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PA Health Policy Update for January 24

The following is an update of selected state health policy developments in Pennsylvania January 20 – 24.  (Some of the language used below is taken directly from state documents). 

Pennsylvania Row Offices 

Pennsylvania’s three row officers – Attorney General Dave Sunday, Auditory General Tim DeFoor, and Treasurer Stacy Garrity – were sworn into office on Tuesday, January 21. This marks the first time all three row offices are held by Republicans. 

General Assembly

Following the unfortunate passing of Rep. Matt Gergely (D-Allegheny), Speaker McClinton has scheduled a special election for the 35th Legislative District to occur on Tuesday, March 25.

The state House of Representatives and Senate are scheduled to return to session on Monday, January 27, 2025. The following is a selection of health care-related legislative activity currently scheduled for next week. 

  • The Senate Health & Human Services Committee is scheduled to meet “off the floor” on Monday, January 27 to consider Senate Bills 155, 156, and 157, which are part of a package of bills aimed at eliminating waste, fraud, and abuse in public assistance programs.
  • The House Aging & Older Adult Services Committee will convene on Tuesday, January 28 at 9:30 a.m. for an informational meeting on direct care workers and the homecare industry. The meeting will be held in Room G-50 of the Irvis Office Building.
  • The House Insurance Committee is scheduled to meet on Tuesday, January 28 “at the call of the chair” to consider, among other bills, House Bill 111, which prohibits insurers from denying coverage to individuals solely because they have an opioid reversal agent in their prescription profile.  The meeting will be held in Room B-31 of the Main Capitol.
  • The House Human Services Committee will convene on Wednesday, January 29 at 9:00 a.m. for an informational hearing on traumatic brain injury care needs and coverage options. The hearing will be held in Room G-50 of the Irvis Office Building.
  • The House Health Committee will convene on Wednesday, January 29 at 10:00 a.m. in Room G-50 of the Irvis Office Building to consider the following bills.
    • House Bill 27, which requires health care facilities to adopt and implement policies to mitigate exposure to surgical smoke through the use of a smoke evacuation system for each procedure that generates surgical smoke.
    • House Bill 33, which implements greater oversight of medical marijuana labs and product testing.
    • House Bill 79, which establishes a medical debt relief program in the commonwealth. 

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 December.

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

Department of Health  

The Department of Health (DOH) and the Patient Safety Authority have released draft recommendations to all hospitals and birthing centers to mitigate the risk of harm related to shoulder dystocia. Find the draft recommendations and instructions on how to comment in this Pennsylvania Bulletin notice.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs’ (DDAP) State Epidemiological Outcomes Workgroup (SEOW), in partnership with Drexel University’s Department of Community Health and Prevention, has released two new reports.

State Board of Nursing  

The State Board of Nursing has issued proposed rulemaking that would amend regulations related to professional, practical, and certified registered nurse practitioner education programs. The proposed amendments also codify current board practice and update requirements to meet national standards. Find the proposed rulemaking in this Pennsylvania Bulletin notice. 

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has released new county-level utilization data and condition-specific reports, which provide greater insight into ambulatory/outpatient utilization and hospitalization rates for high interest conditions. Find the full reports here. 

Around the State  

  • Pennsylvania anticipates it will receive $212 million over 15 years from a multi-state opioid settlement recently reached with the Sackler family and Purdue Pharma. Read the Pennsylvania Capital-Star’s coverage here. 
  • The Philadelphia Inquirer has published an article about the challenges confronting Governor Shapiro, who is mid-way through his first term, including an anticipated $4.5 billion budget deficit.
  • The Patriot-News has written an article about Pennsylvania’s continued downward trajectory of vaccination rates among children.
  • Spotlight PA has published a detailed article about Bucktail Medical Center and its recent receipt of $1 million from the state in an effort to prevent its closure.

 Stakeholder Meetings

Council on Aging – 2025 Meeting Dates

The Pennsylvania Council on Aging, an independent advisory board under the Office of the Governor and supported by the Department of Aging, has released its meeting schedule for 2025. Find the full schedule and details on how to participate in this Pennsylvania Bulletin notice.

2025-01-24T20:07:55+00:00January 24th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for January 24
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PA Health Policy Update for January 17

The following is an update of selected state health policy developments in Pennsylvania January 13 – 17.  (Some of the language used below is taken directly from state documents). 

General Assembly 

The state House of Representatives and Senate are scheduled to return to session on Monday, January 27, 2025. 

Department of Human Services

  • The Department of Human Services (DHS) has issued final-form regulations regarding Psychiatric Rehabilitation Services (PRS). The regulations, which are effective upon publication in the Pennsylvania Bulletin incorporate several updates, including lowering the minimum age to 14 years old for PRS eligibility, the inclusion of individuals with posttraumatic stress disorder, bipolar disorder, major depressive disorder, and anxiety disorders without requiring an exception process, and the implementation of a weekly file note requirement. Find additional information in this Pennsylvania Bulletin notice. 
  • DHS has provided final notice of the FY 2024-2025 nursing facility assessment amount, the assessment methodology, and the estimated aggregate impact on nursing facilities subject to the assessment. Find those details in this Pennsylvania Bulletin notice.  
  • DHS has issued a Medical Assistance Bulletin to advise providers that it has updated the top 15 non-English languages used by Medicaid beneficiaries and to remind providers of their responsibility to provide interpretation and translation services free of charge to all individuals who have limited English proficiency, vision limitations, and/or auditory limitations. 

Health Department

  • The Department of Health (DOH) has issued a Health Advisory (PA-HAN 782) to share information with health care professionals about exposure to environmental contaminants, including a list of trainings and resources from academic and governmental organizations that can help providers assess environmental exposures and respond to patient concerns.
  • DOH has shared an announcement from the Federal Office of Rural Health Policy regarding new funding available for the Rural Residency Planning and Development (PRPD) program.

Insurance Department 

The Pennsylvania Insurance Department (PID) has announced it took an important step toward fully implementing the commonwealth’s new Pharmacy Benefit Manager (PBM) reform law. PID established a new process for pharmacies to challenge a health benefit plan’s designation of a specialty drug, as provided by Act 77 of 2024. PBMs and pharmacies looking for more information about Act 77, including a schedule that outlines the Act’s full implementation dates, can visit PID’s website here. 

Pennsylvania Supreme Court 

The Pennsylvania Supreme Court and the Administrative Office of Pennsylvania Courts (AOPC) have announced their efforts to combat the behavioral health crisis, including the establishment of an Office of Behavioral Health.  

Around the State  

  • The Pennsylvania Capital-Star has published an article highlighting laws enacted by the General Assembly in 2024 that will take effect this year, including bills that improve access by mandating insurance coverage of biomarker testing and telemedicine. 
  • Prospect Medical Holding’s, the parent company of Crozer Health in Delaware County, decision to file for bankruptcy was covered by Harold Brubaker for The Philadelphia Inquirer in this article. 
  • WPSU has reported that Bucktail Medical Center in Clinton County has received a $1 million state grant from the Department of Community and Economic Development’s (DCED) Hospital and Healthsystem Emergency Relief fund. 

Stakeholder Meetings

DOH – Achieving Better Care by Monitoring All Prescriptions Board – 2025 Meeting(s)

The Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board, established under the Achieving Better Care by Monitoring All Prescriptions Program (ABC-MAP) has set its calendar for 2025. Find the meeting dates and 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.

2025-01-17T22:38:55+00:00January 17th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for January 17
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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 December 20

The following is an update of selected state health policy developments in Pennsylvania December 16 – 20.  (Some of the language used below is taken directly from state documents). Please note, the next health policy update will be Friday, January 3, 2025. 

Governor Shapiro

Governor Shapiro has announced the appointment of Attorney General Michelle Henry to serve as Pennsylvania’s State Inspector General, effective January 21, 2025. The State Inspector General protects the integrity of commonwealth agencies by investigating fraud, misconduct, and abuse in executive agencies under the governor’s jurisdiction. Find additional information in this press release.

The Shapiro administration, including leaders from the Department of Human Services, Department of Health, Department of Drug & Alcohol Programs, and the Department of Aging, came together this week to highlight mental health, substance use disorder, and other resources available to Pennsylvanians this holiday season. Find additional information in this press release. 

General Assembly 

The Joint State Government Commission has released a report, “Women Veterans Health Care in the Commonwealth,” as directed by Senate Resolution 46. The report evaluates the access to

and quality of health care for women veterans in the commonwealth. A one-page summary of the report is viewable here. 

Department of Human Services 

  • The Department of Human Services (DHS) Office of Mental Health & Substance Abuse Services (OMHSAS) has issued a bulletin to update and clarify the procedure for submitting and processing waiver requests to OMHSAS. The bulletin also makes updates to regulatory waiver language and the process to appeal a waiver determination.
  • OMHSAS has announced updates to the Psychiatric Rehabilitation Services (PRS) regulations, which are scheduled for publication in the Pennsylvania Bulletin on January 18, 2025.  The regulations will be effective upon publication in the bulletin. The final form regulatory package submitted to the Independent Regulatory Review Commission (IRRC) is viewable here. The updates include lowering the minimum age to 14 years old for PRS eligibility, the inclusion of individuals with posttraumatic stress disorder, bipolar disorder, major depressive disorder, and anxiety disorders without requiring an exception process, and implementation of a weekly file note requirement.
  • DHS has announced the implementation of an alternative payment methodology for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) for a supplemental payment on the Medical Assistance (MA) program fee schedule for a Long-Acting Reversible Contraceptive (LARC) device and its insertion, or the removal of a LARC device, in addition to payment for an encounter. The effective date will be the date that the Centers for Medicare & Medicaid Services (CMS) approves DHS’ state plane amendment. Find additional information in this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has issued a Health Advisory (PA-HAN 779) to advise health care providers and stakeholders of severe and worsening presentations of withdrawal among people who use drugs in the Philadelphia area. 

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has issued Licensing Alert 08-2024 to outline the steps for a drug and alcohol treatment facility to obtain a telehealth-only license from DDAP. Although existing providers may provide telehealth services, a telehealth-only license is new in Pennsylvania. It is also important to note that, currently, it is not possible to participate in the Pennsylvania Medical Assistance (MA) program as a 100 percent telehealth behavioral health clinic. 

State Board of Medicine 

Following approval from the Independent Regulatory Review Commission (IRRC), the State Board of Medicine has published final rulemaking which amends the Board’s regulations to allow the initial physical examination required for prescribing, administering, and dispensing controlled substances to be done via telehealth under certain conditions. The final rulemaking also conforms to regulations to the federal opioid use disorder treatment standards. Find additional information in this Pennsylvania Bulletin notice.

Around the StatePennsylvania State Map  

  • NBC local affiliate 21WFMJ has reported about Sharon Regional Medical Center’s filing to close after acquisition discussions with Meadville Medical Center failed to yield a positive outcome.
  • PennLive has written an article about the closure of Hershey Pharmacy in central Pennsylvania. The pharmacy’s owner cited the inability of “community pharmacy’s” to be profitable as a reason for its closure.
  • City & State Pennsylvania has written about the 60th Pennsylvania Electoral College meeting that took place in the Capitol on Tuesday. Nineteen electors convened to cast their votes for president and vice president, respectively. 

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 – 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.

2024-12-20T21:13:48+00:00December 20th, 2024|Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for December 20
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PA Health Policy Update for December 13

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

General Assembly

The state House of Representatives and Senate have released their respective 2025 session calendars. Find the House’s calendar here and the Senate’s calendar here. 

Department of Human Services

  • The Department of Human Services (DHS) has announced the addition of doula services to the Medical Assistance (MA) program fee schedule and the submission of a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS). DHS will issue an MA Bulletin to inform providers enrolled in the MA program of the addition of doula services and how to bill for the provision of doula services. Find additional information in this Pennsylvania Bulletin notice. 
  • The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the Partial Hospitalization Regulatory Compliance Guide. The guidance is intended to help agencies providing partial hospitalization services with the goal of ensuring safe environments and effective services to individuals.
  • DHS has issued revisions to the participating drug company list for the Medicaid Drug Rebate Program. The revisions are viewable here. 

Department of Health 

The Department of Health (DOH) and the Pennsylvania Insurance Department (PID) have reminded Pennsylvanians of the importance of HIV pre-exposure prophylaxis (PrEP) medication for HIV prevention. The Affordable Care Act (ACA) requires that HIV PrEP be covered at zero cost-sharing for insured consumers. Find additional resources and information in this press release. 

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has released a “Family Members Training Needs Survey.”  DDAP has requested feedback from family members and/or significant others of individuals who may be suffering from drug or alcohol use, receiving substance use disorder (SUD) treatment, or in recovery to better understand what would help them navigate SUD services. The survey will remain open until January 6, 2025. 

Around the State  

  • The Pittsburgh Post-Gazette has written an article about the expected increase in the number of Pennsylvanians diagnosed with Alzheimer’s Disease in the next 15 years and the challenges the current treatment system will face according to a recent analysis conducted by the Center for Rural Pennsylvania. 
  • The Pennsylvania Capitol-Star published an article about the potential increase in insurance premiums for Pennsylvanians on Pennie, the state’s health insurance marketplace, if federal subsidies expire. 

Stakeholder Events 

Department of Aging – Pharmaceutical Assistance Board – December 16

The Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, December 16 from 2:00 to 3:30 p.m. For connection information or any questions, please contact Megan McDaniel (memcdaniel@pa.gov).

DOH – Health Policy Board – December 19

The Health Policy Board will hold a meeting on Thursday, December 19 at 12:30 p.m. The purpose of the meeting is to consult with the board of the department’s draft proposed hospital regulations. The meeting will be held virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

2024-12-13T21:47:50+00:00December 13th, 2024|Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for December 13
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PA Health Policy Update for December 6

The following is an update of selected state health policy developments in Pennsylvania November 25 – December 6.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

The Shapiro administration has held two recent roundtable discussions with maternal health stakeholders to inform the development of the administration’s Maternal Health Strategic Plan, which will address high rates of maternal mortality and ensure pregnant women in Pennsylvania receive necessary prenatal and postpartum care. Find additional information in this press release. 

General Assembly

The state House of Representatives and Senate have released their respective 2025 session calendars. Find the House’s calendar here and the Senate’s calendar 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 October. 

Department of Health

The Department of Health (DOH) has released a Respiratory Virus Outbreak Toolkit for long-term care facilities, including personal care homes and assisted living residences. The purpose of the toolkit is to provide recommendations for facilities before and during a respiratory virus outbreak.

DOH has published guidelines and fees that a health care provider or facility may charge in response to a request for production of medical charts or records. Find additional information in this Pennsylvania Bulletin notice. This notice updates the prior notice published on December 9, 2023. 

Revenue Collection Update 

The Department of Revenue has announced Pennsylvania collected $2.9 billion in General Fund revenue in November, which was $87.2 million, or 2.9 percent, less than anticipated. Fiscal year-to-date General Fund collections total $16.4 billion, which is $9.9 million, or 0.1 percent, below estimate. 

Around the State  

  • With the conclusion of the 2023-2024 legislative session, City & State Pennsylvania has published an article highlighting the session’s accomplishments, as well as its unfinished business. 
  • NBC’s local affiliate 21 WFMJ has reported on efforts to keep Sharon Regional Medical Center open.
  • Spotlight PA has published an article about the range of health care workers who provide maternal care in Pennsylvania and their various roles. 

Stakeholder Events

Patient Safety Authority – December 12

The Patient Safety Authority Board will meet on Thursday, December 12 at 1:00 p.m. The meeting will be held virtually. Find details on how to participate here and a draft agenda here. 

Department of Aging – Pharmaceutical Assistance Board – December 16

The Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, December 16 from 2:00 to 3:30 p.m. For connection information or any questions, please contact Megan McDaniel (memcdaniel@pa.gov).

2024-12-06T20:21:33+00:00December 6th, 2024|Financial, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for December 6
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PA Health Policy Update for November 22

The following is an update of selected state health policy developments in Pennsylvania November 18 – 22.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

Governor Shapiro has signed Executive Order 2024-04 creating the Pennsylvania Permit Fast Track Program to streamline the state’s permitting process for key economic development and critical infrastructure projects. Find additional information in this press release. 

General Assembly

The state House of Representatives and Senate have recessed until the call of their respective chair. 

Department of Human Services 

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin with updates to the Medical Assistance (MA) Program Vaccine Desk Reference. This bulletin applies to all providers enrolled in the MA program that may administer vaccines to MA beneficiaries in the fee-for-service or managed care delivery system.

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

Insurance Department

The Pennsylvania Insurance Department (PID) has announced the publication of the first Pennsylvania Affordable Care Act and Qualified Health Plans (QHP) Summary Report. This report examines how PID reviews health insurance products and enforces laws to ensure a fair insurance market and equitable treatment of consumers. Find more information in this press release. 

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has announced it received the following final form regulations, which will be considered at its public meeting on December 5, 2024.

  • State Board of Medicine Opioid Treatment Programs: this final-omitted rulemaking amends the Board of Medicine’s regulations to allow the initial physical examination required for prescribing, administering, and dispensing controlled substances to be done via telehealth under certain conditions.
  • State Board of Osteopathic Medicine Licensure Requirements: this final rulemaking includes amendments to licensure requirements that are, in part, necessary to reflect the merger of the post-graduate training bodies for osteopathic (DO) and allopathic (MD) medical school graduates into a single accreditation system.   

Around the State  

  • The New York Times has written about President Donald Trump’s plan to nominate Pennsylvania resident Dr. Mehmet Oz to serve as the administrator of the Centers for Medicare and Medicaid Services.
  • WKBN 27 has written an article about the Commonwealth’s continued efforts related to the potential sale of Sharon Regional Medical Center, part of Steward Health Care which filed for bankruptcy in May.
  • City & State Pennsylvania has published an article about the five bills signed into law by Governor Shapiro this week and his signing of an executive order on permitting. 

Stakeholder Events 

DHS – Long-Term Services and Supports Subcommittee – December 4

The Long-Term Services and Supports Subcommittee (LTSS) will hold a public meeting on December 4 from 10:00 a.m. to 1:00 p.m. The meeting will be held in person and virtually. Click here for more information. 

DHS – Consumer Sub-MAAC – December 4

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on December 4 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – December 5

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on December 5 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

2024-11-22T22:10:10+00:00November 22nd, 2024|Affordable Care Act, long-term care, Medical Assistance Advisory Committee, Meetings and notices|Comments Off on PA Health Policy Update for November 22
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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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Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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