DPW Updates Pharmacy List

The Pennsylvania Department of Public Welfare has issued a new Medical Assistance Bulletin updating the state’s preferred drug list.  This bulletin applies to all licensed pharmacies and prescribers enrolled in the state’s Medical Assistance program that provide services in the fee-for-service delivery system.  The new bulletin can be found here.
Another document, an update of the Medical Assistance prior authorization handbook for pharmaceutical services, can be found hereBookshelf with law books.
The new policies take effect August 13.

2012-08-08T06:00:33+00:00August 8th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Updates Pharmacy List

PA Cuts Medicaid Dental Benefits

Group of healthcare workersPennsylvania has reduced its Medicaid dental benefits to basic services – mostly, cleanings, fillings, and extractions.
It has eliminated root canal and periodontal procedures and limits dentures.  The changes are expected to save $42 million this year.
Most states do not pay for any dental care.
Read more about the changes in Pennsylvania’s Medicaid dental benefits and their impact on beneficiaries here.

2012-07-17T06:00:55+00:00July 17th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Cuts Medicaid Dental Benefits

Disabled Face New Process for Medical Assistance Eligibility

Low-income and disabled Pennsylvanians who lost General Assistance payments when the state ended the cash assistance aspect of that program may still receive Medical Assistance but face a new process for applying for eligibility.
The current, one-page application form that was completed by providers has been expanded to a longer, more detailed form that seeks more information about the medical condition of the applicant.
Read more about the changes in the state program and the changes providers now face in this Philadelphia Inquirer articleHealth Benefits Claim Form.

2012-07-10T09:51:07+00:00July 10th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on Disabled Face New Process for Medical Assistance Eligibility

Budget Brings Good News for PA Safety-Net Hospitals

The new state budget passed in Harrisburg last weekend restored cuts to key payments to Pennsylvania’s safety-net hospitals.
Harrisburg, PA capital buildingAlthough the budget proposed by Governor Corbett in February called for a four percent cut in fee-for-service hospital base rate payments, that cut was restored – as were mid-year cuts to OB/NICU, burn center, and trauma center payments, which were restored to their FY 2012 enacted levels.
In addition, the budget increased payments to critical access hospitals and restored payments to academic medical centers and physician practice plans.
The budget also restored funding for separate fee-for-service payments for normal newborn care, thereby rescinding at least for FY 2013 an expedited regulation promulgated by the Department of Public Welfare that would have eliminated payments for such services.
For further information about Pennsylvania’s FY 2013 Medical Assistance budget and its implications for Pennsylvania’s safety-net hospitals, please contact Michael Chirieleison, SNAP’s president, at 717-234-6970 or mike@debrunner.us.

2012-07-02T16:24:34+00:00July 2nd, 2012|Medicaid supplemental payments, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off on Budget Brings Good News for PA Safety-Net Hospitals

DPW Announces Fee Schedule Changes, More

The Department of Public Welfare (DPW) has announced changes in the Medical Assistance fee schedule and prior authorization requirements.  To read a notice describing these changes and find a list of affected procedure codes, see this notice in the Pennsylvania Bulletin.

2012-06-25T06:00:41+00:00June 25th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Announces Fee Schedule Changes, More

PA to Discontinue Quality Incentive Program

The Pennsylvania Department of Public Welfare (DPW) is discontinuing its Hospital Quality Incentive Pilot Program.  The program had been “established to provide and reward a hospital’s performance on various quality related measures” in the state’s Medical Assistance program.
Read a formal notice of the termination of this program, and the state’s Hospital Quality Care Investment Grant Program, in this Pennsylvania Bulletin noticeBookshelf with law books.

2012-06-22T11:28:16+00:00June 22nd, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA to Discontinue Quality Incentive Program

DPW Publishes Bulletin Addressing Preventable Conditions

The Pennsylvania Department of Public Welfare (DPW) has posted a new Medical Assistance Bulletin presenting the state Medicaid program’s policies governing the reporting of “provider preventable conditions” effective July 1, 2012.  The policy applies to providers that serve Medical Assistance recipients enrolled in the fee-for-service and ACCESS Plus programs.
Find the Bulletin hereBookshelf with law books.

2012-06-20T06:00:09+00:00June 20th, 2012|Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on DPW Publishes Bulletin Addressing Preventable Conditions

Newspaper Joins Call for Restoring Newborn Payments

Last month, Pennsylvania’s Medical Assistance program stopped paying hospitals for the inpatient care they provide to healthy babies newly born to Medical Assistance-covered mothers.  The hospital industry – including the Safety-Net Association of Pennsylvania (SNAP) – immediately expressed opposition to this new policy and has continued to seek the restoration of these payments as the state legislature considers Pennsylvania’s fiscal year 2013 budget.
Now, the Pittsburgh Post-Gazette has weighed in on this issue – on the side of the hospital industry and the low-income patients it serves – with an editorial entitled “Dropping the baby:  DPW is wrong to cut newborns’ hospital care.”  Read that editorial here.

2012-06-11T06:00:13+00:00June 11th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off on Newspaper Joins Call for Restoring Newborn Payments

News from the Pennsylvania Health Law Project

The Pennsylvania Health Law Project has issued its May 2012 newsletter.  Included in it are articles on the expanded use of HealthChoices in the Medical Assistance program; information about proposed changes in the Medical Assistance Transportation Program; an update on limits on Medicaid recipients’ use of prescription drugs; the removal of children from the state’s Medicaid rolls; and the 2013 increase in Medicaid payments for primary care providers.
Download the May edition of Health Law PA News, the newsletter of the Pennsylvania Health Law Project, hereHarrisburg, PA capital building.

2012-06-07T06:00:24+00:00June 7th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on News from the Pennsylvania Health Law Project

PA Sets Terms of New Telemedicine Expansion

The Pennsylvania Department of Public Welfare (DPW) has announced that it is expanding its use of telemedicine to serve the state’s Medical Assistance population.  Telemedicine is widely considered an especially useful tool for serving rural patients.
Under the new approach, the program will expand the types of medical specialists who may engage in telemedicine, remove the requirement that referring physicians participate in telemedicine consultations, and establish specific technologies for use in such consultations.
DPWBookshelf with law books has issued a new Medical Assistance Bulletin presenting more information about its new approach.
Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30 describes the new program and outlines procedures for engaging in telemedicine consultations.  This bulletin can be found here.  A fee schedule and provider codes can be found here.

2012-05-25T06:00:47+00:00May 25th, 2012|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Sets Terms of New Telemedicine Expansion
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