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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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PA Health Policy Update for Friday, December 23

The following is an update of selected state health policy developments in Pennsylvania for the week of December 19-23, 2022.  (Some of the language used below is taken directly from state documents.)

Department of Human Services

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin informing providers about new procedures for dispensing 340B-purchased drugs to Medical Assistance beneficiaries and about the implementation of the program’s 340B drug exclusion list.  Find the bulletin here.  Find the policies this new bulletin replaces here.
  • DHS has extended its schedule for sending Remittance Advice documents, Medicaid payment checks, and electronic transfers of payments into early February.  Find the updated schedule here.
  • DHS has announced that it will add several prescription drugs to the Medical Assistance program’s list of services and items requiring prior authorization:  corticotropin; targeted systemic immunomodulators for atopic dermatitis, designated as preferred on the program’s preferred drug list (PDL); PCSK9 inhibitor lipotropics, designated as preferred on the PDL; and obesity treatment agents designated as preferred on the PDL.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has posted revisions of the participating drug company list for the Medicaid drug rebate program.
  • DHS has announced its intent to allocate funds in FY 2023 for several classes of inpatient disproportionate share hospital (DSH) payments (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled, qualifying inpatient acute-care general hospitals.  It does not intend to otherwise change the qualifying criteria or payment methodology for these payments.  See the announcement, including information about the different purposes for which Medicaid DSH payments will be made, in this Pennsylvania Bulletin notice.
  • DHS has circulated the following materials from the December 7 meeting of the Medical Assistance Advisory Committee meeting.

Department of Health

  • The Department of Health (DOH) has announced that Pennsylvania will receive $98 million in federal funding to enhance public health infrastructure, including staffing, health planning, and equity and data modernization efforts.  A portion of the funding, from the CDC’s Public Health Infrastructure grant program will be allocated to 10 county and municipal health departments.   Learn more from this Department of Health news release.
  • DOH has issued a health advisory informing providers to be aware of possible increases in group A streptococcal infections.  The alert also informs providers about symptoms, testing, and treatment; provides instructions for laboratories that identify cases; and reminds providers and laboratories that they are required to report such cases to DOH.  Find the alert here.
  • DOH has issued a health advisory with interim guidance for clinicians on how to prioritize antiviral flu treatment at a time when there is limited availability of the drug oseltamivir (Tamiflu).  Find the advisory here.
  • DOH has revised long-term-care nursing facility regulations recently approved by the Independent Regulatory Review Commission to correct typographic errors.  Find the revised, final regulations in this Pennsylvania Bulletin notice.

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania remained steady over the past week but still at an elevated post-Thanksgiving level.  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 and in hospital ICUs remained steady over the past week but the number on ventilators rose 17 percent.
  • The CDC reports no change over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
  • As of December 21, 46 Pennsylvania counties were experiencing high rates of community transmission of COVID-19; 15 were experiencing substantial rates of community transmission; and six counties were experiencing a moderate rate of community transmission.
  • As 2022 draws to a close, Pennsylvania has now experienced 3.4 million confirmed, reported cases of COVID-19 and suffered nearly 49,000 deaths from the virus.
2022-12-23T21:11:29+00:00December 23rd, 2022|COVID-19, long-term care, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for Friday, December 23
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PA Health Policy Update for Friday, December 9

The following is an update of selected state health policy developments in Pennsylvania for the week of December 5-9, 2022.  (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Shapiro announced that he will appoint Uri Monson, the chief financial officer of the School District of Philadelphia, as Budget Secretary.  He also announced Jennifer Selber will be appointed General Counsel and Larry Hailsham, Jr. will be Executive Deputy Chief of Staff.  Selber currently serves as the Executive Deputy Attorney General of Pennsylvania in charge of the criminal division and Hailsham most recently served as the Shapiro campaign’s political director.

General Assembly

  • Democrats and Republicans continue to struggle over control of the state House. On Wednesday Representative Joanna McClinton (D-Philadelphia) was sworn in during an unannounced ceremony as majority leader.  Republicans swiftly denounced the swearing-in as an “illegitimate power grab.”  In addition, Representative Summer Lee (D-Allegheny County) and Representative Austin Davis (D-Allegheny County) formally submitted their resignations on Wednesday.  At the same time they won re-election to those seats Ms. Summer was elected to Congress and Mr. Davis was elected Lieutenant Governor.  Their resignations, along with the passing of Representative Tony DeLuca (D-Allegheny County), make the current breakdown in the state House 101 Republicans and 99 Democrats.
  • The state Senate released its 2023 session calendar through June.  The calendar can be viewed here.

Department of Human Services

COVID-19:  By the Numbers                          

  • The number of new COVID-19 cases reported daily in Pennsylvania rose nearly 30 percent in the past week, an increase possibly attributable to social gatherings over the Thanksgiving holiday.  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, on ventilators because of the virus, and in hospital ICUs remains relatively unchanged.
  • The CDC reports a 22 percent increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
  • As of December 7, 39 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 25 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission.  This is almost identical to the previous week.

Department of Drug and Alcohol Programs

  • The Department of Drug and Alcohol Programs has issued an information bulletin explaining that as a result of a new Pennsylvania law passed last month, private and public treatment and rehabilitation facilities may not deny addiction treatment to individuals based solely on a negative result on a drug test.  This policy takes effect on January 1.  Learn more from this information bulletin.
  • The Department of Drug and Alcohol Programs has announced that it has awarded nearly $19 million in grant funding through its substance use disorder loan repayment program to help substance use disorder treatment professionals repay their outstanding qualifying educational loans.  More than 280 practitioners, including case managers, counselors, licensed social workers, physician assistants, and registered nurses, shared in the funding.  Learn more from this department news release.

State Board of Nursing

The State Board of Nursing proposes amending its process for reactivating nursing licenses.  Learn more from this Pennsylvania Bulletin notice.  Public comments on the proposed changes are due within 30 days.

2022-12-09T21:00:26+00:00December 9th, 2022|COVID-19, DSH hospitals, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for Friday, December 9
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PA Health Policy Update for Friday, December 2

The following is an update of selected state health policy developments in Pennsylvania for the week of November 28 to December 2, 2022.  (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf has announced ​the availability of more than $9 million in state grant funding for Single County Authorities to establish or expand crisis stabilization services for individuals with co-occurring mental health and substance use disorders.  Grants of up to $3 million will be awarded to eligible Single County Authorities and can be applied toward a range of activities, including construction and building infrastructure, staffing, and programming.  Learn more about how the state envisions counties using this money from this announcement from the governor’s office.

Governor-Elect Shapiro

The Shapiro-Davis transition team announced that Dana Fritz will serve as chief of staff in a new Shapiro administration.  Immediately prior to joining the incoming administration, Ms. Fritz, a long-time aide to Shapiro, served as his campaign manager.  Find additional information about the transition here.

Revenue Collection Update

The Department of Revenue has released its monthly revenue update for November.  General Fund revenue collections were $201.9 million, or 6.8 percent, below estimate for the month.  The shortfall is due, in part, to personal income tax revenue being deposited in December rather than November. Fiscal year-to-date General Fund collections total $15.7 billion, which is $183.2 million, or 1.2 percent, above estimate.

Department of Human Services

  • The Department of Human Services (DHS) has announced its intent to update the qualifying criteria and payment methodology for Medicaid disproportionate share hospital (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled and qualifying emergency departments in acute-care general hospitals by adding references to the report used in determining the eligibility for and the payment amounts beginning FY 2022-2023.  This announcement appears to be a codification of current state policy.  Learn more from this Pennsylvania Bulletin notice.
  • DHS has announced that it plans to expand the Living Independence for the Elderly (LIFE) Program to serve Carbon County and Monroe County as one area and is soliciting expressions of interest in serving this area.  Learn more about the LIFE program, DHS’s intentions for Carbon and Monroe counties, and the process for pursuing an opportunity to establish a LIFE program in those counties from this Pennsylvania Bulletin notice.
  • CMS has written to states to remind them that with the passage of the Inflation Reduction Act, Medicaid and Children’s Health Insurance Program (CHIP) programs will be required to provide coverage for approved adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) without cost-sharing for certain enrollees beginning October 1, 2023.  Learn more from this CMS notice.
  • DHS has circulated the minutes of the October 26 meeting of the Medical Assistance Advisory Committee’s consumer subcommittee.  Find those minutes here.

Department of Health

  • The Department of Health (DOH) issued a press release announcing its plans to distribute approximately $11.7 million in federal CDC funding to help long-term-care facilities build resilience to sustain quality care.  The money will be invested for purposes such as workforce development, staff retention, and infrastructure developments that support infection prevention control and emergency preparedness.  Eligible applicants include skilled nursing facilities, personal care homes, assisted living facilities, and intermediate care facilities.  Learn more about the program and find links to additional information about it here.  The deadline for applying for funding is December 31.
  • DOH has issued a health alert informing health care providers of a recent increase in reports of mushroom poisoning received by poison control centers in the state.  The majority of these cases have involved individuals consuming wild mushrooms foraged from backyards, public parks, wooded areas, and other locations in the southeastern part of the state.  Learn more from this department health alert.
  • DOH has updated the guidelines and fees that health care providers and facilities may charge in response to requests for production of medical charts or records.  Learn more, including the new fees, from this Pennsylvania Bulletin notice.
  • In preparation for the holiday season, DOH has established ten temporary COVID-19 testing and home test distribution sites across the state.  Go here for information about the location and hours for these sites.

COVID-19:  By the Numbers                          

  • According to the CDC, the number of new COVID-19 cases reported daily in Pennsylvania and the number of new deaths has remained steady in recent weeks, with the state averaging about 1400 new daily cases and 16-20 new daily deaths.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs remains relatively steady as well.
  • The CDC reports a modest decrease in the seven-day rolling average of new daily COVID-19 hospital admissions.
  • As of November 30, 38 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 26 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission.

Pennsylvania Health Care Cost Containment Council

PHC4 has issued “COVID-19 Disaster Emergency Report,” to provide data on the effect of the COVID-19 emergency on the financial performance of Pennsylvania hospitals and health care facilities.  According to the report, Pennsylvania hospitals and health systems reported $206 million in COVID-19 costs, between related expenses and revenue losses, for the period April-June of 2022.  Total COVID-19-related expenses and lost revenue reported by Pennsylvania hospitals and health systems through December 2021 are $7.8 billion but these figures do not reflect emergency funding provided under federal or state laws.  Learn more from this PHC4 news release and the report itself.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – December 7

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, December 7 at 10:00.  Interested parties can join the meeting in person or via webinar.  For information about the location of the meeting and how to join virtually, see this DHS notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – December 7

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, December 7 at 1:00.  Go here to register to participate.

Department of Health – Infant Hearing Screening Advisory Committee – December 8

The Infant Hearing Screening Advisory Committee will hold a public meeting in Harrisburg on Thursday, December 8 at 1:00; individuals also may participate virtually.  For more information about the meeting, including its location and how to join virtually, see this Pennsylvania Bulletin notice.

Department of Aging – Pennsylvania Long-Term Care Council – December 8

The Department of Aging’s Pennsylvania Long-Term Care Council will meet publicly on Thursday, December 8 at 10:00.  For information about how to attend in person or virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – December 8

The board of directors of the state’s Patient Safety Authority will meet virtually on Thursday, December 8 at 1:00.  Learn about how to register for and participate in this meeting from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – December 8

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, December 8 at 10:00.  Go here to register to participate.

 

2022-12-05T13:53:45+00:00December 2nd, 2022|COVID-19, Federal Medicaid issues, Medicaid supplemental payments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for Friday, December 2
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PA Health Policy Update for Friday, November 18

The following is an update of selected state health policy developments in Pennsylvania for the week of November 14-18, 2022.  (Some of the language used below is taken directly from state documents.)

Governor-Elect Shapiro

Governor-Elect Josh Shapiro held a press conference Wednesday, November 16 along with Governor Wolf and Lieutenant Governor-Elect Austin Davis to discuss the gubernatorial transition process.  The governor-elect announced that Akbar Hossain, who previously served as his campaign’s policy director, will be executive director of the transition.  Amanda Warren, formerly director of finance for the campaign, will serve as executive director of the inauguration.  Additional transition announcements will be made in the coming weeks.  Further information about the transition will be available here.

General Election Update

State Representative Todd Stephens (R-151) conceded to his challenger, Melissa Cerrato (D), yesterday afternoon.  Representative Stephens’ concession gives Democrats the 102 seats needed to control the state House of Representatives; Republicans have 101 seats.  The initial path forward for Democratic control is unclear, however, because of three impending vacancies in the Democratic caucus that will require special elections in early 2023.

General Assembly Update

  • The state House and Senate briefly convened for voting session this week – the final voting session of the year.  Both chambers will return to Harrisburg for the commencement of the new legislative session on January 3.
  • The Senate Health & Human Services Committee held a hearing on Tuesday to examine the Behavioral Health Commission’s recommendations for the allocation of $100 million earmarked in the FY 2023 budget.  Testimony and a recording of the hearing may be viewed here.
  • The Senate Republican and Democratic caucuses held leadership elections this week for the new legislative session.  Senator Kim Ward (R-39) was elected the state’s first female Senate President Pro Tempore.  Senator Joe Pittman (R-41) was elected majority leader and Senator Scott Martin (R-13) was chosen chairman of the Appropriations Committee.  Senator Jay Costa (D-43) was re-elected by his caucus to serve as minority leader.  A complete list of the Senate Republican leadership team can be found here and a list of the Senate Democratic leadership team can be found here.

Department of Human Services

  • As of December 5, DHS is adding a new procedure code to the Medical Assistance fee schedule for COVID-19 tests provided to Medicaid beneficiaries and removing the previous code for those tests.  Learn more from this Pennsylvania Bulletin notice.
  • DHS will increase Medical Assistance fees for certain ambulance transportation services beginning on January 1.  Learn more, including the new fees, from this Pennsylvania Bulletin notice.
  • Pennsylvania’s Independent Regulatory Review Commission has received final form rulemaking from DHS that would effectively rescind a provision in existing regulations that prohibits providers from co-locating or leasing space to another provider within a provider’s office.  This change was originally proposed in July 2021 and the commission is expected to approve the change at its December 8 meeting.  Find notice of the action in this Pennsylvania Bulletin listing.
  • Next month, DHS’s Office of Long-Term Living will submit a proposed amendment to Pennsylvania’s OBRA 1915(c) home and community-based waiver to the Centers for Medicare & Medicaid Services (CMS).  To view a side-by-side comparison of the current and revised language and to see the amendment in its entirety, go to the OLTL Waiver Amendments, Renewals, and Accompanying HCBS Transition Plans webpage and select “2023 OBRA Waiver Amendment” under “Additional Resources.”  For additional information about the proposed amendment and how to submit written comments, see this Pennsylvania Bulletin notice.  The deadline for submitting comments has been extended to December 14.
  • Next month, DHS’s Office of Long-Term Living will submit to CMS a proposed amendment to Pennsylvania’s Community HealthChoices 1915(c) home and community-based waiver.  To view a side-by-side comparison of the current and revised language and see the amendment in its entirety, go to the OLTL Waiver Amendments, Renewals, and Accompanying HCBS Transition Plans webpage and select “2023 Community HealthChoices (CHC) Waiver Amendment” under “Additional Resources.”  Learn more about the proposed amendment from this Pennsylvania Bulletin notice.  The deadline for submitting comments has been extended to December 14.
  • DHS is making available for public review and comment the Office of Long-Term Living’s proposed home and community-based services provider sites that qualified for heightened scrutiny under CMS requirements.  Learn more about the types of sites to which this requirement applies and DHS’s actions to bring them into compliance with federal standards from this Pennsylvania Bulletin notice.

COVID-19:  By the Numbers                          

  • According to the CDC, the number of new COVID-19 cases reported daily in Pennsylvania over the past week declined 18 percent while the number of deaths remains unchanged.  The state is now averaging more than 1400 new reported cases a day and about 19 daily deaths.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and on ventilators because of the virus remains relatively steady but the number in hospital ICUs fell 16 percent from the last week after two weeks of rising totals.
  • The CDC reports a modest decrease in the seven-day rolling average of new daily COVID-19 hospital admissions.
  • As of November 18, 27 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 34 are experiencing substantial rates of community transmission; and six counties are experiencing moderate rates of community transmission.

Pennsylvania Health Care Cost Containment Council

PHC4 has published “Financial Analysis 2021:  Rehabilitation • Psychiatric • Long-Term Acute Care • Specialty:  An Annual Report on the Financial Health of Pennsylvania Non-GAC Hospitals.”  The report’s highlights include:

  • During FY 2021, the operating margin for rehabilitation hospitals was 9.19 percent, for psychiatric hospitals was negative 2.86 percent, for long-term acute-care hospitals was 8.98 percent, and for specialty hospitals was negative 11.76 percent.
  • During FY 2021, the total margin for rehabilitation hospitals was 12.04 percent, for psychiatric hospitals was negative 3.02 percent, for long-term acute-care hospitals was 7.76 percent, and for specialty hospitals was 9.9 percent.
  • As a group, the foregone dollar value of uncompensated care for non-general acute-care hospitals decreased 6.19 percent, or $1.1 million, from $18.7 million during FY 2020 to $17.7 million in FY 2021.  Uncompensated care as a percentage of net patient revenue in FY 2021 among non-general acute-care hospitals ranged from 0.22 percent for long-term acute-care hospitals to 1.44 percent for psychiatric hospitals.

Learn more about the PHC4 report from this news release and the report itself.  In addition, go here to download data from the report in Excel format.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – December 7

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, December 7 at 10:00.  Interested parties can join the meeting in person or via webinar.  For information about the location of the meeting and how to join virtually, see this DHS notice.

Department of Health – Infant Hearing Screening Advisory Committee – December 8

The Infant Hearing Screening Advisory Committee will hold a public meeting in Harrisburg on Thursday, December 8 at 1:00; individuals also may participate virtually.  For more information about the meeting, including its location and how to join virtually, see this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – December 7

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, December 7 at 1:00.  Go here to register to participate.

DHS – Medical Assistance Advisory Committee – December 8

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, December 8 at 10:00.  Go here to register to participate.

 

2022-11-18T22:22:41+00:00November 18th, 2022|COVID-19, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for Friday, November 18
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PA Health Policy Update for Friday, November 10

The following is an update of selected state health policy developments in Pennsylvania for the week of November 7-10, 2022.  (Some of the language used below is taken directly from state documents.)

2022 Election Update

While the results are not official, current Democratic Lieutenant Governor John Fetterman has defeated Republican Mehmet Oz to replace retiring U.S. Senator Pat Toomey. Pennsylvania’s congressional incumbents all won another term. The state’s two open congressional seats (PA-12 and PA-17) were captured by Summer Lee (D) and Chris Deluzio (D), respectively.

At the state level, Democrat Josh Shapiro, the state’s current Attorney General, defeated Republican State Senator Doug Mastriano and will be Pennsylvania’s next governor.

Republicans will retain control of the state Senate with 28 of the chamber’s 50 seats; they have been in the majority in the Senate since 1994.  In an unanticipated outcome, Democrats made significant gains in the state House, and as of Thursday afternoon, November 10, are in striking distance of having a majority.  A handful of House races remain too close to officially call and may be headed for a recount. Except for a four-year period from 2007 through 2010, Republicans have been in the majority in the House since 1995.

Come January, Pennsylvania will have a new governor, a vacancy at Attorney General, and nearly a quarter of the General Assembly’s members will be new so there will be changes in caucus and committee leadership.

General Assembly

As of Thursday afternoon, the state House is schedule to return to session on Monday, November 14 and the Senate is scheduled to return on Tuesday, November 15.

The Senate Health and Human Services Committee will hold a public hearing next Tuesday, November 15th at 10:00 a.m.. to review the recently released Behavioral Health Commission report. The hearing can be livestreamed here.

Department of Human Services

Department of Health

The Department of Health has written to nursing home administrators to inform them that temporary nurse aides (TNAs) hired on or before June 6, 2022 have until the end of the federal public health emergency or April 5, 2023, whichever date comes first, to successfully pass the nurse aide exams and have their name enrolled on the Nurse Aide Registry.  Find that letter here.

COVID-19:  By the Numbers

  • According to the CDC, the number of new COVID-19 cases reported in Pennsylvania continues to fall in the 1700-1800 a day range while the number of deaths is generally between 17 and 20 a day.
  • According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs because of the disease remained relatively steady over the past week.

Stakeholder Events

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – December 7

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, December 7 at 10:00.  Interested parties can join the meeting in person or via webinar.  For information about the location of the meeting and how to join virtually, see this DHS notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – December 7

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, December 7 at 1:00.  Go here to register to participate.

DHS – Medical Assistance Advisory Committee – December 8

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, December 8 at 10:00.  Go here to register to participate.

2022-11-14T21:35:19+00:00November 10th, 2022|COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid policy|Comments Off on PA Health Policy Update for Friday, November 10
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  • 2020 Safety-Net Association of Pennsylvania

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