The following is an update of selected state health policy developments in Pennsylvania for the week of October 10-14, 2022.  (Some of the language used below is taken directly from state documents.)

The Wolf Administration

Governor Wolf has announced that Pennsylvania is proposing to enter a new profit-sharing agreement with its Medical Assistance physical health managed care organizations.  Under the proposed agreement, the physical health managed care organizations would be limited to three percent profits annually with the requirement to invest additional profits in approved projects and initiatives that directly benefit the health and well-being of Pennsylvanians.  The agreement would take effect for the 2023 contract year.  Learn more about the proposal from this Wolf administration news release.

General Assembly

The state Senate will return to session next week.  Monday, October 17 is a non-voting session day. Tuesday, October 18 and Wednesday, October 19 are voting session days.  The state House will continue to be in recess next week.

The Senate Health & Human Services Committee will convene on Tuesday, October 18 to consider the following bills.

• Senate Resolution 352 requires the Joint State Government Commission to study the specific data, calculations, and mechanisms the Department of Human Services (DHS) uses to determine the capitation rate paid to drug and alcohol treatment providers in Pennsylvania.
• Senate Bill 359 requires the Secretary of DHS to apply for a waiver that would extend Medicaid coverage for pregnancy-related and postpartum medical assistance for up to an additional ten months.
• Senate Bill 1136 amends the Vital Statistics Law to expressly include the Legislative Budget and Finance Committee as a government entity and to clarify that it may have access to vital statistics for research purposes.
• Senate Bill 1358 places certain restrictions on non-compete clauses for health care practitioners and requires patient notification. Legislative text is not currently available.
• House Bill 293 allows FDA-approved anti-obesity drugs to be considered a compensable service under the state’s Medicaid program.
• House Bill 1443 permits certain diagnostic laboratory services to be marketed directly to Pennsylvania consumers.
• House Bill 1630 grants the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid.
• House Bill 2293 requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.
• House Bill 2357 prohibits the preparation, manufacture, sale, or distribution of unsafe kratom products and the sale or distribution of kratom products to individuals younger than 21 years of age.
• House Bill 2530 ends the practice of prudent pay in the Department of Human Services’ Office of Developmental Programs.

Department of Human Services

• The Department of Human Services (DHS) has posted information for providers about an electronic submission process that will soon be available in the PROMISe portal for fee-for-service 180-day exception requests and other claims requiring documentation.  Find DHS notice here.
• Effective October 1, Pennsylvania has increased the income threshold for applicants for the Supplemental Nutrition Assistance Program (SNAP) to 200 percent of federal poverty income guidelines.  This will make more than 420,000 Pennsylvanians and more than 174,000 households newly eligible for SNAP and an average of $63 a month to help pay for groceries.  For additional information about these changes and where to direct individuals to apply for them, see this DHS news release.
• DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has released “Pennsylvania Behavioral Health Telehealth Phase II Roadmap,” which offers and prioritizes recommendations for short-term and long-term implementation of telehealth services in the state.

Centers for Medicare & Medicaid Services

The federal Centers for Medicare & Medicaid Services (CMS) has approved Pennsylvania’s request for a statewide waiver to extend the October 6, 2022 deadline for temporary nurse aides (TNAs) to gain certification to April 5, 2023 or until the end of the COVID-19 public health emergency (whichever comes first).  This statewide approval applies to all nursing care facilities in Pennsylvania, so individual facilities do not need to request a waiver.  For information about how temporary TNAs can pursue certification, see this notice.

To evaluate Medicaid and the Children’s Health Insurance Program (CHIP) coverage for children, states report data to CMS about program eligibility, enrollment, operations, expenditures, program goals, and more.  CMS has published CHIP data submitted to it by Pennsylvania for FY 2021.  Find that data here.

Department of Health

The Department of Health has issued a health alert giving providers interim guidance on risk assessment and management of patients who may have been exposed to the Ebola virus.  It issued this guidance after a case of Ebola was recently diagnosed in Uganda but notes that no reported or confirmed cases have been found in the U.S.  Learn more from this health advisory.

COVID-19:  By the Numbers

• According to the CDC, the number of new COVID-19 cases in Pennsylvania over the past week was down 18 percent from the previous week (which was 20 percent less than the week before that) and the number of deaths was unchanged.
• According to the Department of Health, the number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus remains relatively steady while the CDC reports a nine percent decrease in the seven-day rolling average of new daily COVID-19 hospital admissions (after a seven point increase the previous week).
• Sixty-two of Pennsylvania’s 67 counties are experiencing a high rate of community transmission of COVID-19.  The remaining five counties – Adams, Centre, Lebanon, Philadelphia, and Snyder – are experiencing moderate rates of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs (DDAP) announced that the 2022 open enrollment period is under way 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).  Treatment facilities currently not enrolled in ATLAS may submit their information during this open enrollment period through December 30, 2022.  In addition, current enrollees may update facility information during this period.  For additional information, see this DDAP news release.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has released its state ambulatory surgery center financial analysis for 2021.  Its report shows that the average total margin for ambulatory surgery centers increased 1.61 percentage points, from 23.36 percent in fiscal year 2020 to 24.97 percent in FY 2021.  The average statewide operating margin for ambulatory surgery centers increased 1.58 percentage points, from 22.29 percent in FY 2020 to 23.87 percent, in FY 2021.  Learn more from this PHC4 news release and the PHC4 report “Financial Analysis 2021:  Ambulatory Surgery Centers.”  Go here for downloadable data in Excel format (this link opens to a download).

Stakeholder Events

Department of Health – Special Supplemental Nutrition Program for Women, Infants and Children Advisory Committee – October 18

The Department of Health’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Advisory Committee will meet virtually on October 18 at 1:00 to elect officers and discuss future suggestions and next steps for the committee.  For information about participating in the meeting and obtaining an agenda, see this Pennsylvania Bulletin notice.

DHS – Office of Mental Health and Substance Abuse Services and Office of Developmental Programs – Suicide Prevention – October 21

The Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs will host a quarterly “Statewide Positive Approaches & Practices” meeting that will share the most recent research and resources to help people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities live everyday lives.  The specific subject of the meeting, to be held on Friday, October 21 at 9:00, will be suicide prevention and intervention.  Find the meeting agenda and information about how to register to participate from this DHS notice.

Department of Health – Renal Disease Advisory Committee – October 21

The Department of Health’s Renal Disease Advisory Committee will hold its quarterly meeting in person and virtually on Friday, October 21 at 10:00.  For information about participating in the meeting, see this Pennsylvania Bulletin notice.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – October 25

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will hold its next meeting on Tuesday, October 25 at 9:30.  The meeting location will depend on COVID-19 mitigation efforts at that time.  If the meeting can be held in person it will be in Room 129 in the Pennsylvania Health and Welfare Building at 625 Forster Street in Harrisburg.  If the meeting is held virtually it will be held at bit.ly/ABC_MAP.  To dial in, call 267-332-8737, conference ID 440 338 696#.  Learn more from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – October 26

The Medical Assistance Advisory Committee’s Consumer Subcommittee will meet virtually on Wednesday, October 26 at 1:00.  Go here to register to participate.

DHS – Medical Assistance Advisory Committee – October 27

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, October 27 at 10:00.  Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program – Advisory Council – October 27

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, October 27 at 10:00.  Interested individuals may attend in person or participate virtually.  For information on the location of the meeting and how to join the meeting virtually, see this Department of Health notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Support Subcommittee – November 2

The Managed Long-Term Services and Support Subcommittee of DHS’s Medical Assistance Advisory Committee will meet publicly on Wednesday, November 2 at 10:00 in Harrisburg.  Interested parties may attend in person or via webinar; those participating through the webinar must register in advance.  For information about the location of the meeting, how to join it virtually, how to register, and how to offer comments or submit questions, see this DHS notice.