Pennsylvania Medicaid Archives - Page 15 of 20 - Safety-Net Association of Pennsylvania

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its November 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

How the renewal of the federal COVID-19 public health emergency declaration extends key Medicaid protections.
State planning for children with complex needs.
State efforts to connect people to COVID-19 testing and care.
An upcoming webinar about challenging Medicaid and Community HealthChoices waiver service denials.

Read about these subjects and more in the Pennsylvania Health Law Project’s November 2020 newsletter.

PA Safety Net Admin2020-11-17T15:00:32+00:00November 4th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its September 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

How Pennsylvania Medicaid beneficiaries who turn 21 during the COVID-19 emergency remain eligible for EPSDT services.
Pennsylvania Health Law Project navigators who can help direct people to COVID-19 testing and treatment.
A warning that without increased federal Medicaid matching money, states may seek to reduce Medicaid provider payments, increase beneficiary cost-sharing, or reduce services.

Read about these subjects and more in the Pennsylvania Health Law Project’s September 2020 newsletter.

PA Safety Net Admin2020-10-08T06:00:21+00:00October 8th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid|Comments Off

Medicaid and CHIP Enrollment Rising in Pandemic

Medicaid enrollment rose 6.2 percent and CHIP enrollment 0.5 percent during the first four months of the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services reports.

The enrollment increase can be traced to rising unemployment, with many people losing their employer-sponsored health insurance. The new figures cover five months, from February through June, the latter four of which marked the beginning of the COVID-19 pandemic.

Pennsylvania safety-net hospitals already serve significant numbers of Medicaid and CHIP patients; an increase in their rolls will prove financially challenging to them.

The information comes from CMS’s first monthly “Medicaid and CHIP Enrollment Trends Snapshot.” Go here for CMS’s news release explaining its new initiative and here to see the trends snapshot itself, which includes figures for Pennsylvania.

PA Safety Net Admin2020-10-06T06:00:16+00:00October 6th, 2020|Pennsylvania Medicaid, Uncategorized|Comments Off

Medicaid Enrollment on the Rise

More people are enrolling in Medicaid, and much of the increase is driven by the COVID-19 emergency.

Or so reports the organization Families USA in a new study.

Pennsylvania State Map According to the study,

Over half of the 38 states reporting monthly enrollment through May or later have seen greater than 7% growth in enrollment since February. For the eight states reporting August enrollment, their average enrollment growth since February is approximately 11%.

But the implications are even greater, according to the analysis, which found that in large part because of COVID-19 job loss,

Medicaid enrollment among the 38 states reporting has already increased by 4.3 million people and is poised to increase much more in the near future. Analysis by Health Management Associates projects that up to 27 million people will lose their job-based insurance this year and that Medicaid will see an increase in enrollment of up to 18 million people by the end of 2020, depending on the severity of the economic downturn.

The effects of COVID-19 job loss and accompanying loss of insurance already appears to be visible in Pennsylvania, where Medicaid enrollment rose from 2.84 million in March of 2020 to 2.89 million in April, 2.94 million in May, and 2.977 million in June. Growing Medicaid enrollment poses a challenge for Pennsylvania’s safety-net hospitals because they care for so many low-income patients and payments from the state’s Medicaid program often do not cover the cost of the care they provide.

Learn more about the nation-wide trend in the Families USA report “Rapid Increases in Medicaid Enrollment: A Review of Data from Six Months.”

PA Safety Net Admin2020-09-16T06:00:58+00:00September 16th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania safety-net hospitals|Comments Off

Eliminate Medicaid DSH Cut, SNAP Asks PA Delegation

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states, and the Safety-Net Association of Pennsylvania has written to the state’s congressional delegation asking its members to convey this message to congressional leaders.

The cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to the delegation, SNAP wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured, including nearly 700,000 Pennsylvanians – a number thought to be rising because of the job loss associated with COVID-19. When these people are sick or injured, most will turn to the state’s 41 private safety-net hospitals for care. These hospitals depend heavily on their Medicaid DSH payments to underwrite the cost of care for their uninsured patients, so they have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never permitted those cuts to go into effect. The most recent delay expires after November 30..

Because they serve so many uninsured and underinsured patients, Medicaid DSH payments from the state are especially important for Pennsylvania’s safety-net hospitals.

PA Safety Net Admin2020-09-15T06:00:16+00:00September 15th, 2020|Affordable Care Act, Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

CMS Provides Guidance on Medicaid DSH Calculations

State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services.

In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date, CMS will enforce its own interpretation of the policy.

In new guidance, CMS presents two methodologies for accounting for its mid-year policy change and reminds stakeholders about its new methodology for calculations after June 2, 2017. Pennsylvania’s Department of Human Services and its Office of Medical Assistance Programs have not yet indicated how they will respond to the options CMS has presented.

Learn more from this Medicaid notice and from its accompanying CMS informational bulletin “Treatment of Third Party Payers (TPP) in Calculating Uncompensated Care Costs (UCC).”

PA Safety Net Admin2020-08-31T19:55:39+00:00August 27th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its August 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

The Department of Human Services’ selection of new managed care plans to serve Pennsylvania Medicaid’s Community HealthChoices program.
The end of ensured continuity of long-term services and supports for participants in the Community HealthChoices program in northeastern Pennsylvania.
The availability of navigators to help connect people to COVID-19 testing and treatment.

Read about these subjects and more in the Pennsylvania Health Law Project’s August 2020 newsletter.

PA Safety Net Admin2020-08-05T06:00:27+00:00August 5th, 2020|HealthChoices, long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

COVID-19 Update: March 27, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 4:30 p.m. on March 27.

Pennsylvania Updates

Governor Wolf

Today Governor Wolf expanded his ‘Stay at Home’ order to include nine more counties to mitigate the spread of the virus: Berks, Butler, Lackawanna, Lancaster, Luzerne, Pike, Wayne, Westmoreland, and York counties. The governor’s amended order, the secretary of health’s amended order, and the stay at home guidance are available online. The order takes effect for these nine counties tonight at 8:00 p.m. and will continue for all of the affected counties until April 6.
Today Governor Wolf approved and signed several bills into law to provide emergency relief to schools (SB 751), unemployment compensation rules (HB 68), delaying the primary election (SB 422), and the $50 million in immediate funding for health care supplies via HB 1232. We do not yet know how this funding will be distributed but are monitoring it closely. According to the enabling legislation and a press release Governor Wolf issued yesterday, “The $50 million in funding will be deposited into a restricted account under the governor’s jurisdiction and funds will be used if there are insufficient funds available from the disaster proclamation ‘to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand. Health care entities include hospitals, nursing facilities and emergency medical services’.”

Department of Human Services

The Department of Human Services (DHS) has published a reminder that Governor Wolf has signed an executive order prohibiting elective medical and surgical procedures for the duration of the COVID-19 crisis.
Pennsylvania has been granted a section 1135 Medicaid waiver by the federal government. Key elements of the waiver address:
- Temporarily suspending Medicaid fee-for-service prior authorization requirements.
- Extending pre-existing authorizations for which a beneficiary has previously received prior authorization through the end of the public health emergency.
- Suspending Pre-Admission Screening and Annual Resident Review (PASRR) Level I and Level II Assessments for 30 days.
- State Fair Hearing Requests and Appeal Timelines.
- Provider Enrollment.
- Provision of Services in Alternative Settings.

These waivers will remain in effect until the current health crisis ends. See the letter from CMS to the state that explains all of these aspects of the waiver in greater detail.

DHS’s Office of Children’s Health Insurance Program has issued a CHIP policy clarification authorizing pharmacies to override early refill alerts for medications.
The same office has published an FAQ addressing CHIP coverage of COVID-19 testing and related services.

Department of Health

During her daily briefing today, Secretary Levine reported that the number of new COVID-19 cases in Pennsylvania yesterday declined slightly from the day before, although she dismissed this decline as “not statistically significant.” There are now COVID-19 cases in 50 of Pennsylvania’s 67 counties. While the number of hospitalizations, ICU cases, and patients put on ventilators remain low, she said those numbers remain in line with trends elsewhere in the country and her department’s own projections.
The department has revised its guidance prohibiting the provision of dental treatment except for urgent and emergency services.

Department of State

The Department of State requested, and Governor Wolf granted, an extension for 90 days of certain license renewal deadlines that fall between April 30, 2020, and June 30, 2020. Affected boards include the State Board of Medicine, State Board of Nursing, and State Board of Examiners of Nursing Home Administrators. Any associated regulations that establish these dates are temporarily suspended. While the department will provide guidance encouraging licensees to renew on time, if possible, this waiver ensures that if they miss the deadline their licenses will remain valid and they will have an additional 90 days to renew them.

Federal Updates

Congress

The House of Representatives passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act passed by the Senate late Wednesday. It now goes to the president for his signature and he has indicated he will sign it.

President Trump

President Trump sent a letter to governors thanking them for their efforts in fighting the COVID-19 emergency, outlining upcoming federal efforts, and expressing hope for the future.

Department of Health and Human Services

The Department of Health and Human Services has provided guidance to states asking them to take immediate action to waive restrictions on licensure, scope of practice, certification, and recertification/relicensure consistent with changes announced in federal programs. See that guidance here.
Secretary Azar sent a letter to governors requesting immediate action on a number of measures to help “extend the capacity of the health care workforce to address the pandemic.”
The department’s Office of Family Assistance Services has posted an FAQ about TANF (the Temporary Assistance for Needy Families) program and COVID-19.

Centers for Medicare & Medicaid Services

CMS has issued guidance for CLIA laboratories regarding the review of pathology slides, proficiency testing, alternate collection devices, and requirements for a CLIA certificate during the COVID-19 public health emergency.
CMS has released a notice announcing that it is delaying the release of its minimum data set (MDS – 3.0 v1.18.1) for nursing home and swing bed providers.

Centers for Disease Control and Prevention

An updated CDC FAQ on COVID-19.
CDC offers strategies for optimizing supplies of personal protective equipment.
The CDC has published guidance on self-quarantine for New York City transportation and delivery service workers.

Food and Drug Administration

The FDA established a process for companies that have interrupted or discontinued the manufacture of components of the medical product supply chain that could lead to disruptions or shortages of drug and biological products.
The FDA has published an FAQ for consumers on the use of hand sanitizer when fighting COVID-19.
The FDA has pulled together several of its COVID-19 FAQs in one space. Included are FAQs for:
- Laboratories and manufacturers offering testing for COVID-19.
- General FAQs.
- “What if I do not have…” (technical/clinical, mostly involving medical materials)
- Clinical laboratories
- Test kit manufacturers

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

PA Safety Net Admin2020-03-27T17:25:53+00:00March 27th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off

COVID-19 Update: March 25, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania as of 5:15 on March 25.

State Legislature

Today the Senate passed House Bill 1232, as amended, which includes up to $50 million of additional funding to be made available for the state’s COVID-19 response efforts. The legislation stipulates that funding shall only be used to buy medical equipment and supplies for health care entities to meet urgent patient and staff needs to address surge demand. It also requires available federal funding and any funding made available through the governor’s disaster proclamation to be used before these funds. The authority to transfer funds expires on September 30, 2020.

Senate leadership noted that this is the first phase in its crisis response and recognizes that additional funds will likely be needed. The House is expected to pass the bill as amended today. The bill will then be signed in both chambers and sent to the governor for consideration and he is expected to sign it. It would take effect immediately.

The Administration

Governor Wolf

Today the governor added Lehigh and Northampton counties to his stay-at-home order.

Department of Health

Secretary Levine today issued an order requiring hospitals to make daily report of specified data regarding hospital facilities, beds, supplies, equipment, and staffing. Among the measures hospitals will be required to report daily are available beds, psychiatric beds, number of other beds in facilities, current emergency department capacity, number of COVID-19 patients, expected number of days remaining N-95 masks will last, expected number of days remaining until other personal protective equipment supplies will exhausted, supply of remaining NP specimen collection supplies in days, number of ventilators in facility and in use, and number of employees available for work. See the secretary’s order here.

Department of Human Services – Office of Medical Assistance Programs

The Office of Medical Assistance Programs has issued billing guidance to CHIP managed care organizations on the subject of alternative screening sites related to COVID-19. Find that two-page document here.
It issued another policy clarification to CHIP managed care organizations with directions to bypass the prior authorization requirements for chest CT scans for COVID-19 payments. See that policy clarification document here.

Another notice announces a new ICD-10 code for COVID-10 that takes effect on April 1. Find it here.

The Office of Medical Assistance Programs has posted an FAQ on Medicaid program coverage of COVID-19 testing and related services. It includes information about what Pennsylvania Medicaid will pay for COVID-19 testing, the services it will cover, and more. Find it here.

Department of Human Services – Office of Long Term Living

The Office of Long Term Living (OLTL) has published guidance on conducting pre-admission screening and resident reviews for applicants to and residents of Medicaid-certified nursing facilities. This includes an explanation of performing such screens by phone or video conference. See the guidance here.
OLTL also has sent a memo to nursing home transition coordination agencies about a new, COVID-19-motivated nursing home transition tenant-based rental assistance process. Find that memo here.
OLTL also communicated via its listserv that it is delaying the implementation deadline for electronic visit verification (EVV) until October 1, 2020.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs (DDAP) has issued a document clarifying the state’s response to federal guidance on the disclosure of patients’ substance abuse disorder records during the telehealth process. See that policy clarification here.
DDAP has issued a policy bulletin addressing telehealth services for gambling treatment. Find that bulletin here.

Department of State

The Pennsylvania Department of State, which is responsible for licensing many health care providers, has announced new guidelines and processes for reactivating the licenses of retired health care professionals such as doctors, nurses, nurse practitioners, pharmacists, and others. This new policy supplements previous announcements the department has made on this subject. Find this updated information here.

Pennsylvania Health Centers Awarded Federal Funds

The federal Health Resources and Services Administration has awarded $100 million in grants to 1381 health centers across the country. Among them are 43 health centers in Pennsylvania that will share $12.9 million in federal funds. See a list of those grant recipients here.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

Pennsylvania Emergency Preparedness Guide

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

PA Safety Net Admin2020-03-26T06:00:31+00:00March 26th, 2020|Coronavirus, COVID-19, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

COVID-19 Update: March 20, 2020

The following is a summary of the major COVID-19-related developments in Pennsylvania today as of 5:30 p.m. on March 20, 2020.

Pennsylvania Administration

Since yesterday, the Department of Human Services has issued the following four new guidance documents:

We notified you last night that the governor issued an order to close all “non-life-sustaining businesses.” Below please find two resources for additional information.

Any business that would like to seek a waiver to the mandate to close can send a request to this email address: RA-dcexemption@pa.gov
In addition, questions about whether or not your specific business needs to close can be directed to: ra-dcedcs@pa.gov

At the Secretary of Health’s daily update she noted that the number of diagnosed COVID-19 cases in the state doubled in the past two days.

Federal

Administration

CMS approved Washington state’s 1135 waiver request. The approval letter can be found here.

In addition, CMS released two telehealth toolkits: one for general practitioners that is available here and another for end-stage renal disease providers available here.

Congress

Congress is preparing a combination bill to both combat the spread of the coronavirus and also provide economic stimulus to counteract the negative effects of the state of emergency. As Congress deliberates, SNAP weighed in today with Pennsylvania’s congressional delegation, asking for immediate financial support for hospitals, the elimination of the Affordable Care Act Medicaid DSH cuts, and a moratorium on new regulatory requirements on hospitals. Find a summary of the bill here and SNAP’s letter to the delegation here.