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Advocates Seek More State Staff for Medicaid Eligibility Redeterminations

With the continuous Medicaid eligibility that marked the COVID-19 pandemic coming to an end on April 1 and roughly one-third of the 3.6 million Pennsylvanians enrolled in Medicaid thought to be in jeopardy of losing their coverage, health care advocates are asking the state to invest in more staff to help current participants submit the paperwork needed to retain their coverage as part of what has become known as “Medicaid unwinding.”

In a letter signed by representatives of the Pennsylvania Health Law Project, the Pennsylvania Health Access Network, the Pennsylvania Partnership for Children, and others, advocates noted that the county assistance offices that will play a major role in this process are already understaffed and need more help if deserving Pennsylvanians are to avoid falling through the Medicaid eligibility cracks.  The state has acknowledged the staffing problems at its county assistance offices.

PHE-Phase1-Newsletter-HalfPage-Banner-MA-Renewal

The advocates also have asked the state to publish more information about Medicaid eligibility redetermination and to extend Medicaid and Children’s Health Insurance Program (CHIP) eligibility for children for another year.

A troubled Medicaid unwinding effort would be a troubling development for Pennsylvania’s safety-net hospitals because those hospitals care for especially large numbers of low-income and Medicaid-covered patients and could face the possibility of finding themselves serving significantly more uninsured and underinsured patients than they already do – without reimbursement for that care.

Learn more about the challenges inherent in the Medicaid eligibility redetermination effort and what the advocates seek from the state in the WESA-FM radio article “With major Medicaid changes ahead, advocates want to see increased staffing for assistance offices.”

2023-02-27T18:49:43+00:00February 28th, 2023|COVID-19, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off on Advocates Seek More State Staff for Medicaid Eligibility Redeterminations
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PA Health Policy Update for February 24

The following is an update of selected state health policy developments in Pennsylvania from February 18-24.  (Some of the language used below is taken directly from state documents.)

General Assembly

  • The state House convened for a special session this week and approved two measures addressing the statute of limitations for victims of childhood sexual abuse – House Bill 1 and House Bill 2.  Both pieces of legislation provide a two-year window for victims of childhood sexual abuse to file civil claims.
  • The state House and Senate will meet for regular session next week – Monday, February 27 through Wednesday, March 1.
  • The Senate Banking & Insurance Committee is scheduled to meet on Tuesday, February 28 to consider Senate Bill 8, which requires insurers to cover costs associated with genetic counseling and genetic testing for the BRCA1 and BRCA2 gene mutation if a person is diagnosed with breast or ovarian cancer or has a family history of breast or ovarian cancer.  It also requires insurers to cover all costs associated with a supplemental breast screening by MRI or ultrasound for women at increased risk of breast cancer pursuant to Act 52 of 2020.

Department of Human Services

  • The Department of Human Services (DHS) has updated its calendar for the delivery of Remittance Advice (RA) notices, electronic fund transfers, and mailing reimbursement checks into early April.  Find the updated calendar here.
  • DHS has issued a Medical Assistance Bulletin advising providers that it will begin covering shadow nursing for private duty/shift nursing services provided to Medical Assistance beneficiaries under 21 years of age effective with dates of service on and after January 1, 2023.  The bulletin includes a procedure code and rate information.  Find the bulletin here.
  • DHS has released its physical health managed care program enrollment report for January.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has sent a notice to stakeholders explaining that with adoption of the federal Consolidated Appropriations Act of 2023, Congress has eliminated the “DATA-Waiver Program.”  For DEA registrants, this means that DATA-Waiver registration is no longer required to treat patients with buprenorphine for opioid use disorder; all prescriptions for buprenorphine only require a standard DEA registration number; there are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine; and in Pennsylvania, no current state laws or regulations prohibit practitioners from adopting this change.  The law also introduced new training requirements for all prescribers that will take effect on June 21.  States now await further guidance on these requirements.  Go here to see the message the Department of Drug and Alcohol Programs shared with stakeholders.

COVID-19:  By the Numbers           

  • The number of new COVID-19 cases reported daily in Pennsylvania and the number of new daily deaths in the past week declined slightly compared to last week.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and on ventilators held steady over the past week while the number in hospital ICUs rose 17 percent.
  • The CDC reports a 13 percent increase in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19.
  • For the week ending February 22, two Pennsylvania counties experienced a moderate rate of community transmission of COVID-19; 13 counties experienced a substantial rate of community transmission; and the remaining 52 counties experienced a high rate of community transmission – all the same numbers as last week.

Stakeholder Events

DHS – Managed Long-Term Services and Supports Subcommittee Meeting – March 1

The Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee will meet in Harrisburg on Wednesday, March 1 at 10:00.  For information on the location of the meeting or how to participate virtually, see this DHS notice.

Pennsylvania Health Care Cost Containment Council – March 2

The members of PHC4 will hold a public meeting on Thursday, March 2 at 10:00.  For further information about the location of the meeting and its agenda, see this Pennsylvania Bulletin notice.

Department of Aging – Pennsylvania Long-Term Care Council – March 9

The Department of Aging’s Long-Term Care Council will meet in Harrisburg on Thursday, March 9 at 10:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – March 22

The consumer subcommittee of the Medical Assistance Advisory Committee will meet virtually on Wednesday March 22 at 1:00.  Go here to register to participate.

DHS – Medical Assistance Advisory Committee – March 23

The Medical Assistance Advisory Committee will hold its next public meeting virtually on Thursday, March 23 at 10:00.  Go here to register to participate.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

2023-02-24T20:10:53+00:00February 24th, 2023|COVID-19, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for February 24
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PA Health Policy Update for February 17

The following is an update of selected state health policy developments in Pennsylvania from February 11-17.  (Some of the language used below is taken directly from state documents.)

General Assembly

The state House of Representatives will convene for session on Tuesday, February 21 at 12:00 p.m. The state Senate is scheduled to return on Monday, February 27.

Department of Human Services

  • The fee-for-service subcommittee of the Department of Human Services (DHS) Medical Assistance Advisory Committee met on Wednesday, February 8.  See the presentation made by Office of Medical Assistance officials during that meeting.
  • DHS’s Office of Long-Term Living offered a presentation during the February 14 meeting of the Medical Assistance Advisory Committee’s long-term services and supports subcommittee.  Find that presentation here.
  • DHS has published a notice of its funding allocation for FY 2023 inpatient disproportionate share hospital (DSH) payments to qualifying inpatient acute-care general, psychiatric, and rehabilitation hospitals and qualifying psychiatric and rehabilitation units of acute-care general hospitals; outpatient supplemental payments to qualifying inpatient acute-care general hospitals; direct medical education payments to qualifying inpatient acute-care general hospitals; and certain DSH and supplemental payments to new hospitals.  It is not otherwise changing the qualifying criteria or payment methodology for these payments.  These payments will amount to $257.76 million in total funds.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has published a notice of its funding allocation for DSH payments to qualifying acute-care general hospital burn centers, to qualifying acute-care general hospitals providing obstetrical and neonatal services, to critical access and qualifying rural hospitals, and to qualifying acute-care general hospitals that treat a high percentage of Medical Assistance patients under 18 years of age.  Together, the payments amount to $107.655 million in total state and federal funds.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has published procedure codes and payment rates for the administration of the Pfizer and Moderna bivalent booster dose of the COVID-19 vaccines.   Find the codes, the rates, and their effective dates in this Pennsylvania Bulletin notice.
  • DHS’s Office of Long-Term Living has informed stakeholders that the Centers for Medicare & Medicaid Services has approved renewal of the Community HealthChoices waiver, effective January 1, 2023, for five years.  See the DHS message here.
  • DHS has published a notice announcing that it will increase fees in the Medical Assistance Program for certain ambulance transportation services in both the fee-for-service and managed care delivery systems, effective with dates of service on and after January 1, 2023.  Those fees will be not less than $325 for basic life support ambulance transportation services, not less than $400 for advanced life support ambulance transportation services, and not less than $4 per loaded mile for each loaded mile beyond 20 loaded miles for ground ambulance transportation.  Learn more from this Pennsylvania Bulletin notice.

Department of Health

  • The Department of Health (DOH) has issued a health alert to providers advising them about a possible nation-wide increase in invasive group A streptococcal (iGAS) infections in children.  This increase, however, reflects only a return to pre-pandemic levels.  The alert includes information about the condition and offers guidance for clinicians and laboratories.  Find the alert here.
  • DOH has published information about its Medical Care Availability and Reduction Error (MCARE) Act surcharge for FY 2023, a per unit assessment of approximately $156.56 payable by June 1.  Learn more about the surcharge and the providers to which it applies from this Pennsylvania Bulletin notice.
  • DOH has published information about its Nursing Home Patient Safety Trust Fund surcharge for FY 2023.  That surcharge will be $13.83 per nursing facility bed.  Learn more from this Pennsylvania Bulletin notice.
  • DOH has published a list, as required by regulation, of hospitals that have chosen to exercise their religious or moral beliefs regarding the provision of certain contraception-related emergency services and will instead refer patients to other hospitals to receive such services.  Learn more from this Pennsylvania Bulletin notice.

COVID-19:  By the Numbers           

  • The number of new COVID-19 cases reported daily in Pennsylvania and the number of new daily deaths in the past week remained at the same levels as last week.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and on ventilators held steady over the past week while the number in hospital ICUs declined 25 percent.
  • The CDC reports a six percent decline in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19.
  • For the week ending February 15, five Pennsylvania counties experienced a moderate rate of community transmission of COVID-19; 16 counties experienced a substantial rate of community transmission; and the remaining 46 counties experienced a high rate of community transmission – all the same numbers as last week.

Department of Drug and Alcohol Programs

In response to the continuing challenge health care providers are having maintaining an adequate workforce, the Department of Drug and Alcohol Programs is conducting a workforce climate survey among drug and alcohol service providers to learn about which jobs and positions are in short supply or understaffed, the challenges these providers face, what they are doing to address them, and how they think the state can help them address those challenges.  Find that survey here.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission has issued comments in response to regulations proposed by the State Board of Nursing that address licensure by endorsement and reactivation.  Find those comments in this Pennsylvania Bulletin notice.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – February 22

The consumer subcommittee of the Medical Assistance Advisory Committee will meet virtually on  Wednesday, February 22 at 1:00.  Learn more from the meeting’s agenda and go here to register to participate.

DHS – Medical Assistance Advisory Committee Meeting – February 23

The Medical Assistance Advisory Committee will meet virtually on Thursday, February 23 at 10:00.  For the meeting agenda go here and to register to participate go here.

DHS – Managed Long-Term Services and Supports Subcommittee Meeting – March 1

The Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee will meet in Harrisburg on Wednesday, March 1 at 10:00.  For information on the location of the meeting or how to participate virtually, see this DHS notice.

Department of Aging – Pennsylvania Long-Term Care Council – March 9

The Department of Aging’s Long-Term Care Council will meet in Harrisburg on Thursday, March 9 at 10:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

 

2023-02-17T21:42:53+00:00February 17th, 2023|COVID-19, DSH hospitals, long-term care, Medicaid supplemental payments, Meetings and notices, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for February 17
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PA Health Policy Update for February 10

The following is an update of selected state health policy developments in Pennsylvania from February 4-10.  (Some of the language used below is taken directly from state documents.)

General Assembly

  • Three special elections were held this week to fill vacancies in the state House of Representatives.  Matt Gergley (D) was elected to represent the 35th legislative district, where he will take the seat formerly held by Lieutenant Governor Austin Davis.  Abigail Salisbury (D) was elected to represent the 34th legislative district, replacing former Representative Summer Lee, who was elected to Congress in November.  Joe McAndrew (D) was elected to represent the 32nd legislative district, filling the seat left vacant by the death of Tony DeLuca.  When the three members are sworn in later this month Democrats will have 102 seats in the House and Republicans will have 100 after Senator-elect Linda Schlegel Culver resigns her House seat to be sworn in to the state Senate.
  • The state House has scheduled additional session days and the chamber will return to session on Monday, February 21. Click here to view the updated calendar.
  • Republican members of the state House Appropriations Committee held a roundtable discussion this week with several Medicaid managed care organizations (MCOs). Go here to learn more about the event and see a list of the MCO participants.

Department of Human Services

The Department of Human Services (DHS) has posted information about new medical group provider access to the PROMISe provider internet portal for the reactivation or revalidation of changes of group members.  Starting on February 24, active provider groups that need to reactivate, revalidate, or make changes to group members will be able to log onto the portal with their active group credentials.  Learn more from this DHS notice.

Department of Health

The Department of Health has issued a health advisory informing providers of an outbreak of highly drug-resistant pseudomonas aeruginosa associated with artificial tears products.  No such cases have been reported in Pennsylvania.  Learn more about the outbreak, the condition, and how to identify and treat it from this Department of Health advisory.  Providers who diagnose the condition are asked to report it to the state or their local health department.

The Department of Health has proposed adding mucopolysaccharidosis type II disorder (MPS II) to the supplemental conditions mandated for screening and follow-up as part of the state’s newborn screening program as of July 1.  Learn more about the condition and how to submit written comments in response to this proposed addition to the screening program from this Pennsylvania Bulletin notice.  Comments are due within 30 days of the notice’s February 11 official publication.

COVID-19:  By the Numbers           

  • The number of new COVID-19 cases reported daily in Pennsylvania rose slightly over the past week and the number of new daily deaths declined slightly.  Both figures fall within the general range for the state in recent months.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and in hospital ICUs with the virus fell slightly over the past week and the number on ventilators declined 31 percent.
  • The CDC reports no change over the past week in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19.
  • For the week ending February 8, five Pennsylvania counties experienced a moderate rate of community transmission of COVID-19; 16 counties experienced a substantial rate of community transmission; and the remaining 46 counties experienced a high rate of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has awarded $9 million in grants to four county agencies to establish or expand crisis stabilization services for individuals with co-occurring mental health and substance use disorders.  Learn more about the grant recipients and how they are expected to use the money from this department news release.

Stakeholder Events

Department of Health – Preventative Health and Health Services Block Grant Advisory Committee Meeting – February 13

The Department of Health’s Preventative Health Services Block Grant Advisory Committee will meet in Harrisburg on Monday, February 13 at 1:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Health – WIC Advisory Board – February 14

The Department of Health’s WIC Advisory Board will meet virtually on Tuesday, February 14 at 1:00 to gather suggestions of strategies for increasing participation in and improving the WIC program.  For information about how to obtain the meeting agenda and participate, see this Pennsylvania Bulletin notice.

DHS – Managed Long-Term Services and Supports Subcommittee Meeting – March 1

The Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee will meet in Harrisburg on Wednesday, March 1 at 10:00.  For information on the location of the meeting or how to participate virtually, see this DHS notice.

Department of Aging – Pennsylvania Long-Term Care Council – March 9

The Department of Aging’s Long-Term Care Council will meet in Harrisburg on Thursday, March 9 at 10:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

 

2023-02-10T21:59:36+00:00February 10th, 2023|COVID-19, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for February 10
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PA Health Policy Update for February 3

The following is an update of selected state health policy developments in Pennsylvania from January 28 to February 3.  (Some of the language used below is taken directly from state documents.)

Governor Shapiro

Governor Shapiro has signed an executive order seeking to improve the state’s licensing, permitting, and certification processes, launching a review of how long it takes agencies to process applications and how workers and businesses apply online.  This executive order seeks to establish definitive dates for when applicants for licenses, permits, and certificated will hear back from the state, and if applicants do not receive a response by that date, the agency responsible will refund their application fee.  Learn more from this news release from the governor’s office and from the executive order.

General Assembly

State Representative Lynda Schlegel Culver won a special election this week to replace former state Senator John Gordner, who resigned to become counsel to Senate President Kim Ward.  Senator-elect Culver will represent the 27th district, which includes all of Columbia, Montour, Northumberland, and Snyder counties and part of Luzerne County.  Once she resigns from her state House seat a special election will be scheduled to replace her.

Department of Human Services

  • The Department of Human Services (DHS) has notified hospitals with accredited Level I, II, III, or IV trauma centers of the required annual attestation for inclusion in the FY 2022-23 Trauma DSH Program.  The deadline to submit completed attestations is February 24.  Potentially eligible trauma centers that have not been notified should contact DHS at RA pwdshpymt@pa.gov.  Questions regarding the attestation form and the Trauma DSH Program also should be directed to this address.
  • DHS has posted information for providers on how to check the status of their electronic Medical Assistance provider enrollment application and what to do if their application was returned for additional information.  Find it here.
  • DHS has posted information for group providers on how to reactivate, revalidate, or make
    changes to group members.  Find it here.
  • DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has announced a grant program through which qualified entities may apply for funding to invest in technology and training for behavioral health telehealth providers.  The state has allocated $4 million for one-time grants of up to $50,000 for providers that meet a number of criteria, including having fewer than 50 employees and at least 51 percent of their clients enrolled in Medicaid.  Learn more about the program, eligibility criteria, and how to apply from this OMHSAS notice.  Applications will be accepted until December 31 or until the $4 million is exhausted.
  • DHS has posted the presentations offered during the January 26 meeting of the Medical Assistance Advisory Committee.  See presentations from the:

COVID-19:  By the Numbers           

  • The number of new COVID-19 cases reported daily in Pennsylvania declined over the past week and the number of new daily deaths returned to the usual range for COVID-19-related deaths in recent months.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on a ventilator because of the virus, and in hospital ICUs with COVID-19 all declined slightly over the past week.
  • The CDC reports an 11 percent decrease in the seven-day daily average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
  • For the week ending February 2, one Pennsylvania county – Cameron – experienced a low rate of community transmission of COVID-19; seven counties experienced a moderate rate of community transmission; eight counties experienced a substantial rate of community transmission; and the remaining 49 counties experienced a high rate of community transmission.

Insurance Department

The Insurance Department is conducting a medical professional liability insurance study to determine whether sufficient capacity exists to increase the basic coverage limits of insurance required by the Medical Care Availability and Reduction of Error (MCARE) Act.  Learn more about the issues the study will address from this Pennsylvania Bulletin notice.  Stakeholder comments are due by March 4.

Stakeholder Events

Department of Health – Preventative Health and Health Services Block Grant Advisory Committee Meeting – February 13

The Department of Health’s Preventative Health Services Block Grant Advisory Committee will meet in Harrisburg on Monday, February 13 at 1:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

DHS – Managed Long-Term Services and Supports Subcommittee Meeting – March 1

The Medical Assistance Advisory Committee’s Managed Long-Term Services and Supports Subcommittee will meet in Harrisburg on Wednesday, March 1 at 10:00.  For information on the location of the meeting or how to participate virtually, see this DHS notice.

Department of Aging – Pennsylvania Long-Term Care Council – March 9

The Department of Aging’s Long-Term Care Council will meet in Harrisburg on Thursday, March 9 at 10:00.  For information on the location of the meeting or how to participate virtually, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

 

2023-02-03T20:51:28+00:00February 3rd, 2023|COVID-19, Medicaid supplemental payments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for February 3
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PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2023 Health Law News newsletter.

Included in this month’s issue are articles about:

  • Pennsylvania ending its practice of paying parents to serve as home health aides
  • the end of pandemic-related continuous Medicaid eligibility as of April 1
  • Tempus updates for Community HealthChoices participants and direct care workers
  • steps by the federal government to eliminate barriers to Medicaid eligibility for former foster care youth
  • health care options for older immigrants

Read about these subjects and more in the Pennsylvania Health Law Project’s January 2023 newsletter.

2023-01-31T18:35:43+00:00February 1st, 2023|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Law Project Newsletter
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PA Health Policy Update for January 27

The following is an update of selected state health policy developments in Pennsylvania from January 21-27.  (Some of the language used below is taken directly from state documents.)

Harrisburg, PA capital buildingGeneral Assembly

  • The Legislative Budget and Finance Committee (LBFC) met this week and approved the release of a report entitled “Prescription Drug Pricing Under the Medical Assistance Managed Care Program.”  Act 120 of 2020 directed LBFC to conduct a study analyzing prescription drug pricing in the Medical Assistance managed care program; review reimbursement practices by PBMs (pharmacy benefit managers) to pharmacies and to PBMs by MCOs; investigate and compare reimbursement rates by PBMs to independent pharmacies and to chain pharmacies; and study state laws and best practices adopted by other states regarding PBMs and pharmacy reimbursement.  Find the report here.
  • Although the House has not adopted a rules package or formally established standing committees for the 2023-2024 legislation session, the Republican caucus announced its selections for committee chairs this week.  Representatives Kathy Rapp and Tina Pickett will remain Republican chairs of the Health Committee and the Insurance Committee, respectively, while Doyle Heffley will be the new Republican chair of the Human Services Committee.  In addition, Representative Carl Metzger will be the Republican chair of the Professional Licensure Committee, Steven Mentzer will be the Republican chair of the Aging & Older Adult Services Committee, and Linda Schlegel Culver will be the Republican chair of the Children & Youth Committee.  Find the full list of Republican committee chairs here.
  • The state House Democratic Policy Committee convened in Pittsburgh for an informational hearing examining the health care staffing crisis.  Find the meeting agenda and testimony offered during the hearing here.

Department of Human Services

  • The Department of Human Services’ (DHS) Office of Mental Health and Substance Abuse Services (OMHSAS) has issued a bulletin providing guidance for the implementation of Act 65 of 2020, which governs who can provide consent for voluntary mental health treatment of minors who are 14 years of age and less than 18 years of age in both inpatient and outpatient settings.  Act 65 also addresses which individuals may grant consent for the release of a minor’s medical records.  Find that bulletin here.
  • DHS has issued a Medical Assistance Bulletin informing providers that it has increased fees for certain ambulance transportation services on the Medical Assistance fee schedule effective with dates of service on or after January 1, 2023.  Find that bulletin here.
  • DHS has published final notice of the assessment amount, the assessment methodology, and the estimated aggregate impact on nursing facilities that will be subject to the Nursing Facility Assessment Program for FY 2023.  Learn more about which types of facilities to which the assessment applies and how much their 2023 assessment will be from this Pennsylvania Bulletin notice.
  • At the January 26 meeting of the Medical Assistance Advisory Committee, DHS’s Office of Long-Term Living offered a presentation on the efforts of the managed care plans that serve Community HealthChoices members to redetermine the eligibility of their current participants in the wake of the upcoming end of continuous Medicaid eligibility and vaccination rates among Community HealthChoices participants.  Find that presentation here.
  • DHS has updated its physical health managed care enrollment report.

Department of Health

Pennsylvania’s Executive Board has approved a reorganization of the Department of Health.  Find an organizational chart that reflects this reorganization in this Pennsylvania Bulletin notice.

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania held steady over the past week, remaining higher than prior to Thanksgiving, and the number of new daily deaths rose more than 50 percent over the past week after a decline of 50 percent the week before.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined seven percent last week after a 14 percent decline the previous week; the number on a ventilator because of the virus remained steady; and the number in hospital ICUs fell 15 percent after a six percent decline the week before.
  • The CDC reports a slight decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
  • As of January 25, four Pennsylvania counties are experiencing a moderate rate of community transmission of COVID-19; 15 counties are experiencing a substantial rate of community transmission; and the remaining 48 counties are experiencing high rates of community transmission.

Stakeholder Events

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30.  For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00.  Interested parties may attend in person or virtually.  Go here for further information about the meeting, its location, and how to participate virtually.

Department of Health – Organ Donation Advisory Committee Meeting – February 2

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting on Thursday, February 2 at 10:00.  The purpose of the meeting is to review progress in the area of organ and tissue donation in Pennsylvania, recommend education and awareness activities, recommend priorities in expenditures from the Organ and Tissue Donation Awareness Fund, and advise the Department of Health on matters involving administration of that fund.  Interested parties may attend in person or virtually.  For further information about the meeting and how to attend, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – February 3

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Harrisburg on Friday, February 3 at 10:00.  Meeting materials will be sent out before the meeting and will also be available on the board’s web and at the meeting location.  For further information about the meeting and its location, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

 

2023-01-27T21:38:47+00:00January 27th, 2023|COVID-19, long-term care, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for January 27
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PA Health Policy Update for January 20

The following is an update of selected state health policy developments in Pennsylvania from January 14-20.  (Some of the language used below is taken directly from state documents.)

Governor Shapiro

  • Josh Shapiro was sworn in as Pennsylvania’s 48th governor on Tuesday.  Much of the governor’s inaugural speech focused on preserving democracy.  He also highlighted the need for unity and emphasized bringing people together.  Find a transcript of the governor’s speech here.
  • On Wednesday Governor Shapiro issued his first executive order, which prioritizes work experience, skill, and competency for state jobs and highlights that 92 percent of the state’s jobs do not require a four-year college degree.
  • Information about the Shapiro administration’s health-related agency nominees can be found here and a complete list of the Shapiro administration appointments made to date can be found here.

General Assembly

The state Senate convened for voting session this week and the House briefly convened for non-voting session.  Both chambers are now recessed.  The Senate is scheduled to return on Monday, February 27 while the House has yet to release a session calendar.

Department of Human Services

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin rescinding Medical Assistance Bulletin 01-22-78, titled “340B Drug Pricing Program – Dispensing 340B Purchased Drugs,” which was issued on December 22, 2022.  Instead, Medical Assistance Bulletin 99-13-08, titled “340B Drug Pricing Program Provider Requirements and Billing Instructions – Pharmacy Services,” remains in effect.  Go here to see the new bulletin rescinding the December 22 version.
  • DHS has extended its calendar for Remittance Advice (RA) notifications and the delivery of electronic payments and checks into early March.  Find the updated calendar here.
  • DHS has issued a Medical Assistance Bulletin informing providers that it has added CPT codes 0124A, 0154A (Pfizer) and 0134A, 0144A (Moderna) to its fee schedule for the administration of a bivalent booster dose COVID-19 vaccine.  Find the bulletin here.
  • DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has written to stakeholders informing them that it has extended until March 31 its requirement that providers capture consent to treat, service verifications, and approval of treatment plans for Medicaid-funded behavioral health services delivered via telehealth.  At the end of this period providers must have an electronic capability to secure auditable electronic signatures for consent and service verification.  Learn more from OMHSAS’s message to stakeholders.
  • DHS has informed stakeholders that Jennifer (Jen) Smith has joined the department as deputy secretary for OMHSAS.  Smith previously served as Secretary of the Department of Drug and Alcohol Programs.  Learn more from DHS’s message to stakeholders.
  • DHS has posted information about an electronic submission process for Medicaid fee-for-service 180-day exception requests and other claims requiring documentation that will soon be available in the PROMISE portal.  Find that information here.
  • DHS has updated its Medicaid managed care organization directory.
  • DHS has published its peer groups, peer group medians, and peer group prices for non-public nursing facilities, including hospital-based nursing facilities and special rehabilitation facilities.  DHS used these peer groups, peer group medians, and peer group prices to determine case-mix rates for non-public nursing facilities for FY 2023.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has published its final annual case-mix per diem payment rates for FY 2023 for non-public and county nursing facilities that participate in the Medical Assistance program.  Learn about those rates from this Pennsylvania Bulletin notice.

Department of Health

  • The Department of Health (DOH) has updated its telemedicine interpretive guidance for hospitals.  Find the updated guidance here.
  • DOH has updated its FAQ on innovative care models for hospitals.  Find the updated FAQ here.  The changes, which address critical access hospitals and small rural hospitals, are highlighted in red.
  • DOH has updated its criteria and guidance for establishing an outpatient emergency department.  The changes, which address critical access hospitals, small rural hospitals, and rural emergency hospitals, are highlighted in red.  Find the updated guidance here.
  • DOH also has updated its matrix on how facilities can qualify as an innovative hospital model.  Find the updated matrix here.   Changes again are highlighted in red.
  • DOH has issued guidance requiring prospective new owners of skilled nursing facilities to inform facility residents, representatives, and employees of the possibility of a change of ownership of the facility.  Learn more from this DOH guidance.

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania declined 27 percent over the past week and the number of new daily deaths, after a 50 percent increase a week ago, returned this week to its level of recent months.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined nearly 14 percent last week after an 11 percent decline the previous week; the number on a ventilator because of the virus rose nine percent; and the number in hospital ICUs fell six percent.
  • The CDC reports a five percent decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
  • As of January 18, four Pennsylvania counties are experiencing a moderate rate of community transmission of COVID-19; eight counties are experiencing a substantial rate of community transmission; and the remaining 55 counties are experiencing high rates of community transmission.

Health Care Cost Containment Council (PHC4)

PHC4 is beginning the verification process for hospital self-pay records for fiscal year 2021.  Its self-pay data reconciliation web application on the PHC4 portal enables hospitals to reconcile their self-pay records, which eventually will be provided to DHS to be used as a part of its calculation of the extraordinary expense portion under Act 77 (the state’s 2001 tobacco settlement law).  Find PHC4’s letter to hospitals here and the portal for self-pay records here.

Stakeholder Events

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00.  Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00.  Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, January 26 at 10:00.  To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – January 26

The Patient Safety Authority will meet virtually on Thursday, January 26 at 1:00.  For information about how to participate in this meeting, see this Pennsylvania Bulletin notice.  Registration is required.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30.  For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00.  Interested parties may attend in person or virtually.  Go here for further information about the meeting, its location, and how to participate virtually.

Department of Health – Organ Donation Advisory Committee Meeting – February 2

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting on Thursday, February 2 at 10:00.  The purpose of the meeting is to review progress in the area of organ and tissue donation in Pennsylvania, recommend education and awareness activities, recommend priorities in expenditures from the Organ and Tissue Donation Awareness Fund, and advise the Department of Health on matters involving administration of that fund.  Interested parties may attend in person or virtually.  For further information about the meeting and how to attend, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – February 3

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Harrisburg on Friday, February 3 at 10:00.  Meeting materials will be sent out before the meeting and will also be available on the board’s web and at the meeting location.  For further information about the meeting and its location, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates:  March 9 and May 16, both at 8:30.  This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria.  The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies.  The program will be held on May 16 at 8:30.  Continuing education credits are available.  Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice.  Please note that this program is identical to one offered on March 9.

2023-01-20T21:47:06+00:00January 20th, 2023|340b, COVID-19, long-term care, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for January 20
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PA Health Policy Update for January 13

The following is an update of selected state health policy developments in Pennsylvania from January 7-13.  (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-Elect Josh Shapiro announced the nomination of several cabinet-level officials this week, including Dr. Valerie Arkoosh as Secretary of the Department of Human Services, Dr. Debra Bogen as Secretary of the Department of Health, Dr. Latika Davis-Jones as Secretary of the Department of Drug and Alcohol Programs, Mr. Jason Kavulich as Secretary of the Department of Aging, and Mr. Michael Humphreys as Insurance Commissioner.  All of these nominees are subject to confirmation by the state Senate.  Find additional information about the health-related agency nominees’ respective backgrounds here and a complete list of the Shapiro-Davis administration appointments made to date here.

Governor-Elect Josh Shapiro and Lieutenant Governor-Elect Austin Davis will be sworn into office next Tuesday, January 17 at 12:00 p.m.

General Assembly

The state House and Senate both convened this week for a special session to consider a constitutional amendment extending the statute of limitations for victims of sexual abuse to file civil claims.  The Senate passed Senate Bill 1 by a vote of 28-20; the bill includes three proposed constitutional amendments.  In addition to extending the statute of limitations, Senate Bill 1 also requires voters to present a valid form of ID before voting in an election and prevents the governor from vetoing the General Assembly’s disapproval of a regulation.  After convening on Monday, the House recessed without agreement.  Speaker Rozzi subsequently appointed a committee of six House members (three Republicans and three Democrats) to negotiate a path forward.

The state Senate is scheduled to return to session Tuesday, January 17 at 10:00 a.m.

Department of Human Services

  • The Department of Human Services (DHS) has updated its web page addressing the unwinding of continuous Medicaid and CHIP eligibility established by the Families First Coronavirus Response Act to reflect federal legislation that will launch a path toward bringing that continuous eligibility to an end:  specifically, the federal Consolidated Appropriations Act of 2023 set April 1, 2023 as the end of continuous coverage for Medical Assistance and CHIP.  After April 1, DHS will return to normal eligibility processes.  This means that all Medical Assistance and CHIP recipients must complete an annual renewal to see if they are still eligible for coverage.  Learn more from DHS’s web page addressing the unwinding of continuous Medicaid and CHIP eligibility.
  • DHS will hold a COMPASS Community Partner technical assistance call on Tuesday, January 24 at 1:00 that may address this subject, among other matters.  Go here to register (the registration deadline is January 17) and to submit questions to be addressed during the meeting.
  • DHS has published a co-location regulatory change that has been under development since 2021.  The purpose of change is to eliminate a prohibition against providers leasing or renting space, shelves, or equipment within a provider’s office to another provider or from allowing the paid or unpaid staff of a provider to be placed in another provider’s office.  As the published announcement explains, “Developments in the health care industry have emphasized the need for integrated health care.  The Department recognizes the benefits of integrated care and deletes this subsection to support the enrollment in the Medical Assistance (MA) Program of providers that share space (co-locating providers).  By expanding provider qualifications to include co-locating providers, the Department seeks to support more coordinated and integrated care within the MA Program.”  Learn more from this Pennsylvania Bulletin notice.
  • DHS has released quarterly licensing and enforcement activity data for its five licensing offices that oversee providers of long-term care, child care, behavioral health care, day activity programs, and residential care for individuals with intellectual disabilities and autism.  Learn more about the outcome of these licensing and enforcement efforts from this DHS news release.

Centers for Medicare & Medicaid Services

CMS has shared a presentation with states addressing how they can work with Medicaid managed care plans to review the eligibility of current Medicaid beneficiaries once the continuous eligibility requirement for current Medicaid participants ends on April 1.  Learn more from the CMS presentation “Strategic Approaches to Engaging Managed Care Plans to Maximize Continuity of Coverage as States Resume Normal Eligibility and Enrollment Operations.”

Department of Health

The Department of Health (DOH) has issued a health advisory informing providers that as of January 1 it has introduced a new surveillance case definition for multisystem inflammatory syndrome in children (MIS-C) for reporting cases of MIS-C.  Providers are required to report cases that meet the new criteria to their local health department.  Learn more from this health advisory.

DOH and Berks County will be the nation’s first to test a new federal COVID-19 Home Test to Treat Pilot Program run by the National Institute of Health (NIH) and HHS’s Administration for Strategic Preparedness and Response (ASPR).  Learn more about the program from this DOH news release.

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania declined slightly over the past week but the number of new daily deaths rose nearly 50 percent over the high end of the death rate in recent months.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined nearly 11 percent over the past week; the number on a ventilator because of the virus fell 20 percent; and the number in hospital ICUs held steady.
  • The CDC reports a five percent decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
  • As of January 11, four Pennsylvania counties – Forest, McKean, Potter, and Sullivan – are experiencing a low rate of community transmission of COVID-19; nine counties are experiencing a substantial rate of community transmission; and the remaining 54 counties are experiencing high rates of community transmission.

Department of Drug and Alcohol Programs

Information bulletins that have been removed are:

Stakeholder Events

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – January 18

The Department of Health’s Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will hold a public meeting on Wednesday, January 18 at 9:00.  Interested parties may attend in person or virtually.  Learn more about the committee, where the meeting will be held, and how to participate virtually from this Pennsylvania Bulletin notice.

Department of Health – Renal Disease Advisory Committee – January 20

The Department of  Health’s Renal Disease Advisory Committee will meet in Harrisburg on Friday, January 20 at 10:00.  To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Department of Human Services – COMPASS Community Partner Technical Assistance Call – January 24

DHS will hold a COMPASS Community Partner technical assistance call on Tuesday, January 24 at 1:00.  Go here to register (the registration deadline is January 17) and to submit questions to be addressed during the meeting.

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00.  Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00.  Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, January 26 at 10:00.  To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – January 26

The Patient Safety Authority will meet virtually on Thursday, January 26 at 1:00.  For information about how to participate in this meeting, see this Pennsylvania Bulletin notice.  Registration is required.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30.  For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00.  Interested parties may attend in person or virtually.  Go here for further information about the meeting, its location, and how to participate virtually.

2023-01-13T20:52:23+00:00January 13th, 2023|COVID-19, Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for January 13
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PA Health Policy Update for January 6

The following is an update of selected state health policy developments in Pennsylvania from December 23 through January 6.  (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Josh Shapiro announced the appointment of his first cabinet-level officials this week, including Akbar Hossain, who will serve as Secretary of Policy and Planning, and Mike Vereb, who will be Secretary of Legislative Affairs.  Hossain is currently the transition team’s executive director and prior to that served as the Shapiro campaign’s policy director.  Vereb, a long-time advisor to Shapiro, previously worked as legislative affairs director for the Office of the Attorney General. Governor-elect Shapiro also announced the appointment of his deputy chiefs of staff.  Lindsey Mauldin, who currently works for Planned Parenthood Pennsylvania, will be Deputy Chief of Staff for Health and Human Services.  Prior to joining Planned Parenthood, Mauldin coordinated Pennsylvania’s COVID-19 pandemic response efforts.  A complete list of the Shapiro-Davis administration appointments made to date may be viewed here.

General Assembly

The General Assembly convened on Tuesday, January 3 to swear in members of the House and Senate and the respective chambers’ presiding officers.  The Senate made history by electing Senator Kim Ward (R-Westmoreland) President Pro Tempore; she is the first woman to hold the position.  Senator Ward also was sworn in as Lieutenant Governor, a position she will hold until Lieutenant Governor-Elect Austin Davis is sworn in on January 17.  After what appeared to be an impasse choosing a Speaker of the state House, Representative Mark Rozzi (D-Berks) was elected by a vote of 115 to 85 to serve as Speaker.  Sixteen Republicans joined Democrats in voting for Rozzi, who committed to being an independent Speaker and not to caucus with either party.

Revenue Collection Update

The Department of Revenue has released its monthly revenue update for December.  General Fund revenue collections were $319.9 million, or 8.6 percent, above estimate for the month.  Fiscal year-to-date General Fund collections total $19.7 billion, which is $503.1 million, or 2.6 percent, above estimate.

Centers for Medicare & Medicaid Services

  • CMS has issued guidance on a way for states to address unmet health-related social needs for Medicaid beneficiaries.  This option will help states offer alternative benefits, such as housing and nutrition assistance, through the use of a service or setting that is provided to an enrollee in lieu of a service or setting covered under their state’s Medicaid plan to address a range of unmet health-related social needs to help enrollees maintain their coverage and improve their health outcomes.  Learn more from this CMS news release and this letter from CMS to state Medicaid directors.
  • CMS has issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries.  For the first time, state Medicaid and CHIP programs will be able to pay specialists directly when a beneficiary’s primary health care provider asks for advice.  For example, if a pediatrician consults with a specialty behavioral health provider about a specific patient’s needs, both providers may be reimbursed for their care – even if the patient is not present.  This move to pay for interprofessional consultations seeks to link routine care with specialty care, enabling more people to benefit from practitioners with specialized knowledge.  Learn more from this CMS news release and the guidance letter CMS sent to state Medicaid directors about this subject.
  • CMS has sent a letter to state Medicaid programs that provides a detailed description of the configuration/implementation plan, testing plan, and testing results that states will need to submit to the federal government when the public health emergency and continuous Medicaid enrollment condition end.  This document seeks to help states understand systems readiness artifacts that are routinely submitted to CMS’s state systems team during IT project and certification reviews.  See the CMS letter here.

Department of Human Services

  • The Department of Human Services (DHS) has published a Medical Assistance Bulletin to inform providers that it will reinstate provider enrollment requirements that were in place prior to the COVID-19 public health emergency, including an enrollment application fee, fingerprint-based background checks, and site visits for providers.  Providers temporarily enrolled in the program during the public health emergency who did not satisfy enrollment requirements that were suspended at the time now must satisfy those requirements.  This policy takes effect on February 27.  Find the bulletin here.
  • DHS has published a Medical Assistance Bulletin to inform providers about the procedures for dispensing 340B drugs to Medical Assistance beneficiaries and about implementation of the Medical Assistance program’s 340B drug exclusion list.  The policies took effect on January 1.  Find the bulletin here.
  • DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has issued a bulletin to inform peer support service providers and Medicaid behavioral health managed care organizations that peer support services identified in beneficiaries’ individual service plans may be provided during transit.  The policy took effect on December 28.  The bulletin also includes revised provider handbook pages.  Find the bulletin here.
  • DHS has updated its COMPASS Community Partners web page with new information about steps that can be taken to help people retain health care coverage after the COVID-19 public health emergency ends, including a new FAQ and an updated public health emergency toolkit.  Learn more about COMPASS Community Partners and these new developments from this message from DHS.
  • DHS has added a new procedure code to the Medical Assistance program fee schedule for a second nurse to shadow a nurse providing private duty/shift nursing to beneficiaries under 21 years of age, effective with dates of service on and after January 1.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has published a summary of the December 8 meeting of the Medical Assistance Advisory Committee.  Find it here.
  • DHS has updated its telephone directory for those seeking assistance with different Medical Assistance-related issues.  Find the updated directory here.
  • DHS has updated its Medicaid managed care organization directory.
  • DHS has published its physical health Medicaid managed care enrollment report for November.

Department of Health

  • The Department of Health has written to long-term-care facilities to inform them that it will no longer provide short-term crisis staffing support or staffing support for test swabbing missions as of January 14.  It also encourages those facilities to engage with their local LTC RISE partner, which will continue to provide COVID-19 outbreak response consultative support.  Learn more from the department’s letter to long-term-care facilities.
  • The Childhood Blood Lead Test Act signed into law on November 3 took effect on January 2.  The act provides for blood lead assessment and testing of certain children and pregnant women by health care providers; imposes duties on the Department of Health; and requires certain health insurance policies to cover blood lead tests.  Learn more about the new law from this Pennsylvania Bulletin notice.

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania rose 21 percent over the past week.  The number of new deaths remains within the usual range for recent months.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 is the highest it has been since last February 22; the number on a ventilator because of the virus is the highest it has been since March 9; and the number in hospital ICUs is greater than it has been since March 4.
  • The CDC reports a 15 percent increase in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 since December 21.
  • As of January 5, one Pennsylvania county – Cameron – is experiencing a low rate of community transmission; 12 counties are experiencing a substantial rate of community transition; and the remaining 54 counties are experiencing high rates of community transmission of COVID-19.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued an information bulletin informing single- county authorities, substance use disorder treatment providers, and other substance use disorder treatment-related organizations that they may be asked to serve on a death review team and that they may be asked to provide records as part of a death review team’s duties.  Find the bulletin here.

The Department of Drug and Alcohol Programs announced an open enrollment period last October for licensed substance use disorder treatment providers in Pennsylvania to submit their information to be included in the Addiction Treatment Locator, Assessment, and Standards Platform, ATLAS.  This open enrollment period has been extended, and will now continue through January 13.  Go here to see the original notice of the open enrollment period and here to see the department’s recent communication on this subject.

Insurance Department

An Insurance Department examination of Capital Blue Cross has identified concerns with claims processing, including claims being denied for lack of prior authorization when prior authorization had already been obtained, and a coordination of benefits issue that has since been updated.  The examination also reported additional Unfair Insurance Practices Act violations involving unclear communication with members.  The exam also found mental health parity violations.  Learn more about why the department conducted the review, what it found, and how it is addressing the problems it identified from this news release.

Stakeholder Events

Pennsylvania Health Care Cost Containment Council – January 12

The Pennsylvania Health Care Cost Containment Council (PHC4) will hold a public meeting on Thursday, January 12 at 10:00.  For additional information about the session, see this Pennsylvania Bulletin notice.

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – January 18

The Department of Health’s Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will hold a public meeting on Wednesday, January 18 at 9:00.  Interested parties may attend in person or virtually.  Learn more about the committee, where the meeting will be held, and how to participate virtually from this Pennsylvania Bulletin notice.

Department of Health – Renal Disease Advisory Committee – January 20

The Department of  Health’s Renal Disease Advisory Committee will meet in Harrisburg on Friday, January 20 at 10:00.  To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00.  Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00.  Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, January 26 at 10:00.  To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30.  For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00.  Interested parties may attend in person or virtually.  Go here for further information about the meeting, its location, and how to participate virtually.

 

2023-01-06T21:54:53+00:00January 6th, 2023|340b, COVID-19, Federal Medicaid issues, health equity, Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for January 6
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