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PA Health Policy Update for the Week of June 21-25

The following is an update of selected state health policy developments in Pennsylvania for the week of June 21-25, 2021.  (Some of the language used below is taken directly from state documents.)

State-Wide Mask Mandate

The Department of Health announced that it is lifting its order requiring universal face coverings at 12:01 a.m. on Monday, June 28.   See the announcement here.  The department continues to urge Pennsylvanians to follow CDC guidance for wearing a mask where required by law, rule, and regulations, including health care, local business, and workplace guidance.  For the protection of themselves and others, individuals who have not yet been vaccinated or are partially vaccinated are still encouraged to wear a mask when in public.

Legislative Update

The following are health care bills that have received third and final consideration in the state House and/or Senate as of Thursday, June 24. Both chambers will hold voting session on Friday and Saturday and we anticipate there will be additional health care-related measures passed. We will provide an update following the end of session on any pertinent bills.

  • Senate Bill 115 – establishes the Nurse Licensure Compact Act, which upon enactment makes the Commonwealth a party to the Nurse Licensure Compact with all other states that have joined the compact. The bill was passed by the House 146-55 and sent to the Governor’s desk.
  • Senate Bill 425 – amends the Medical Care Availability and Reduction of Error (MCARE) Act to permit a physician to fulfill their duty to obtain a patient’s or the patient’s authorized representative’s consent by a qualified practitioner prior to conducting surgery or administering radiation or chemotherapy blood transfusions, or medications and devices. The bill was unanimously passed by the House on June 24th and sent to the Governor’s desk.
  • Senate Bill 484 – adds the chair of the State Veterans’ Commission or a designee to the Pennsylvania Long-term Care Council. The bill was unanimously passed by the House on June 24th and sent to the Governor’s desk.
  • Senate Bill 618 – prohibits the use of vaccine passports by government entities. It also prohibits institutions of higher education from requiring proof of vaccination against COVID-19 to use a service, enter a building, or undertake an activity, including attending class in person. In addition, the bill further restricts the Secretary of Health’s ability to implement certain disease control measures for individuals who have not been exposed, potentially or otherwise, to a contagious disease. The bill was signed in the state House and Senate on June 24th and sent to the governor. The governor has indicated he will veto

Department of Human Services

Department of Health

Effective at midnight on June 23, 2021, the Department of Health terminated its order requiring skilled nursing facilities to complete a vaccine needs assessment survey since those facilities are now reporting to the federal government.

COVID-19:  By the Numbers

  • The daily number of new COVID-19 cases continues to decline significantly.  The 174 new COVID-19 cases reported on Wednesday marked the lowest new daily case count since March 25, 2020, when 276 new cases were announced.
  • The number of COVID-19 deaths continues to decline significantly as well.
  • For the week from June 11 through June 17 the state’s overall COVID-19 test positivity rate was 1.4 percent, down from 1.9 percent last week and 2.9 percent the week before.
  • Sixty-four counties had a positivity rate lower than five percent, up from 62 last week, and no counties had a positivity rate greater than 20 percent for the eighth consecutive week.
  • Thirty-seven counties are currently experiencing low levels of community transmission of COVID-19, up from 22 last week; the remaining 30 Pennsylvania counties are experiencing moderate levels of community transmission and no counties are experiencing a high level of community transmission.
  • Since June 1 the number of Pennsylvanians hospitalized with COVID-19 has fallen 62 percent; the number on a ventilator has fallen 54 percent; and the number in hospital intensive care units has fallen 70 percent.
  • 5.3 million Pennsylvanians have been fully vaccinated against COVID-19, according to the state’s COVID-19 dashboard.  Growth in this number has slowed significantly over the past month and only about 150,000 new vaccinations were reported in the past week. Another 760,000 people have been vaccinated in Philadelphia.  According to the state, 59.4 percent of Pennsylvanians 18 years of age and older are now fully vaccinated and 62.2 percent of the entire population has now received at least the first dose of a vaccine.

Around the State

Two Pennsylvania children’s hospitals ranked among the best ten such hospitals in the U.S. in the latest rankings published by U.S. News & World Report:  Children’s Hospital of Philadelphia ranked second and UPMC Children’s Hospital of Pittsburgh ranked ninth.

Two Pennsylvania-based health insurers, Highmark and Independence Blue Cross, are among five Blues plans joining forces in a new venture called Evio, a for-profit venture that will seek to make prescription drugs more affordable and improve health care outcomes.  Learn more here.

Stakeholder Events

  • Maternal Mortality Review Committee

June 28 at 8:00

This meeting will be held via conference call.  The purpose of the meeting is to discuss new and ongoing procedural issues relating to the review process for the committee.  To join the call, dial +1 (267) 332-8737 and when prompted, enter the following conference code: 522 321 931#.

  • DHS Office of Long-Term Living – Financial Management Services Meeting

June 28 at 11:00 a.m.

The purpose of this meeting is to discuss upcoming changes in the administration of financial management services under the Community HealthChoices, OBRA Waiver, and Act 150 programs.  Representatives from the Office of Long-Term Living and Community HealthChoices managed care organizations will discuss the upcoming changes.  Interested parties can join the meeting in the following ways:

From the meeting link:

https://pa-hhs.webex.com/pa-hhs/j.php?MTID=m15e2e495a802f00df6fa38c9e645237d

By meeting number:

Meeting number (access code): 132 280 2499

From a mobile device (attendees only):

1-408-418-9388,,1322802499## United States Toll

1-202-860-2110,,1322802499## United States Toll (Washington D.C.)

By phone:

+1-408-418-9388 United States Toll

+1-202-860-2110 United States Toll (Washington D.C.)

Meeting password: Stakeholder

From a video system or application

Dial 1322802499@pa-hhs.webex.com

You can also dial 173.243.2.68 and enter your meeting number

  • Managed Long-Term Services and Supports Subcommittee Meeting

July 7 at 10:00 a.m.

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

Webinar registration – go here

Dial in:  1-914-614-3221, access code 716-025-613

Remote captioning and streaming link – go here

  • Newborn Screening and Follow-Up Technical Advisory Board

July 15 at 10:00

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

  • Special Pharmaceutical Benefits Program

July 29, 2021 at 10:00

This is a telephone meeting.

Join on your computer or mobile app

Click here to join the meeting

Or call in (audio only)

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

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

Phone Conference ID: 785 376 728#

Stakeholder Event Report

Medical Assistance Advisory Committee Meeting – June 24

Deputy DHS Secretary Sally Kozak announced that DHS will perform readiness reviews of the managed care organizations selected to participate in the latest HealthChoices program procurement.  The procurement remains the subject of litigation so DHS will stop short of negotiating with the managed care organizations until there is a final decision in that case.

Stakeholder Events Materials

DHS has posted four presentations offered at the June 24 meeting of the Medical Assistance Advisory Committee.  Those presentations were delivered by its:

 

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law booksThe Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work.  In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Issues Bulletin on Medicaid Expansion

The Pennsylvania Department of Human Services (DHS) has issued a new Medical Assistance Bulletin on the state’s expansion of its Medicaid program via the HealthChoices managed care program.
Bookshelf with law booksThe bulletin notifies providers of the introduction of a new adult benefit package that applies to all adult Medicaid recipients in the state, highlighting some of the major changes in benefits from past packages.  It also provides information about the state’s plan for a phased transition from the current private care option (PCO) insurance plans to HealthChoices plans over the coming months.
See DHS Medical Assistance Bulletin 99-15-05 here.

2015-04-30T06:00:10+00:00April 30th, 2015|HealthChoices PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Issues Bulletin on Medicaid Expansion

PA Revises Guidelines for Medicaid Presumptive Eligibility

The Pennsylvania Department of Human Services has revised its guidelines for hospitals qualified to make presumptive eligibility determinations for potentially Medicaid-eligible patients who seek services but are uninsured.
Bookshelf with law booksThe revisions are described in Medical Assistance Bulletin 01-15-08, “Revised Presumptive eligibility as Determined by Hospitals,” which was issued on February 24 but is retroactive to January 1.
In support of that new guidance the state also has issued an addendum for providers outlining their responsibilities and a worksheet for hospitals to use in determining eligibility.

2015-03-05T06:00:02+00:00March 5th, 2015|Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Revises Guidelines for Medicaid Presumptive Eligibility

PA Officially Ends Enhanced Medicaid Payments

The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31.
Bookshelf with law booksWhile some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1.
See the Medical Assistance Bulletin notice here.

2014-12-29T06:00:31+00:00December 29th, 2014|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Officially Ends Enhanced Medicaid Payments

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments:  a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Issues Bulletin Detailing Healthy PA Benefits

PA Makes Healthy PA Implementation Official

The Pennsylvania Department of Public Welfare (DPW) has published an official notice in the state’s Medical Assistance Bulletin announcing the implementation of the Healthy Pennsylvania Medicaid expansion program on January 1, 2015.
The notice provides background information about the plan, how it will work, and how it will differ from the state’s current Medicaid program.  It also presents the final word on how the state will define “medically frail” for determining which benefits package participants will receive, outlines how the program’s health screening of applicants will work, and explains enrollees’ cost-sharing responsibilities.
The Bulletin notes that the state will issue a separate announcement to providers with more information about the scope of benefits to be provided, how the program will employ private insurers to serve the state’s Medicaid population, and when training will be offered to familiarize providers on how to work with the new program.
Find the Bulletin here.

2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Makes Healthy PA Implementation Official

Providers Must Re-enroll to Serve PA Medicaid Population

All health care providers that serve Pennsylvania’s Medicaid population must re-enroll with the state if they wish to continue doing so.
Pennsylvania State MapThe requirement, established under the Affordable Care Act, applies to providers that participate in both the state’s Medicaid managed care and fee-for-service programs.
Additional information can be found about the requirement and how to re-enroll in this Medical Assistance Bulletin notice.

2014-03-14T06:00:34+00:00March 14th, 2014|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on Providers Must Re-enroll to Serve PA Medicaid Population

DPW Announces Revisions of Medicaid Fee Schedule

The Pennsylvania Department of Public Welfare (DPW) has published a notice of its intention to implement changes in the Medicaid fee schedule and to update selected prior authorization requirements.
Those notices are published here, in the June 22 edition of the Pennsylvania Bulletin, and the changes took effect on June 24.
DPW also published a Medical Assistance Bulletin on the procedure code updates and a table showing the updates.  Find the bulletin here and the table here.

2013-06-26T06:00:45+00:00June 26th, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Announces Revisions of Medicaid Fee Schedule

DPW Establishes Exceptions to Monthly Prescription Limit

Since January of last year, Pennsylvania’s Medical Assistance program has limited categorically needy adult recipients over the age of 21 to six prescriptions a month.
While Medical Assistance has established a process for seeking exceptions to this limit, the Department of Public Welfare has now published a new MA Bulletin that lists exceptions that will automatically be granted.
Find that list in thisBookshelf with law books MA Bulletin.

2013-05-03T06:00:51+00:00May 3rd, 2013|Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Establishes Exceptions to Monthly Prescription Limit
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