Pennsylvania Department of Human Services Archives - Page 8 of 9

PA Health Policy Update for April 7

The following is an update of selected state health policy developments in Pennsylvania from April 3 to April 7. (Some of the language used below is taken directly from state documents.)

General Assembly

The House and Senate Appropriations Committees will resume budget hearings next week.

- On Tuesday, April 11 at 10:00 a.m., the Department of Human Services will appear before the House Appropriations Committee. The hearing will be held in the House chamber and will also be live streamed here. 
- On Wednesday, April 12 at 9:30 a.m., the Department of Human Services will appear before the Senate Appropriations Committee. The hearing will be held in Hearing Room 1 of the North Office Building and will also be live streamed here. 
- On Thursday, April 13 at 9:30 a.m., the Department of Health will appear before the Senate Appropriations Committee. The hearing will be held in Hearing Room 1 of the North Office Building and will also be live streamed here. 
- A complete schedule for the House Appropriations Committee can be viewed here and a complete schedule for the Senate Appropriations Committee can be found here.

The House Health Committee will hold an informational hearing Wednesday, April 12 at 10:00 a.m. on prescription drug affordability boards. The hearing will be held in in Room 205 of the Ryan Office Building and will be live streamed here.

The House Democratic Policy Committee will hold a public hearing Thursday, April 13 at 12:00 p.m. on black maternal health. The hearing will be held in Room G-50 of the Irvis Office Building and will be live streamed here.

The House Aging and Older Adult Services Committee will hold an informational hearing Thursday, April 13 at 1:00 p.m. on PACE/PACENET, the State Long-Term Care Ombudsman and AARP. The hearing will be held in Room 515 of the Irvis Office Building and will be live streamed here.

The state House and Senate are currently recessed.  They will return to Harrisburg on Monday, April 24 following the conclusion of budget hearings.

Department of Health

The Department of Health (DOH) published the Pennsylvania State Health Improvement Plan (SHIP) that outlines goals, objectives, and strategies to improve the health of Pennsylvania residents over the next five years. The 2023-2028 SHIP was developed in collaboration with the Healthy Pennsylvania Partnership, which is made up of nearly 300 health care professionals, associations, health systems, health and human services organizations, community collaborations, local public health agencies, and government agencies.

DOH issued a health update reminding healthcare facilities, providers, and laboratories to have heightened awareness for C. auris in their patients and updating a previous alert with information on new confirmed cases in Cumberland, Erie, and Monroe counties.  C. auris has been detected in ventilator-capable skilled nursing facilities, long-term acute care hospitals, and acute care hospitals since the current outbreak began in March 2020.  Find more information in this Health Update.

DOH has alerted providers and laboratories to current outbreaks of Marburg virus in Tanzania and Equatorial Guinea and recommends they consider Marburg virus in patients with recent travel to those areas.  Find details in the Health Alert here.

Department of Human Services

The Department of Human Services (DHS) announced the Centers for Medicare & Medicaid Services (CMS) approved the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) waiver amendment, which took effect April 1, 2023. Changes in the approved waiver include benefits counseling, home health aide services, nursing services, and occupational, physical, and speech and language therapy services. The current approved CHC Waiver can be found here.

OLTL released a transition plan to phase out temporary changes to the CHC 1915(c) Waiver. Effective May 11, 2023, OLTL will phase out its emergency flexibilities to coincide with the end of the federal Public Health Emergency.

DHS announced CMS has approved OLTL’s OBRA Waiver amendment, which took effect April 1, 2023, for home and community-based services. The current OBRA Waiver can be viewed here.

The Department of Human Services (DHS) issued a Medical Assistance Bulletin to notify dental providers enrolled in the Medical Assistance program that DHS will begin accepting the 2019 American Dental Association (ADA) Claim Form upon issuance of this bulletin and will no longer accept the 2012 ADA Claim Form for dates of service on and after June 1, 2023.

DHS released a Provider Quick Tip (#263) notifying providers about an electronic submission process for FFS 180-day exception requests and other claims requiring documentation will soon be available in the Promise Portal.

DHS has posted the minutes of the March 23, 2023 meeting of the Medical Assistance Advisory Committee.

Department of Drug & Alcohol Programs

The Department of Drug and Alcohol Programs and DHS jointly issued a bulletin to update the guidance in OMHSAS bulletin 06-03 dated February 10, 2006. This bulletin includes the definitions of co-occurring capable and co-occurring enhanced programs as set forth in The ASAM Criteria. The information may be used to assist SCAs, BH-MCOs, and treatment providers in identifying co-occurring capable and co-occurring enhanced programs and in referring individuals to those programs.

Revenue Collection Update

The Department of Revenue announced Pennsylvania collected $6.2 billion in General Fund revenue in March, which was $499.4 million, or 8.8 percent, more than anticipated. Fiscal year-to-date General Fund collections total $32.3 billion, which is $1.1 billion, or 3.7 percent, above estimate.

Around the State

WHYY reported about the end of continuous Medicaid enrollment, beginning April 1, 2023, and how individuals can prepare for renewals.

The Erie Times-News published an article about the drug-resistant fungus, Candida auris, which was found in a patient at a health care facility in Erie County.

Stakeholder Events

PHC4 – Data Systems Committee – April 10

The Pennsylvania Health Care Cost Containment Council (PHC4) has scheduled a Data Systems Committee meeting on April 10 at 10:00 a.m. Go here for additional information and details on how to participate.

DOH – State Child Death Review Team – April 20

The State Child Death Review (CDR) Team will hold a public meeting on Thursday, April 20 from 1:00 – 3:00 p.m. Go here for additional information and details on how to participate.

DOH – Renal Disease Advisory Committee – April 21

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, April 21 from 10:00 a.m. to 12:00 p.m. Go here for additional information and details on how to participate.

DHS – Drug Utilization Review (DUR) Board – April 26

The DUR Board will meet Wednesday, April 26 from 9:00 a.m. to 4:00 p.m. Go here for additional information and details on how to participate.

DHS – Medical Assistance Consumer Subcommittee – April 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee is scheduled to meet on April 26, 2023, at 1:00 pm. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – April 27

The Medical Assistance Advisory Committee is scheduled to meet on Thursday, April 27 at 10:00 a.m.  Go here to register to participate.

Patient Safety Authority – April 27

The Patient Safety Authority’s board will meet virtually on Thursday, April 27 at 1:00 p.m. Go here for additional information and details on how to participate.

DHS – Managed Long-Term Services and Supports Subcommittee – May 12

The Managed Long-Term Services and Supports (MLTSS) Subcommittee will hold a meeting on Friday, May 12 from 10:00 a.m. – 1:00 p.m. in the Department of Education Building’s Honors Suite, 1st floor, at 333 Market Street in Harrisburg, or via webinar. You may register for the webinar here.

PA Safety Net Admin2023-04-20T17:15:29+00:00April 7th, 2023|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

Change Atop PA’s Department of Human Services

Teresa Miller is out and Meg Snead will be in as Pennsylvania’s new Secretary of the Department of Human Services.

In separate news releases the Wolf administration announced that Miller, who has led DHS since 2015, “will be moving on to a new opportunity outside Pennsylvania” and leave her job at the end of April and that she will be replaced by Meg Snead, who currently serves as the governor’s Secretary of Policy and Planning.

Snead’s nomination is subject to confirmation by the state Senate.

The Secretary of the Department of Human Services is important to SNAP members and Pennsylvania safety-net hospitals because the state’s Medicaid program is administered by that department’s Office of Medical Assistance Programs.

Learn more about Miller’s departure here and about Snead’s nomination here.

PA Safety Net Admin2021-03-25T06:00:37+00:00March 25th, 2021|Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|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

Wolf Administration Proposes New Human Services Initiatives for FY 2021

New human services efforts to support vulnerable populations are a major part of Governor Tom Wolf’s proposed $36.06 billion FY 2021 budget for Pennsylvania.

The proposed budget, presented to the state legislature earlier this week, includes the following new initiatives:

creating pathways to success in the workforce for low-income Pennsylvanians
increasing the minimum wage to $15
increasing Department of Human Services staffing to support licensing and oversight
supporting adults in long-term-care facilities
legal services for vulnerable populations
direct care worker comprehensive training
commitment to performance-based metrics, accountability, and transparency in services and licensing
supporting vulnerable populations through home- and community-based services and reducing waiting lists
prevention services to support at-risk families
improving food security while supporting agriculture

Go here to see DHS’s presentation of these initiatives.

In addition, the Safety-Net Association of Pennsylvania has prepared a detailed memo describing the proposed FY 2021 budget’s implications for Pennsylvania safety-net hospitals and the state’s Medicaid program. For a copy of this memo, use the “contact us” link in the upper right-hand corner of this page.

PA Safety Net Admin2020-02-07T06:00:38+00:00February 7th, 2020|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2021 budget, Pennsylvania safety-net hospitals, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

DHS Secretary Describes Initiatives

In an op-ed piece in the Scranton Times-Tribune, Pennsylvania Department of Human Services Secretary Ted Dallas has outlined his organization’s major achievements of 2015 and its plans for 2016.
Among them are the state’s expansion of its Medicaid program and its plans to establish new contracts with HealthChoices managed care organizations that seek to shift the program’s emphasis from volume of care to value and outcomes through greater use of accountable care organizations (ACOs), bundled payments, patient-centered medical homes, and other value-based initiatives.
Find Secretary Dallas’s commentary here.

PA Safety Net Admin2016-01-04T11:40:53+00:00January 4th, 2016|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

PA Puts New HealthChoices Contracts Up for Bid

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program.
The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January.
The contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years. Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes.
With a projected value of about $17 billion, the RFP is expected to attract interest from national organizations that have not necessarily served Pennsylvania’s Medicaid population in the past.
To learn more about the state’s HealthChoices plans, see this news release from the Department of Human Services and this Philadelphia Inquirer article. Find the RFP itself here.

PA Safety Net Admin2015-09-23T06:00:50+00:00September 23rd, 2015|HealthChoices PA, Meetings and notices|Comments Off

DHS Issues RFI for Vendors to Help Monitor Payments

Pennsylvania’s Department of Human Services (DHS), which administers the state’s Medicaid program, is seeking information from vendors that offer data mining and predictive analytics that might help the state monitor Medicaid and other payments.
DHS seeks to use such services to “…detect patterns of waste, fraud, and abuse in its programs on a prospective or retrospective basis.”
Among the challenges such vendors might address in their responses, as stated in the RFI, are:

Identifying claim review strategies that efficiently and proactively prevent or address potential errors (e.g., prepayment edit specifications or parameters).
Providing mechanisms to investigate patterns that may indicate abuse of services by clients.
Producing innovative views of utilization or billing patterns that illuminate potential errors.
Maximizing recoveries by identifying high volume or high cost services that are widely over utilized.
Identifying areas of potential errors (e.g., services which may be non-covered or not correctly coded) that poses the greatest risk or vulnerability.
Establishing baseline data to enable DHS to dynamically recognize unusual trends, changes in utilization over time, or schemes to inappropriately maximize reimbursement. Adapting systems, rules, and algorithms on an ad hoc basis in order to be responsive to emerging trends, patterns, and issues as they are identified.
Clearly distinguishing which applications are standardized as part of the product package and which applications will need to be purchased as a system enhancement.
Establishing baseline data and recommendations to improve the client experience related to access to services and the quality of the services received.

The call for vendors is a request for information (RFI) and not a request for proposals (RFP) but it appears likely that the state will issue an RFP after it has had an opportunity to review the information submitted to it.
RFI submissions are due on November 9. See the RFI document here.

PA Safety Net Admin2015-09-17T06:00:51+00:00September 17th, 2015|Meetings and notices|Comments Off

DHS Reorganizes

The Pennsylvania Department of Human Services (DHS), which administers the state’s Medicaid program, has reorganized both the department as a whole and its Office of Medical Assistance Programs.
New tables of organizations for both entities have been published in the Pennsylvania Bulletin. Find them here.

PA Safety Net Admin2015-09-01T06:00:43+00:00September 1st, 2015|Pennsylvania Bulletin|Comments Off

PA Seeks to Modernize, Improve Medicaid Program Integrity

The Pennsylvania Department of Human Services (DHS) has announced new steps to enhance its program integrity efforts and reduce improper and fraudulent payments, including Medicaid payments.
The proposed new approach will rely heavily on automation, analytics, and technology. Major changes include:

Consolidation of the Office of Program Integrity and Bureau of Program Integrity
Issuing a request for information for program integrity data analysis of provider payments
Implementation of a customer portal for third-party liability
Implementation of “identity proofing” of program recipients
Automating provider enrollment
Eliminating manual updating of milestone changes

In the state’s 2015 fiscal year it prevented nearly $600 million in improper payments, 74 percent of which were potential provider payments.
For a closer look at the state’s plans, see this DHS news release.

PA Safety Net Admin2015-08-07T06:00:01+00:00August 7th, 2015|Pennsylvania Medicaid policy|Comments Off

PA Moves to Streamline Medicaid Provider Enrollment

In response to the challenges the state has encountered processing Medicaid provider enrollment applications, the Pennsylvania Department of Human Services (DHS) has unveiled what it believes will be an improved approach to tackling this problem.
The improvements include electronic enrollment, standardization of policies and procedures, and additional provider enrollment staffing.
At the heart of the backlog are Affordable Care Act requirements.
Go here to see a message from DHS acting secretary Theodore Dallas on this subject.

PA Safety Net Admin2015-04-23T06:00:08+00:00April 23rd, 2015|Affordable Care Act, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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