. to 4:30 p.m. The meeting will also be held virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Spinal Cord Research Advisory Committee – November 18

The Spinal Cord Research Advisory Committee will hold a public meeting on Monday, November 18 from 10:30 a.m. to 11:30 a.m. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.   

2024-11-01T20:14:07+00:00November 1st, 2024|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for November 1
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PA Health Policy Update for October 18

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

Governor Shapiro

Governor Shapiro has signed the following bills into law this week.

  • House Bill 155, now known as Act 96 of 2024, removes the requirement that direct care workers be interviewed in-person for a position.
  • House Bill 2084, now known as Act 101 of 2024, establishes a license for prescription drug virtual manufacturers.
  • House Bill 2127, now known as Act 102 of 2024, allows hospitals, birthing centers, physicians, and midwives or nurse-midwives to provide patients with a fact sheet regarding postpartum depression and counseling resources.
  • Senate Bill 668, now known as Act 109 of 2024, permits certified nurse aides to become certified medication aides in long-term care facilities, assisted living residences, and personal care homes.
  • Senate Bill 840, now known as Act 111 of 2024, creates an Alzheimer’s Disease and related disorders division within the Department of Aging and establishes an Alzheimer’s, Dementia and Related Disorders Advisory Committee. 

General Assembly

  • The state House of Representatives and Senate are scheduled to return to Harrisburg on Monday, October 21 for session. This is the last scheduled session week prior to the November 5 General Election. 
  • The House Children & Youth Committee will meet on Tuesday, October 22 at 10:00 a.m. in Room 515 of the Irvis Office Building to consider House Bill 1600, which expands oversight of juvenile justice facilities, and House Bill 2461, which establishes an Ebony Alert system.
  • The House Children & Youth Committee will also meet on Wednesday, October 23 at 10:00 a.m. in Room 515 of the Irvis Office Building for an informational meeting the CCAP Complex Case Task Force report and the DHS Blueprint report. 
  • The Senate Aging & Youth and Banking & Insurance Committees will hold a joint hearing on Wednesday, October 23 at 9:00 a.m. on protecting senior citizens, with a focus on House Bill 2064 and possible revisions to the Older Adult Protective Services Act. The meeting will be held in Hearing Room 1 of the North Office Building. 

Department of Human Services 

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) that DHS will continue the alternative payment methodology and pay the Medical Assistance (MA) program fee schedule rate for the administration of the novel coronavirus (SARS-CoV-2) vaccine during a SARS-CoV-2 vaccine-only visit.
  • DHS has shared the agenda for the next Medical Assistance Advisory Committee (MAAC) meeting on Thursday, October 24. Find additional details on how to participate in Stakeholder Events below.

Department of Health 

The Department of Health (DOH) has reminded long-term care providers that its annual questionnaire of long-term care facilities must be completed and submitted to the department electronically by Friday, October 25, 2024. Any questions regarding the questionnaire may be directed to RA-dohbhssurveys@pa.gov.

Around the State  

Spotlight PA published an article about the increasing number of long-term care facility closures in the commonwealth. 

Pennsylvania pharmacists are receiving less money for drugs dispensed to Medicaid patients, the Pennsylvania Capital-Star reports. 

Stakeholder Events 

DHS – Consumer Sub-MAAC – October 23

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on October 23 at 1:00 p.m. The meeting will be held in the Forest Room of the Keystone Building (400 North Street, Harrisburg, PA 17120). Click here for additional information.

DHS – Medical Assistance Advisory Committee – October 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on October 24 at 10:00 a.m. The meeting will be held in the Forest Room of the Keystone Building (400 North Street, Harrisburg, PA 17120). Click here for additional information. 

DOH – Special Pharmaceutical Benefits Program (SPBP) Advisory Council – October 24

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a hybrid public meeting on Thursday, October 24, 2024, from 10 a.m. to 3 p.m. Find more information in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – November 1

The Brain Injury Advisory Board (Board) will hold a public meeting on Friday, November 1, 2024, from 10 a.m. to 3 p.m. Find additional information in this Pennsylvania Bulletin notice.

2024-10-21T20:36:11+00:00October 18th, 2024|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for October 18
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PA Health Policy Update for September 20

The following is an update of selected state health policy developments in Pennsylvania from September 16 – 20.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

This week the Shapiro administration recognized September as Suicide Prevention Month. Leaders from multiple state agencies, including Department of Human Services Secretary Dr. Val Arkoosh, highlighted the various resources dedicated to suicide prevention and efforts underway to address behavioral health challenges. Find more information in this press release. 

General Assembly

The Senate convened in Harrisburg for session this week. Following is a selection of relevant health care-related legislative activity.

  • The Senate passed Senate Bill 1255, which amends the definition of an “advanced practice professional” to include a physician assistant in the Outpatient Psychiatric Oversight Act. The bill will now be sent to the House of Representatives for consideration.
  • The Senate Consumer Protection & Professional Licensure Committee met on Tuesday, September 17 and favorably reported, among other bills, Senate Bill 1281, which establishes scope of practice and licensing standards for medical imaging specialists, radiation therapists, and radiology assistants.
  • The Senate Aging & Youth and Banking & Insurance Committees met on Wednesday, September 18 for a joint informational hearing on protecting seniors from financial exploitation and updating the state’s Older Adult Protective Services Act. The meeting’s agenda, testimony, and a recording of the are viewable here.

The state House of Representatives and Senate will be recessed next week. Both chambers will reconvene for voting session on Monday, September 30. 

Department of Human Services 

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that it will be increasing fees for certain ophthalmology services on the Medical Assistance (MA) program fee schedule effective for dates of service on or after September 15, 2024.
  • The Office of Mental Health & Substance Abuse Services (OMHSAS) has announced it will need to delay the addition of Psychiatric Rehabilitation Services (PRS) to Pennsylvania’s Medicaid state plan until 2026. PRS will continue to be covered as an in-lieu of service within the Behavioral Health HealthChoices program while OMHSAS continues to work on implementation.
  • DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through October. Find the updated calendar here.
  • DHS has issued revisions to the participating drug company list for the Medicaid Drug Rebate Program. The revisions are viewable here.
  • DHS has published notice of its intent to make additional supplemental ventilator care and tracheostomy care payments to qualified non-public and county skilled nursing facilities, which remain open as of July 11, 2024, that qualified for supplemental ventilator care and tracheostomy care payments in FY 2014-2015 with a percentage of Medical Assistance recipient residents who required medically necessary ventilator care or tracheostomy care greater than 90%. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has announced that it intends to continue to make Medical Assistance Day One Incentive (MDOI) payments to qualified non-public nursing facilities for FY 2024-2025. The MDOI payments will provide incentives to nursing facilities to provide services to individuals who are Medicaid eligible on the day of admission. The MDOI payments are intended to encourage non-public nursing facilities to increase access to care for the poor and indigent citizens of this commonwealth. Find additional information in this Pennsylvania Bulletin notice. 

Department of Health 

The Department of Health (DOH) has announced skilled nursing facilities throughout the commonwealth are eligible to train up to two staff members through a DOH-funded infection prevention and control training course offered by the Association for Professionals in Infection Control and Epidemiology (APIC). The course is available through December 2024 and continuing education credits may be available. Click here for more information and to enroll in the program. 

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced that it has begun studying the prevalence and impact of non-compete agreements in Pennsylvania as directed by Act 74 of 2024 (formerly House Bill 1633). PHC4 is collecting public comments for analysis and inclusion in its final report. Comments are due by October 21, 2024. Find details on how to comment in this Pennsylvania Bulletin notice. 

PHC4 has published a list of diseases, procedures, and medical conditions for which it will require data collection. Find the comprehensive list in this Pennsylvania Bulletin notice. 

Independent Regulatory Review Commission 

The Independent Regulatory Review Commission (IRRC) has published a notice in the Pennsylvania Bulletin of actions taken at its September 11 meeting, including its review of existing regulations and determination that some are outdated and no longer in the public interest. Among those IRRC determined to be outdated are clinical laboratory, health care facility identification badge, and hospital regulations. IRRC’s comprehensive review, including its recommendations, can be found here. 

IRRC has announced it received final form regulations from the State Board of Nursing that address requirements for reactivation of a license and add provisions related to licensure by endorsement, provisional endorsement license, and licensure by endorsement fee. IRRC will consider these regulations at its October 24 meeting. Find a copy of the final form regulations here.

Around the State 

  • Harold Brubaker has written an article for The Philadelphia Inquirer about an increase in medical malpractice filings in Philadelphia due to a change that has allowed cases to be filed in Philadelphia even if the incident occurred outside the city.
  • The Philadelphia Inquirer also reported about St. Luke’s University Health Network’s discussions to acquire Grand View Health in Bucks County.
  • The Tribune-Review has published an article about the use of artificial intelligence (AI) in the medical field. 

Stakeholder Events

DHS – Consumer Sub-MAAC – September 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 25 at 1:00 p.m. The meeting will be held virtually. Register to participate here.

DHS – Medical Assistance Advisory Committee – September 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 26 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

DOH – Renal Disease Advisory Committee – October 18

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, October 18 from 10:00 a.m. to 12:00 p.m. The meeting will be held in person and virtually. Find additional information in this Pennsylvania Bulletin notice.

2024-09-20T19:15:56+00:00September 20th, 2024|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for September 20
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PA Health Policy Update for September 13

The following is an update of selected state health policy developments in Pennsylvania from September 9 – 13.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

Governor Shapiro signed two executive orders this week related to gun violence prevention and affordable housing.

  • Governor Shapiro signed Executive Order 2024-02 updating an executive order issued by former Governor Tom Wolf and re-establishing the Pennsylvania Office of Gun Violence Prevention within the Pennsylvania Commission on Crime and Delinquency (PCCD). Find more details in this press release.
  • Governor Shapiro signed Executive Order 2024-03 directing the administration to create Pennsylvania’s first comprehensive housing action plan to address the state’s housing shortage, address homelessness, and expand affordable housing options. Find more details in this press release. 

General Assembly

The state Senate will convene for voting session Monday, September 16 through Wednesday, September 18. The House of Representatives will remain recessed until Monday, September 30.

The Senate Aging & Youth and Banking & Insurance Committees will meet on Wednesday, September 18 at 10:00 a.m. in Room 156 of the Main Capitol for a joint informational hearing on protecting seniors from financial exploitation. 

Department of Human Services 

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to announce changes to the Medical Assistance fee schedule, including changes resulting from clinical review, provider request, and recommendations from the Advisory Committee on Immunization Practices (ACIP) and the U.S. Food and Drug Administration (FDA).  These changes are effective for dates of service on or after September 9, 2024.
  • DHS has issued a Medical Assistance Bulletin to advise providers of updates to the Medical Assistance program fee schedule for certain family planning and family planning-related services. The updates are effective for dates of service on or after July 1, 2024.
  • DHS has announced updates to the Medical Assistance program fee schedule for ophthalmology services. The updates are effective for dates of service on or after September 15, 2024. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has announced its intent to allocate $258 million for FY 2024-2025 inpatient disproportionate share hospital (DSH) payments. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has published final notice of its intent to increase funding for a class of supplemental payments for qualifying acute care general hospitals for FY 2023-2024 that treat a high volume of opioid use disorder patients in their emergency rooms. Find additional details in this Pennsylvania Bulletin notice.

Department of Health 

The Department of Health (DOH) has announced it will host a webinar next Monday, September 16 at 10:00am to discuss the details of new respiratory illness data submission that is required by CMS beginning in October. This event is meant for compliance staff, emergency management staff, IT professionals, and hospital leadership. DOH will explain its plans to continue using PA HIMS (currently Juvare’s EMResource) and automatic upload processes to meet these requirements. Click here to register to attend.

The Shapiro administration has announced that all school districts, intermediate units, career and technical centers, and brick-and-mortar charter schools will receive funding to provide free period products to students. Funding will be proportional to the total number of students enrolled in a school and based on a rate of $1.75 per student. Schools may use the funding for period product purchases made between July 1, 2024, and June 30, 2025. Find additional information here. 

Department of Drug & Alcohol Programs 

The Department of Drug and Alcohol Programs (DDAP) has announced the availability of more than $26 million in funding to expand drop-in center services for individuals with substance use disorders (SUD) across Pennsylvania. DDAP will award approximately 14 grants of up to $1,875,000 each. Eligible applicants, including existing community organizations, Single County Authorities, and DDAP-licensed treatment providers, can find the grant application here. Find more details in this press release.

DDAP joined individuals in recovery, advocacy organizations, and providers this week to kick off National Recovery Month in Pennsylvania. Throughout September, DDAP will be holding several other recovery-focused events. Find those events and additional recovery resources offered by DDAP here. 

Independent Regulatory Review Commission 

The Independent Regulatory Review Commission (IRRC) has conducted a review of existing regulations at the request of legislative standing committees, including the House Health and Aging & Older Adult Services Committees. The review covered rulemakings from 10 different agencies, including 40 prior rulemakings, 103 additional Chapters of regulations, and two subchapters. IRRC’s final report, including its recommendations, can be found here. 

Stakeholder Events 

DOH – Medical Marijuana Advisory Board – September 18

The Medical Marijuana Advisory Board has provided notice that it will meet on Wednesday, September 18 and Wednesday, November 13 from 10:30 a.m. to 12:30 p.m. The meetings will be held in the Capitol Media Center with an option for board members to participate virtually. These meetings will be broadcast live for the public through Commonwealth Media Services. Find additional details here.

DHS – Consumer Sub-MAAC – September 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 25 at 1:00 p.m. The meeting will be held virtually. Register to participate here.

DHS – Medical Assistance Advisory Committee – September 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 26 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

2024-09-13T19:50:01+00:00September 13th, 2024|Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for September 13
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PA Health Policy Update for August 23

The following is an update of selected state health policy developments in Pennsylvania from August 19 – 23.  (Some of the language used below is taken directly from state documents). 

General Assembly

  • The state House of Representatives and Senate are recessed until Monday, September 23 and Monday, September 16, respectively.
  • When they return, the Senate Aging and Youth and Banking and Insurance Committees announced they will meet on September 18 at 9:00 a.m. for a joint hearing on protecting seniors from financial exploitation. 

Department of Health 

  • The Department of Health (DOH) has issued a memo to hospitals outlining the department’s plan to comply with the federal government’s renewed data reporting requirements for COVID-19 and other respiratory illnesses. CMS will require weekly reporting beginning November 1 and facilities have the option for DOH to facilitate reporting on their behalf. In the memo, the Bureau of Emergency Preparedness and Response strongly encourages facilities to utilize this reporting pathway. More information, including required data elements and a data dictionary is forthcoming.
  • The DOH policy office has temporarily paused its efforts to collect input on potential amendments to the hospital licensure regulations. The department commenced a stakeholder engagement process earlier this month that was designed to solicit feedback from various stakeholders, including hospitals. DOH will reconvene stakeholder meetings in the fall or winter to inform proposed regulations to be released in Spring 2025.
  • DOH issued a health advisory (PA HAN 766) related to recent Oropouche virus activity in travelers who have visited the Amazon basin and other areas of South America. 

Department of Human Services 

  • The Department of Human Services (DHS) announced the results of the reprocurement of the Community HealthChoices program for plan years beginning in 2025 through at least 2029. Similar to today’s program, the selected applicants are identical for each of the five CHC operating zones and include Aetna Better Health of Pennsylvania, Health Partners Plans, PA Health and Wellness, UPMC For You, and Vista Health Plan (AmeriHealth). The plans will begin a readiness review with DHS shortly which will include an examination of their provider network adequacy. Find the DHS announcement here.
  • DHS issued a Medical Assistance provider bulletin to advise providers of changes to the manual edit thresholds for electronic visit verification records in both personal care and home health services effective with dates of service on and after January 1, 2025.
  • The DHS Office of Mental Health and Substance Abuse Services (OMHSAS) encourages providers to participate in a survey of provider readiness to introduce additional tobacco interventions as part of the Pennsylvania Statewide Tobacco-Free Recovery Initiative (PA STFRI) funded by the CDC. The Public Health Management Corporation conducted a similar survey in 2021, and this 15-minute survey will be a useful measure of the initiative’s progress. Click here to access the survey, which will close on August 31. 

Stakeholder Events 

DOH – HIV Community Prevention Planning Committee – August 29 – CANCELLED

The statewide Human Immunodeficiency Virus (HIV) Planning Group has cancelled its public meeting on Thursday, August 29 from 9:00 a.m. to 4:30 p.m.

 

2024-08-23T20:40:15+00:00August 23rd, 2024|Medical Assistance Bulletin, Meetings and notices|Comments Off on PA Health Policy Update for August 23
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PA Health Policy Update for July 12

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

FY 2024-2025 Budget Update 

Late Thursday evening the General Assembly passed Senate Bill 1001 – the General Appropriations Act – to fund Pennsylvania’s FY 2024-2025 budget. Governor Shapiro promptly signed Senate Bill 1001, as well as the various enabling pieces of legislation necessary to implement the budget, which marked the completion of the FY 2024-2025 budget process, more than 10 days after the commonwealth’s constitutionally mandated deadline.

In total, the FY 2024-2025 budget spends $47.6 billion, which represents a $2.7 billion, or 6.6 percent, increase over the prior fiscal year. It is nearly $700 million less than Governor Shapiro’s initial budget proposal. The FY 2024-2025 budget increases spending for K-12 and higher education. It also makes targeted investments in health and human services. The budget doesn’t include any tax increases or the Governor’s proposal to legalize cannabis. The final budget does include Governor Shapiro’s economic development proposal to create the Pennsylvania Strategic Investments to Enhance Sites (PA SITES) program and authorize up to $500 million in new funding to invest in site development, preparation, and readiness for businesses to locate or expand in Pennsylvania.

The following are key budget-related pieces of legislation.

General Assembly

The state House of Representatives and Senate convened in Harrisburg for session this week. The following is an overview of selected health care-related legislative activity that occurred.

  • The Senate passed House Bill 1993, which seeks to reform certain practices by pharmacy benefit managers (PBMs) that have an adverse impact on pharmacies and patients, by a vote of 48-1. The House of Representatives subsequently voted to concur with the Senate’s amendments and sent the bill to Governor Shapiro for his signature.
  • The Senate passed House Bill 1633, which establishes restrictions on non-compete covenants for certain health care practitioners, on third and final passage. The House of Representatives subsequently voted to concur with the Senate’s amendments and sent the bill to Governor Shapiro for his signature.
  • The House of Representatives voted to concur with the Senate’s amendments to House Bill 1664, which prohibits insurers from restricting their method of payment to participating health care providers so that the only payment method is by credit card. The bill will now be sent to Governor Shapiro for his signature.
  • The Senate passed House Bill 1853, which requires the Department of Health to meet annually with licensed nursing facilities in an effort to improve communication and collaboration around facility surveys, on third and final consideration. The bill will now be sent to Governor Shapiro for his signature.
  • The House of Representatives passed House Bill 2339, which establishes hospital price transparency reporting and disclosure requirements. The bill also stipulates penalties for noncompliance. The bill, which passed by a vote of 168-34, will now be sent to the Senate for consideration.
  • The House of Representatives also passed House Bill 2344, which imposes more reporting requirements and additional oversight on health care facility mergers and acquisitions, on third and final consideration. The bill will now be sent to the Senate for consideration.
  • The House of Representatives passed House Bill 1425, which directs the Department of Human Services to develop a five-year plan to offer evidence-based maternal home visiting programs for eligible families. The bill will now be sent to the Senate for consideration. 

The House and Senate have recessed until Monday, September 23 and Monday, September 16, respectively. 

Department of Human Services 

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that DHS will increase fees for certain ophthalmology services on the Medical Assistance (MA) program fee schedule, effective for dates of services on and after August 1, 2024. 

DHS has published the transcript and a recording of the July 2 meeting of the Long-Term Services and Supports Subcommittee. 

Centers for Medicare and Medicaid Services 

The Centers for Medical and Medicaid Services (CMS) has proposed amending the Medicaid clinic services regulation, which currently permits Medicaid payment for clinic services furnished outside of the four walls of a clinic only to individuals who are unhoused, to authorize federal reimbursement for services furnished outside the four walls of a freestanding clinic by IHS/Tribal clinics.  In addition, at state option, federal reimbursement also would be available for services provided by behavioral health clinics and services provided by clinics located in rural areas.  For clinics located in rural areas, CMS is not proposing a specific definition of rural but is seeking public comment on different alternative definitions for consideration in final rulemaking. 

Stakeholder Events   

DOH – Organ Donation Advisory Committee – August 8

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 8 from 10:30 a.m. to 1:30 p.m. The meeting will be held in person and virtually. Find additional information on how to participate in this Pennsylvania Bulletin notice.

DHS – Consumer Sub-MAAC – July 24

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on July 24 at 1:00 p.m. The meeting will be held in person. It will be located in the Forest Room of the Keystone Building – 400 North St., Harrisburg, PA 17120.

DHS – Medical Assistance Advisory Committee – July 25

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on July 25 at 10:00 a.m. The meeting will be held in person. It will be located in the Forest Room of the Keystone Building – 400 North St., Harrisburg, PA 17120.

2024-07-12T20:34:18+00:00July 12th, 2024|Federal Medicaid issues, Financial, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off on PA Health Policy Update for July 12
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  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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