Pennsylvania Medicaid Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for October 31

The following is an update of selected state health policy developments in Pennsylvania from October 27- October 31 (Some of the language used below is taken directly from state documents).

Budget Update

In a hopeful sign, top legislative leaders have met daily with the Governor and key staff throughout the week. The House and Senate are both set to return on November 17th. As negotiations continue, school districts and counties are adjusting services and payments to navigate the impasse.

General Assembly

During this week’s session, the House unanimously passed Rep. Ben Sanchez’s HB 446, allowing patients to take home unused medications following a hospital stay. The House also passed HB 1828, vaccine coverage and access legislation offered by Rep. Arvind Venkat, by a margin of 104-99. Both bills now move to the Senate for consideration.

The House Professional Licensure committee advanced Sen. Rosemary Brown’s SB 507. This legislation would update and modernize midwifery services in Pennsylvania.

The Senate Health & Human Services Committee voted to advance SB 270 and SB 614. Senator Amanda Cappelletti’s SB 270 would restrict online sales of human donor milk. SB 614, Chairwoman Michele Brooks’ legislation on FQHC Preceptors, was amended to limit the program to only rural areas.

The Senate Institutional Sustainability and Innovation Committee met to consider HB 157, SB 804, and SB 998. Rep. Kathy Rapp’s HB 157 would create a Rural Health Care Grant Program within the Department of Health. Senate Bill 804 from Sen. Boscola would prohibit toxic additives in IV Bags and medical equipment. Senate Bill 998, introduced by Rep. Rosemary Brown, would create a Nursing Education Capacity Expansion Grant Program within the Department of Community & Economic Development.

The House Health Committee held an informational meeting on the Department of Health’s Newborn Screening program on October 28^th where Rep. Sailsbury’s House Bill 1652 was discussed. This legislation would add Gaucher Disease to the Newborn Screening program.

The Senate State Government Committee held a hearing to discuss SB 125, Sen. Dush’s proposed constitutional amendment to address change of judicial venues.

The House Human Services Committee amended and advanced House Bill 1974 by Rep. Venkat. HB 1974 proposes to create a Contingency Management Support Grant Program within the Department of Drug and Alcohol Programs (DDAP), enabling Single County Authorities to apply for grants supporting Contingency Management programs and activities like staff training, drug-testing supplies, incentive tracking systems, evaluation, and non-cash incentives.

The House Consumer Protection, Technology, and Utilities Committee voted out HB 1530 which would establish privacy protections for Pennsylvania consumers regarding their genetic data collected by direct-to-consumer genetic testing companies (e.g., commercial DNA testing services).

Below is a list of health and human services-related legislation and co-sponsor memos released this week.

Rep. Danielle Friel Otten released a co-sponsor memo for legislation to require coverage of obesity treatments.

Rep. Wendy Fink introduced HB 1997 which allows autologous or directed blood donations for certain medical procedures.

Department of Human Services

The Department issued several changes to the MA Fee Schedule, adding procedure codes, prior authorization requirements, and changing units and limitations on procedure codes.

State Board of Nursing

The State Board of Nursing issued final form regulations effective upon today’s publishing in the PA Bulletin, but with provisions relating to organ & tissue donation taking effect May 1, 2026.

Independent Regulatory Review Commission

IRRC will consider DHS’ proposed Covered Outpatient Drugs Regulation at their November 20^th public meeting.

Stakeholder Meetings

The Department of Health’s Statewide HIV Planning Group will hold their public meeting on Wednesday Nov. 19^th and Thursday November 20^th both from 9am-3pm.

DOH’s Infant Hearing Screening Advisory Committee will meet on Thursday Nov. 13^th from 10am – Noon.

DOH’s Spinal Cord Research Advisory Committee will meet on Friday Nov. 7^th from 8:30am – 9:30am.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2025-10-31T18:57:20+00:00October 31st, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medical Assistance, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for October 24

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

Budget Update

Earlier this week, the Senate passed Senate Bill 160 (PN 1258) by party line vote in yet another volleying of a General Appropriations Act bill to the House. The Senate’s amendments to the bill reduced the overall spend number to $47.9 billion, down from the House’s last proposal of $50.25 billion.

The bill reflects a prior version (PN 529) of the budget bill but with increased appropriations for debt service payments and school employees’ pensions, while also reducing operating expense line items for the General Assembly. The Governor labeled the Senate’s most recent effort as “unserious.”

As the impasse continues, meaningful impacts to Pennsylvanians and providers are becoming more frequent. Absent budget enactment, Head Start providers are signaling closures, Westmoreland County plans to furlough workers soon, and Lancaster County intends to pause social services payments.

The House and Senate are both set to return on October 27^th.

General Assembly

Last week, the Senate was in session and passed by a margin of 49-1, Sen. Rosemary Brown’s SB 507, legislation to update and modernize midwifery services in Pennsylvania. The bill will be considered by the House Professional Licensure Committee on October 28^th.

The Senate Labor & Industry Committee voted in support of SB 69 offered by Sen. Langerholc by a party line vote. This bill would create a “Recovery-to-Work” pilot program.

Next week, on October 28^th, the House Health Committee will hold an informational meeting on the Department of Health’s Newborn Screening program.

On October 29^th, the House Human Services Committee will meet to consider Rep. Benham’s HB 1939, and House Bill 1974 by Rep. Venkat. HB 1939 would require DHS to update fee schedule rates for home and community-based services provided through intellectual disability and autism programs based on the Consumer Price Index. HB 1974 proposes to create a Contingency Management Support Grant Program within the Department of Drug and Alcohol Programs (DDAP), enabling Single County Authorities to apply for grants supporting Contingency Management programs and activities like staff training, drug-testing supplies, incentive tracking systems, evaluation, and non-cash incentives.

The House Consumer Protection, Technology, and Utilities Committee will meet on October 29^th to vote on HB 1530 which would establish privacy protections for Pennsylvania consumers regarding their genetic data collected by direct-to-consumer genetic testing companies (e.g., commercial DNA testing services).

On October 27^th, the Senate State Government Committee will consider SB 125, Sen. Dush’s proposed constitutional amendment to address change of judicial venues.

Below is a list of health and human services-related legislation and co-sponsor memos released this week.

Marla Brown introduced HB 1962 which would cease state funding for any provider offering abortion services in PA.
HB 1965, introduced by Rep. Ryan Bizzarro, would allow EMS providers to perform community paramedicine services.
Paul Takac introduced HB 1980 which would require doctors to do an hour of medical nutrition continuing education every two years.
Mastriano introduced SB 1018 which would eliminate any mRNA vaccine mandates in Pennsylvania.
SB 1041 by Sen. Rosemary Brown would create the Complex Care Assistant Program, creating a certification program for family caregivers offering complex medical care to loved ones.
Senator Tartaglione introduced SB 1054 which would require the availability of opioid antagonists in Pennsylvania public schools.
Senator Collett has introduced SB 1055, companion legislation to HB 1881, which would expand pharmacists’ practice authority to provide vaccines in accordance with recommendations from Pennsylvania’s health authorities informed by professional medical societies in addition to FDA guidelines.

Department of Human Services

The Department of Human Services released September’s Physical Health Managed Care enrollment report.

Department of Health

In response to revised CMS guidance on conducting facility surveys during the federal shutdown, which will allow states to request approval from CMS to conduct revisit surveys, DOH notified providers that it will be reviewing outstanding surveys, their timelines, and the deficient practice(s) to request permission from CMS to perform revisit surveys that are necessary to prevent termination or the denial of payment for new admissions.

DOH updated the Resident Data Reporting Manual for long-term care facilities to reflect changes to use the Patient Driven Payment Model (PDPM) for the Pennsylvania case mix payment system.

Stakeholder Meetings

On Nov. 7 from 10am to 3pm, the Brain Injury Advisory Board will hold their quarterly meeting to discuss the Department of Health’s Head Injury Program.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2025-10-24T19:20:42+00:00October 24th, 2025|Meetings and notices, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for October 17

The following is an update of selected state health policy developments in Pennsylvania from October 14- October 17 (Some of the language used below is taken directly from state documents).

Budget Update

The budget process has remained at a stalemate this week with no changes following House action last week. The Senate is scheduled to return this upcoming week. The House is set to return on October 27^th.

General Assembly

Rep. Melissa Shusterman introduced HB 2005, which would remove the counseling and waiting period requirements for abortions in Pennsylvania. This legislation along with several other abortion-related bills will be considered by the House Judiciary Committee on October 22^nd.

The Senate Labor & Industry Committee will convene on October 22^nd to consider Sen. Wayne Langerholc’s SB 69, which would create a “Recovery-To-Work” pilot program.

Rep. Jessica Benham introduced HB 1939, which would require DHS to update fee schedule rates for home and community-based services provided through intellectual disability and autism programs based on the Consumer Price Index.

Senator Michele Brooks introduced SB 1043 and SB 1051, both designed to strengthen Pennsylvania’s eligibility for new federal Rural Health Transformation Fund dollars. The funding application offers states additional points in their total application score if they have adopted certain policy priorities of the Trump Administration or introduced legislation to do so. SB 1043 would require nutrition continuing medical education (CME) for clinicians to ensure providers are better equipped to address diet-related chronic disease. SB 1051 would require PA to join the Physician Assistant Licensure Compact to expand our rural workforce by making it easier for PAs from other states to practice in Pennsylvania.

Sen. Brooks also introduced SR174, which would urge Congress to establish a national database or system to share wage, employment, unemployment compensation and other relevant eligibility data with the states to improve compliance with the recent eligibility verification changes in the federal HR1.

Senator Tina Tartaglione introduced SB 1054, which would require all high schools in Pennsylvania to maintain opioid antagonists, such as naloxone or Narcan, onsite.

Department of Human Services

The DHS Office of Mental Health and Substance Abuse Services (OMHSAS) issued a request for proposals from non-profit organizations interested in expanding the Fairweather Lodge (FWL) model in the commonwealth. The FWL model is a structured, community-based program that supports individuals with serious mental illness reintegrate themselves into the community after facing homelessness or transitioning from state hospitals, correctional facilities, or long-term care settings. FWL providers offer emotional support, a place to live, and employment. OMHSAS is interested in establishing two to five new lodges that would serve up to 18 individuals. Find details and application materials here.

DHS issued Remittance Advice guidance for providers that do not receive a check or Remittance Advice (RA) within established time frames for each RA cycle.

DHS proposed rulemaking on minimum standards for the issuance of licenses to provide emergency behavioral health crisis intervention services in alignment with national best practices for crisis services. This proposed rulemaking also establishes new requirements related to service modalities including facility requirements, quality monitoring, staffing qualifications, services provided and training.

Department of Health

DOH issued a request for proposals from eligible community-based health care clinics (CBHCs) to fund the development of new CBHCs or the expansion of existing clinics to enhance maternity and postpartum care, hospital partnerships, or alternative care delivery systems. The deadline for applications is November 17. Find the RFP with more details and budgeting materials here.

Pennsylvania Insurance Department

PID announced the releasing of the final Affordable Care Act (ACA) health insurance rates for 2026, which reflect significant price increases for Pennsylvanians if Congress fails to extend enhanced premium tax credits (EPTCs).

Department of Aging

The Department of Aging (PDA) announced a new tool for screening in-home care workers to increase hiring transparency and protect older adults.

PDA reminded older Pennsylvanians that Medicare Open Enrollment begins October 15, with free insurance counseling available through Local Aging Agencies.

Stakeholder Meetings

DHS is hosting its next Medical Assistance Consumer Subcommittee meeting on October 22, 2025, at 1:00 pm. Interested attendees can register here. The full MAAC will meet at 10 a.m. on October 23^rdin the Keystone Building, Harrisburg.

DHS and the Treasury Department are partnering on a webinar on a PA Achieving a Better Life Experience (ABLE) Savings Program for OLTL Service Coordinators, Direct Service Providers, MCO Staff, and anyone working in employment support services. The webinar is scheduled for October 29^th from Noon to 1pm. Individuals can register here.

Federal Update

Click here for a review of this week’s federal activities.

PA Safety Net Admin2025-10-17T19:25:43+00:00October 17th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for October 10

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

Budget Update

Tensions rose in the continued budget impasse this week. As the stalemate reached 100 days, House Democrats amended and sent SB 160, a $50.25 billion budget bill, over to the Senate. All four caucuses and the Governor held press conferences staking out their respective positions and the path forward remains uncertain. The Senate placed itself on a 24-hour call-of-the-chair but is formally scheduled to return on October 20^th. The House is set to return on October 27^th.

General Assembly

Rep. Arvind Venkat introduced HB 1925, which would regulate the usage of AI in healthcare.

The House amended a technical amendment into HB 446 which would allow individuals to take dispensed, unused medications home with them following a hospital stay.

HB 1828, which requires private insurance coverage of vaccines without cost-sharing that are FDA-approved and recommended by recognized authorities, was reported from the House Insurance Committee as amended on a party-line vote, with Republicans voting in the negative.

HB 1881, which expands pharmacists’ practice authority to provide vaccines in accordance with recommendations from Pennsylvania’s health authorities informed by professional medical societies in addition to FDA guidelines, was reported from the House Insurance Committee as amended on a party-line vote, with Republicans voting in the negative.

The House Aging & Older Adult Services Committee unanimously passed HB 1894 which would enhance counseling of individuals on the LIFE program during the MA long term care enrollment process.

SB 507 was advanced by the Senate on second consideration and by the Senate Appropriations Committee and is positioned for third and final consideration. This bill would create a licensure pathway for certified midwives in Pennsylvania, allow midwives to prescribe treatment for opioid use disorder, and modernizes the current collaborative agreement structure.

Department of Drug & Alcohol Programs

DDAP, in partnership with CODE PA, announced improvements to the ordering process for PA’s Overdose Prevention Program through a streamlined application process.

Department of Human Services

In this week’s PA Bulletin, DHS announced the addition of targeted case management (TCM) services for eligible juveniles effective October 12, 2025. The Department will use existing payment methodologies for the physical health and behavioral health pre-release and post-release TCM services rendered to eligible juveniles being released from a carceral setting, with CMS approval. The Department will issue an MA Bulletin to advise enrolled providers of the addition of TCM for eligible juveniles to the MA Program Fee Schedule and instructions for billing these services.

Following Executive Order 2025-02 ,  DHS affirmed that Pennsylvania’s Medicaid program will continue to support access to vaccinations at no out-of-pocket cost for Pennsylvanians whose health care is covered by Medicaid and CHIP.

The Department issued a MA Bulletin Notice adopting the American Academy of Pediatric Dentistry’s Dental Periodicity Schedule.

The Department released the MCO Enrollment Report for August 2025.

Department of Health

The Department of Health Division of Acute and Ambulatory Care (DAAC) revised its policy on when facilities must notify DAAC in advance of certain events and removed the requirement to provide 30 days’ notice before adding new equipment. See the revised guidance here and email DAAC at RA-DAAC@pa.gov with any questions.

DOH has updated the forms that hospitals and ambulatory surgical facilities should use for exception requests. Follow the links on this document for the most current forms.

DOH issued a notice to facilities explaining that the department will be adhering to the CMS guidance for survey activities during the federal government shutdown. DOH will continue to conduct state and Medicaid only licensure, occupancy, and complaint surveys. Federal survey activities will be limited to the excepted surveys identified by CMS, including hospice surveys and other facility surveys involving allegations of immediate jeopardy or actual harm and survey-related activities associated with federal terminations from CMS. The department is awaiting CMS guidance on managing any follow-up activities related to surveys completed prior to September 30.

Stakeholder Meetings

DHS and the Treasury Department are partnering on a webinar on a PA Achieving a Better Life Experience (ABLE) Savings Program for OLTL Service Coordinators, Direct Service Providers, MCO Staff, and anyone working in employment support services. The webinar is scheduled for October 29^th from Noon to 1pm. Individuals can register here.

PA Safety Net Admin2025-10-14T16:33:27+00:00October 10th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for September 26

The following is an update of selected state health policy developments in Pennsylvania from September 22- 26 (Some of the language used below is taken directly from state documents).

Budget Update

The state budget impasse continues to drag on. This week, the Senate was not in session but the House met for non-voting session. The Senate has scheduled a non-voting session day on October 3^rd and voting session on October 6^th through 8^th. As highlighted in this Penn Capital Star article, with transit funding handled through other means, counties and schools will become the pressure point as negotiations continue.

Treasurer Stacy Garrity announced the creation of a $500 million loan fund for counties and Head Start providers as a bridge for funding through the budget stalemate.

General Assembly

The House will return for voting session beginning on Monday, September 29^th. For the House session week ahead, the following hearings and voting meetings are scheduled:

Monday, Sept. 29, 9:30am – The House Aging & Older Adult Services Committee will hold an informational meeting on the PA CareKit Program. The Department of Aging will offer testimony.
Monday, Sept. 29, 10:45am – House Human Services Committee will meet to consider HR 290, a resolution recognizing the month of September 2025 as “National Recovery Month” in Pennsylvania.
Tuesday, Sept. 30, 10am – The House Consumer Protection, Technology, and Utilities Committee will hold a voting meeting to consider HB 1530 which would create privacy and transparency requirements genetic data collected through direct-to-consumer genetic testing.
Tuesday, Sept. 30, off-the-floor – The House Health Committee will hold a voting meeting on the following legislation:
HB 880 – Updating and closing loopholes within Pennsylvania’s Clean Indoor Air Act.
HR 271 – A Resolution directing the Joint State Government Commission to establish an advisory committee and conduct a comprehensive study regarding the indoor air quality for seniors and children in this Commonwealth.

Below is some health care-related legislation introduced or co-sponsorship memos circulated this week:

Arvind Venkat introduced HB 1881 which would guarantee that Pennsylvania pharmacists’ vaccination practice authority can be guided by recommendations from Pennsylvania’s health authorities that may be informed by our state’s professional medical societies.
Rich Irvin filed a co-sponsor memo which proposed transferring the pharmacy delivery model in Medical Assistance (MA) from Managed Care back to a Fee-For-Service model as a means to impact reimbursements for pharmacies.
Cris Dush filed a co-sponsor memo proposing a Constitutional Amendment giving the General Assembly the authority to establish laws on venues for civil litigation in the Commonwealth as a way to address venue shopping in malpractice cases.
Lynda Schlegel Culver filed a co-sponsor memo to provide MA coverage for rapid whole genome sequencing (rWGS) for critically ill infants up to one year of age who are admitted to an inpatient intensive care unit with a complex illness.
Senators Michele Brooks and Lisa Boscola filed a co-sponsor memo for a resolution urging Congress to provide Pennsylvania with any and all assistance to help comply with the recent federal changes following the One, Big, Beautiful Bill Act.

Department of Human Services

The Department of Human Services (DHS) issued guidance to providers related to “Date of Death Recovery” following a recent audit noting recipient date of death discrepancies where recipients were deceased prior to the dates of service being billed.

DHS’ Office of Developmental Programs issued guidance for flu, RSV, and COVID vaccinations.

Department of Health

The Department of Health (DOH) issued general immunization guidance to clinicians in response to last week’s federal ACIP meeting. The list clarifies organizations for doctors and families to consult on vaccine recommendations.

DOH issued a health alert to providers with guidance on when and how to exclude health care personnel from direct patient care when they are experiencing respiratory illness symptoms.

DOH reminded long-term care facility providers that the annual long-term care questionnaire is due by October 24. Facilities were contacted directly with instructions to complete the web-based questionnaire. Any questions should be directed to Aicha Hassane Noma at ahassaneno@pa.gov or email RA-dohbhssurveys@pa.gov.

Insurance Department

The Pennsylvania Insurance Department has confirmed the private insurance companies operating in the Commonwealth will continue to cover all of the vaccines covered under ACIP’s 2024 recommendations.

Around the State

A group of statewide researchers have compiled a website which aims to track opioid settlement fund spending data in Pennsylvania, which is driven out primarily through counties.

Stakeholder Meetings

Medical Assistance Advisory Committee

The following materials presented at the September 25^th meeting of the MAAC have been posted on the MAAC website:

PA Safety Net Admin2025-09-26T19:05:37+00:00September 26th, 2025|Governments, Medical Assistance Advisory Committee, Pennsylvania Medicaid, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2026 budget, Pennsylvania state budget issues, Uncategorized|Comments Off

PA Health Policy Update for September 12

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

Budget Update

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

General Assembly

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

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

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

Independent Regulatory Review Commission

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

Department of Human Services

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

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

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

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

Around the State

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

Stakeholder Meetings

Medical Assistance Advisory Committee (MAAC) – Sept. 25

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

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

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

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

PA Health Policy Update for August 29

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

Fiscal Year 2025-26 Budget Update

There was no legislative activity surrounding the state budget this week, with both houses in recess, but officials continue their informal negotiations. The budget impasse is expected to extend into mid-September.

Governor Shapiro pitched an amended budget to legislative leaders, which would increase spending by 5% rather than the 8% increase proposed in February. Democrats, including House Majority Leader Matt Bradford, showed a new willingness to help support transit operating budgets through a special trust fund – as pitched by the Senate Republicans earlier in August – if there could be a plan to replenish that fund with new revenue sources. For more perspectives and statements from other legislators on the budget, see this Spotlight PA article.

The House stands adjourned until September 22 and the Senate until September 8.

Department of Human Services

The Department of Human Services (DHS) shared several resources from the federal government on how individuals can take action to move their Social Security benefit payments to electronic payments before the September 30, 2025 deadline after which paper checks will no longer be issued to beneficiaries. This action is particularly important for administrators of personal care and assisted living facilities who may be receiving checks on behalf of their residents. DHS will host a webinar for providers on September 10 at 1pm.

DHS updated its Medicaid managed care organization directory for September 2025.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) will kick off Recovery Month next week, with events continuing throughout September. For event details taking place throughout the state click here.

Pennsylvania Health Insurance Exchange Authority

Pennie, Pennsylvania’s official health insurance marketplace, in coordination with Health Market Connect LLC (HMC), the newly appointed contractor of Pennie’s Assister Network, are launching a new network of regional organizations dedicated to providing localized support throughout the Commonwealth.

Around the State

An op-ed from a retired county mental health commission member published in PennLive details the risk that the budget impasse poses to Pennsylvania’s behavioral health safety net.

WHYY reported on the state of traffic and commute disruptions in light of the current SEPTA service reductions and predicts how the situation will change as more cuts come into place next week.

The Pittsburgh area NPR partner, WSEA, hosted a story about how their regional transit authority’s cuts to the paratransit and ride share program will impact individuals living with disabilities.

Stakeholder Meetings

Patient Safety Authority – Sept 16

The Patient Safety Authority established by the MCARE Act will hold a virtual board meeting on September 16 at 1pm. For registration and meeting instructions, see this PA Bulletin notice.

Pennsylvania Association of Addiction Professionals (PAAP) Annual Conference – Sept 18

The PAAP annual conference will take place in Trevose, PA on September 18 from 8:00 am to 4:30 pm. The addiction-specific educational experience will feature immersive training sessions, an exhibit hall, and networking opportunities. For more information and to register, click here.

PA Safety Net Admin2025-09-02T13:49:51+00:00August 29th, 2025|Meetings and notices, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for August 1

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

The SNAP State Health Policy Update is taking a summer break and will return on August 15 with more health policy news.

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders continue to negotiate a final Fiscal Year (FY) 2025-26 budget agreement. The state House of Representatives and Senate are currently in recess pending a final budget agreement.

The Senate Republican Policy Committee is holding an informational meeting on August 5 regarding mental health services at the Geisinger Behavioral Health Center in Danville, PA.

Department of Human Services

DHS has issued Provider Quick Tip #278 indicating DHS has experienced a delay in implementing the updates noted in Medical Assistance (MA) Bulletin 99-25-03 titled, “Updates to Screening Guidelines for Prior Authorization”. This MA Bulletin advised providers that the Department would transition from InterQual guidelines to Milliman Clinical Guidelines (MCG) as the screening guidelines for prior authorization requests to determine medical necessity for services, items, procedures, or level of care provided to MA beneficiaries in the Fee-for Service (FFS) delivery system, effective July 18, 2025.

The Department of Human Services has published in this week’s Pennsylvania Bulletin final-form rulemaking to amend a data element in the department’s case-mix payment system for nonpublic and county nursing facilities to utilize the Patient Driven Payment Model (PDPM) in place of the Resource Utilization Groups, Version III (RUG-III) classification system in setting Medical Assistance (MA) payment rates for nursing facilities.

Department of Health

The Department of Health (DOH) recently shared a message from the Pennsylvania State Police (PSP) asking health care operators for assistance investigating an individual who is accused of using several aliases to pose as a licensed practical nurse, registered nurse, and RN supervisor at multiple facilities in the commonwealth. Providers are asked to review their employment records and report new information to PSP directly. Find more information in this PSP notice.

The Department of Health (DOH) is coordinating the statewide distribution of free potassium iodide (KI) tablets on August 14 for all Pennsylvanians who live, work, or study within 10 miles of the four active nuclear power plants in the Commonwealth. The press release can be found here.

Department of Aging

The Shapiro administration announced the members of an advisory committee to support the newly created Alzheimer’s Dementia and Related Disorders Office in the Department of Aging.

Around the State

Secretary of the Budget Office, Uri Monson, penned letters to local educational leaders and county public welfare providers explaining which funds will not be able to be distributed during the budget impasse. Find more information and copies of the letters in this Spotlight PA article.

Less than half of Pennsylvania hospitals are complying with federal price transparency requirements, according to a new study discussed in this article from Erie News Now.

The Philadelphia Inquirer reported on the nutritional value of food in hospitals and how some providers are working to improve it in this article.

Spotlight PA launched the first in a series of articles called The Cost of Failing, which will analyze and chronicle mental health spending and services in all 67 counties over the last few state administrations to show how many fewer people receive mental health services in the commonwealth today than just a few years ago.
City & State reports on how rural hospitals across Pennsylvania are bracing for steep financial stress following the passage of the “One Big Beautiful Bill” and how these hospitals, which rely heavily on Medicaid revenue, face escalating risks of closures and service reductions as proposed cuts drive up uncompensated care and threaten stability in already vulnerable rural communities.

Stakeholder Meetings

DHS – Long-Term Services & Supports Subcommittee – August 6

The Long-Term Services and Supports (LTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold its next public meeting on August 6 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

DOH – Organ Donation Advisory Committee – August 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 7 from 10:00 a.m. to 1:30 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 – Infant Hearing Screening Advisory Committee – August 7

The Infant Hearing Screening Advisory Committee will hold a public meeting on Thursday, August 7 from 12:00 p.m. until 3:00 p.m. at 6340 Flank Drive, Harrisburg, PA 17112. The meeting will be conducted in person only. Find information on how to RSVP in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-08-01T20:53:57+00:00August 1st, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for July 25

The following is an update of selected state health policy developments in Pennsylvania from July 21 – July 25. (Some of the language used below is taken directly from state documents).

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders continue to negotiate a final Fiscal Year (FY) 2025-26 budget agreement. The state House of Representatives and Senate are currently in recess pending a final budget agreement.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) has informed states, including Pennsylvania, that it “does not anticipate approving new state proposals of section 1115 demonstration expenditure authority that allow for expanded continuous eligibility or extending existing section 1115 demonstration authority for expanded continuous eligibility, beyond what is required or available under the Medicaid or CHIP statutes.” This will likely prevent Pennsylvania from implementing continuous eligibility for children on Medicaid until the age of six and 12 months of Medicaid coverage to individuals leaving state correctional facilities.

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 June 2025.

DHS has announced that the Human Services Provider Directory has moved to a new web address. The new address is https://www.humanservices.dhs.pa.gov/human_service_provider_directory/.

Department of Health

The Department of Health (DOH) has announced the launch of seven new training opportunities to assist health care providers reduce overdose risk and improve patient outcomes. Training is available online and in-person at no cost and includes continuing education credits for health care providers. Find additional information in this press release.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of its Cardiac Procedures Report, which includes results for six cardiac procedures performed in Pennsylvania acute care hospitals from January 1, 2022 through December 31, 2023. This report displays hospital-specific ratings for in-hospital mortality, readmissions, extended postoperative length of stay, volume of cases, and average hospital charges.

Board of Dentistry

The State Board of Dentistry has published final form rulemaking to implement licensure by endorsement for dentists. The rulemaking is effective upon its publication in the Pennsylvania Bulletin. Find the final rulemaking here.

Board of Examiners in Speech-Language Pathology and Audiology

The State Board of Examiners in Speech-Language Pathology and Audiology has published final form rulemaking to implement licensure by endorsement. The rulemaking is effective upon its publication in the Pennsylvania Bulletin. Find the final rulemaking here.

Around the State

Spotlight PA has published a piece on the closure of pharmacies across Pennsylvania and the broken payment system that’s being blamed for their closure.

Pennsylvania’s ongoing budget impasse and the impact it will potentially have on schools, county governments, and mass transit was the focus of an article published by The Philadelphia Inquirer.

PennLive has written an article about the potential for additional rural hospital closures due to the federal changes in H.R. 1 that will impact Medicaid funding for hospitals.

Stakeholder Meetings

DHS – Long-Term Services & Supports Subcommittee – August 6

The Long-Term Services and Supports (LTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold its next public meeting on August 6 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

DOH – Organ Donation Advisory Committee – August 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 7 from 10:00 a.m. to 1:30 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 – Infant Hearing Screening Advisory Committee – August 7

The Infant Hearing Screening Advisory Committee will hold a public meeting on Thursday, August 7 from 12:00 p.m. until 3:00 p.m. at 6340 Flank Drive, Harrisburg, PA 17112. The meeting will be conducted in person only. Find information on how to RSVP in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-07-25T19:33:08+00:00July 25th, 2025|Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for July 18

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

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders continue to negotiate a final Fiscal Year (FY) 2025-26 budget agreement. The state House of Representatives and Senate briefly convened in Harrisburg this week to position House Bill 1330, which provides for appropriations from the General Fund, to enable the budget to be swiftly enacted when an agreement is reached. Both chambers are currently recessed pending a final agreement.

General Assembly

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

The House of Representatives unanimously passed House Bill 564, which requires the Department of Human Services (DHS) to implement a campaign to increase public understanding and engagement with the 988 suicide and crisis lifeline. The bill will now be sent to the Senate for consideration.

The Senate passed Senate Bill 604, which authorizes the state to join the National Counseling Compact. The bill was subsequently sent to the House of Representatives and referred to the Professional Licensure Committee.

The Senate Health & Human Services Committee met on Thursday, July 17 and favorably reported House Bill 1429, which requires a study on the feasibility of implementing chip-enabled electronic benefit cards (EBT) for the Supplemental Nutrition Assistance Program (SNAP), and House Bill 1527, which extends the Rare Disease Advisory Council’s sunset date to 2028.

The Center for Rural Pennsylvania held an informational hearing on Wednesday, July 16 regarding health care provider policies that have been implemented in other jurisdictions to address the shortage of health care workers in rural areas. A recording of the hearing is viewable here.

Department of Human Services

The Department of Human Services (DHS) has issued a Remittance Advice (RA) related to its previous announcement that it will begin to mass adjust claims submitted for discharge dates October 1, 2024 through June 6, 2025 due to a delay in implementing Version 42 of the APR DRG classification system for Medical Assistance (MA) enrolled acute care general hospitals.

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

Department of Health

The Department of Health (DOH) has issued final notice to temporarily schedule any material, compound, mixture or preparation which contains any quantity of the following Nitazene substances, their salts, isomers and salts of isomers: Butonitazene, Etodesnitazene, Flunitazene, Isotonitazene, Metodesnitazene, Metonitazene and Protonitazene. This final order to temporarily schedule will temporarily categorize this class of compounds as Schedule I controlled substances. Find more information in this press release.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) along with the Department of Human Services has announced that licensing staff from both agencies will begin conducting coordinated annual inspections of substance use disorder (SUD) and mental health treatment facilities that are licensed by both agencies for outpatient, partial hospitalization and residential services.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of a report that includes state-wide data and facility-specific information about the financial health of Pennsylvania’s general acute care hospitals for fiscal year 2023. Financial Analysis, Volume One, is the first in a three-part series of financial reports produced annually by PHC4.

Around the State

The Pennsylvania Capital-Star has written an article about the potential impact of the recently enacted federal reconciliation package on Medicaid coverage in the Pittsburgh area.

Spotlight PA has published a piece about the board that oversees how Pennsylvania counties spend opioid settlement money and how it operates outside of the state’s transparency laws.

WESA has published an article about Pennsylvania’s FY 2025-26 budget, which is more than two weeks late, and the state of negotiations.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – July 23

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

DHS – Medical Assistance Advisory Committee – July 24

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

DOH – Organ Donation Advisory Committee – August 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 7 from 10:00 a.m. to 1:30 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 – Infant Hearing Screening Advisory Committee – August 7

The Infant Hearing Screening Advisory Committee will hold a public meeting on Thursday, August 7 from 12:00 p.m. until 3:00 p.m. at 6340 Flank Drive, Harrisburg, PA 17112. The meeting will be conducted in person only. Find information on how to RSVP in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-07-18T20:47:25+00:00July 18th, 2025|Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

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