Pennsylvania Health Care Cost Containment Council Archives - Page 3 of 7

PA Health Policy Update for August 25

The following is an update of selected state health policy developments in Pennsylvania from August 14 – 25. (Some of the language used below is taken directly from state documents.)

Fiscal Year 2023-2024 Budget Update

The Senate will return to Harrisburg for voting session Wednesday, August 30 at 1:00 p.m. to consider the remaining pieces of the FY 2023-2024 budget. The Senate Republican Caucus spokesperson released the following statement:

“Our work to complete the necessary budgetary implementation legislation continues… We are in communication with House leaders, and we remain hopeful the House will also choose to reconvene before September 26.”

Senate President Pro Tempore Kim Ward released a statement noting that funding for emergency medical services and hospital and health system relief would be on the agenda when they reconvene. The House has not scheduled voting session days prior to September 26, and it is unclear when an agreement on the final budget implementation language will be reached.

Governor Shapiro

The Shapiro administration has announced it is taking the first step to implement the Nurse Licensure Compact by allowing nurses with multi-state licenses to practice in Pennsylvania beginning September 5. Learn more by reviewing the Department of Health’s health care facility-specific guidance and the Board of Nursing’s Nurse Licensure Compact website.

General Assembly

The House Commerce Committee will hold an informational hearing Wednesday, September 6 at 11:00am on HB 1201, which addresses consumer rights for the sharing of personal data by certain businesses and provides the Attorney General with enforcement authority. The legislation includes several exemptions from the provisions of the act including several health-related exclusions in compliance with HIPAA standards. The informational hearing will be held in Room 515 of the Irvis Office Building and will be livestreamed here.

Department of Human Services

The Department of Human Services (DHS) has announced changes to the Medical Assistance (MA) Program fee schedule. The changes are effective for dates of service on and after September 5, 2023. Learn more in this Pennsylvania Bulletin notice.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through September. Find the updated calendar here.

DHS has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of July.

Department of Health

The Department of Health (DOH) has updated its staffing calculation tool for long-term care facilities. Use of this tool is not required but may be useful when calculating the required number of nursing hours as well as staff ratios. Click here to download the tool (Excel spreadsheet) and here to download the instructions (Word document).

Department of Aging

The Department of Aging has announced it is soliciting stakeholder feedback to assist in the development of the state’s Master Plan for Older Adults. The department has partnered with the University of Pittsburgh to distribute a survey in an effort to develop a profile of the needs of older adults and adults with disabilities that will inform the state’s planning process.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has announced its intent to hold technical assistance webinars regarding substance use disorder (SUD) confidentiality and the impact of Act 33. In preparation, DDAP has requested stakeholders complete their SUD Confidentiality Survey by September 22, 2023. If you are interested in attending one of the webinars, you may email RA-DAASAM@pa.gov to be notified when they’re scheduled.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Counsel (PHC4) has released a new research brief, Severe Maternal Morbidity in Pennsylvania. The brief examines severe maternal morbidity among patients hospitalized in Pennsylvania for delivery between 2016 and 2022. PHC4’s press release announcing the report may be found here.

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

PA Safety Net Admin2023-08-25T21:35:39+00:00August 25th, 2023|Financial, Medicaid Eligibility Redetermination , Pennsylvania Bulletin, Pennsylvania proposed FY 2024 budget|Comments Off

PA Health Policy Update for August 4

The following is an update of selected state health policy developments in Pennsylvania from July 31 – August 4. (Some of the language used below is taken directly from state documents.)

FY 2023-2024 Budget Update

Governor Shapiro signed House Bill 611 – the FY 2023-2024 General Appropriations Act – into law yesterday shortly after it was formally signed in the Senate and sent to his desk. The enactment of House Bill 611 will enable funding to be disbursed to, among other entities, county governments and school districts. The Governor and the General Assembly still need to finalize enabling legislation (i.e., code bills) in order for the budget to be fully enacted. Read more in this press release issued by the Governor’s office.

General Assembly

The Center for Rural Pennsylvania held a public hearing on rural hospital and healthcare sustainability to explore difficulties facing rural hospitals and health systems. Details from the hearing, including the agenda and testimony, may be viewed here.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin updating guidelines for the delivery of physical health services via telehealth. The bulletin applies to all providers enrolled in the Medical Assistance (MA) Fee-for-Service program.

DHS has issued Provider Quick Tip # 85 with information about the department’s Breast & Cervical Cancer Prevention & Treatment Program.

DHS has shared the following information from the Managed Long-Term Services and Supports (MLTSS) Subcommittee meeting on August 2.

Centers for Medicare and Medicaid Services

CMS has issued new guidance to state Medicaid programs as they work to return to normal operations after the end of COVID-19 flexibilities. Specifically, this guidance announces an update of CMS’s policy regarding the end date for flexibilities approved in states’ section 1915(c) Home and Community-Based Services waiver Appendix K amendments. Under CMS’s prior policy, these flexibilities were set to expire six months after the expiration of the COVID-19 public health emergency, but in this letter CMS explains that these flexibilities may remain in effect for a longer period of time.

Department of Health

The Department of Health (DOH) has recently issued two Health Advisories (PAHAN – 713 & PAHAN –711) alerting providers of possible measles exposure in Blair, Clearfield, and Montgomery Counties.

DOH has issued a Health Advisory (PAHAN – 712) notifying providers of a nationwide shortage of Penicillin G benzathine (Bicillin L-A®).

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Counsel (PHC4) has announced it launched a new website. The new website, which is aimed at increasing consumer engagement, may be found here.

Revenue Collection Update

The Department of Revenue announced Pennsylvania collected $2.9 billion in General Fund revenue in July, the first month of the 2023-2024 fiscal year. Note, the July collection data does not include a comparison against anticipated amounts because the official estimate for the 2023-2024 fiscal year has not been certified.

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

PA Safety Net Admin2023-08-04T18:51:26+00:00August 4th, 2023|Medicaid Eligibility Redetermination , Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2024 budget|Comments Off

PA Health Policy Update for July 21

The following is an update of selected state health policy developments in Pennsylvania from July 17 – 21. (Some of the language used below is taken directly from state documents.)

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

DHS has published the following resources to help providers educate patients about Medicaid renewals and what to do if they are no longer eligible for Medicaid.

Governor Shapiro

The Governor’s Budget Office has issued a Budget Impasse FAQ that contains information relevant to commonwealth vendors, grantees, and other stakeholders.

Pennsylvania Executive Order 1996-1 requires all agencies under the jurisdiction of the governor to submit for semi-annual publication an agenda of regulations under development or consideration. These agendas are compiled to give the regulated community advance notice of regulatory activity. Learn more about what the agencies are contemplating and find contact information for seeking additional information from this Pennsylvania Bulletin notice.

General Assembly

The Center for Rural Pennsylvania will hold a public hearing Thursday, August 3 at 9:00am on rural hospital and healthcare sustainability to explore difficulties facing rural hospitals and health systems. The hearing will be held at the University of Pittsburgh at Bradford and will be livestreamed here. More information on the hearing and a tentative agenda can be found here.

Department of Human Services

The Department of Human Services (DHS) has announced Pennsylvania will receive an estimated $42 million in federal funding from CMS through the Money Follows the Person (MFP) program to continue existing activities and support new initiatives focused on serving individuals in the community. Find additional information in this press release.

DHS has issued Provider Quip Tip #263 notifying providers that an electronic submission process is available in the Promise Portal for Office of Medical Assistance fee-for-service (FFS) and Office of Long-Term Living (OLTL) 180-day exception requests and other claims requiring documentation.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through August. Find the updated calendar here.

The Executive Board approved a reorganization of DHS. Additional information and a revised organizational chart is available in this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has issued a Health Advisory (2023 – PAHAN – 708) alerting health care providers to have heightened clinical suspicion of Jamestown Canyon virus (JCV) infection in persons with clinically compatible symptoms (similar to West Nile and Powassan virus).

Department of Aging

The Department of Aging held its third regional town hall to seek input on Pennsylvania’s Master Plan for Older Adults, which will be a 10-year, state-led strategic plan designed to transform the infrastructure and coordination of services for older Pennsylvanians. Governor Shapiro’s executive order directing the department to develop the plan is available here.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has released a new Cardiac Procedures Report. The report focuses on the performance of acute care hospitals for five types of cardiac procedures. Find the report and a press release issued by PHC4 here.

Stakeholder Events

DHS – Medical Assistance Consumer Subcommittee – July 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will meet on Wednesday, July 26 at 1:00 p.m. Click here to register to participate.

DOH – HIV Community Prevention Planning Committee – July 26

The Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will meet on Wednesday, July 26 and Thursday, July 27 from 9:00 a.m. to 4:30 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – July 27

The MAAC will meet on Thursday, July 27 from 10:00 a.m. to 12:00 p.m. Click here to register to participate.

DOH – Newborn Screening and Follow-Up Technical Advisory Board – July 27

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 27 from 10:00 a.m. until 1:00 p.m. The meeting will be conducted in person. The agenda will include discussions about Board member terms; updates from the Bureau of Family Health; and updates from the Lysosomal Storage Disorders/X-ALD, Cystic Fibrosis, Hemoglobinopathy and Critical Congenital Heart Defects subcommittees. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-07-21T20:21:56+00:00July 21st, 2023|Medicaid Eligibility Redetermination , Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for June 30

The following is an update of selected state health policy developments in Pennsylvania from June 26 – 30. (Some of the language used below is taken directly from state documents.)

FY 2023-2024 Budget Update

As of 4:00 p.m. Friday, June 30 Governor Shapiro and the General Assembly have not enacted a final Fiscal Year (FY) 2023-2024 spending plan despite being hours away from the state’s constitutionally mandated deadline. The Senate is preparing to vote on a $45.5 billion spending plan, but the Democratic leaders of the House haven’t signaled support for the measure. Negotiations are ongoing.

Shapiro Administration

Dr. Val Arkoosh officially became Secretary of the Department of Human Services (DHS) in accordance with the Pennsylvania Constitution this week. Find additional information in this press release issued by the DHS.

Governor Shapiro officially recalled the nomination of Dr. Debra Bogen to serve as Secretary of Health. The recall followed a confirmation hearing held by the Senate Health & Human Services Committee. A recording of the confirmation hearing for Dr. Bogen, as well as Dr. Arkoosh, can be viewed here.

General Assembly

The House and Senate returned to Harrisburg this week for voting session. The following are selected health-related proceedings. Please note the House and Senate remain in session as of 4:00 p.m. Friday, June 30. As a result, this is not an exhaustive list of legislative proceedings.

The House passed HB 106, “The Patient Safety Act,” on third and final consideration Wednesday, June 28 by a vote of 119 – 84. The bill, which would implement specific nurse-to-patient ratios, was amended on second consideration to decrease the penalties for violations and create a grant program – funded by the penalties paid by hospitals – for nursing recruitment and retention for rural and high Medical Assistance hospitals. The amendment also delays the ability of the Department of Health to impose penalties on rural and high Medical Assistance hospitals for two years and extended the effective date for the remainder of hospitals to one year, instead of six months. The bill now goes to the Senate for consideration.

The Senate Health and Human Services Committee held a voting meeting Tuesday, June 27 to consider HB 479, which requires both the Medical Assistance Capitation and Fee-for-Service programs to pay for all loaded ambulance miles at $4 per loaded mile beginning on January 1, 2025. A recording of the meeting can be viewed here.

The Senate Banking and Insurance Committee held a voting meeting Tuesday, June 27 to consider SB 739, which defines telemedicine, offers guidelines outlining who can provide telemedicine services, and addresses insurance company reimbursement for these services. The bill was reported as amended. A recording of the meeting can be viewed here.

The House Human Services Committee met this week to consider the following bills:
- HB 1515, to extend the current nonnarcotic medication assisted treatment program in the county correctional system to all mediation assisted treatments. The bill was reported as committed.
- HB 1218, which requires the Department of Human Services to submit a waiver to the Centers for Medicare and Medicaid to establish a program allowing spouse caregivers to receive payment for the services they provide. The bill was reported as amended.

A recording of the meeting can be found here.

The House Human Services Committee is expected to reconvene for a voting meeting Friday, June 30 at the call of the chair to consider HB 876, which requires any entity providing goods or services reimbursable under the medical assistance program to have either a National Provider Identification (NPI) or receive a State Provider Identification number (SPI). The meeting will be held in Room 60 East Wing and livestreamed here.

The House Aging and Older Adult Services Committee is expected to hold a voting meeting at the call of the chair Friday, June 30 to consider HB 1527 to increase the personal needs allowance deduction for residents of nursing facilities to $60 per month and HR 165 to direct the Legislative Budget and Finance Committee to study the effect of the workforce shortage on State supported Medicaid home and community based waiver programs and the Pennsylvania Lottery funded OPTIONS programs. The voting meeting will be held in Room G-50 of the Irvis Office Building and will be livestreamed here.

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

Department of Human Services

The Department of Human Services (DHS) has published its annual list of exceptional Durable Medical Equipment (DME) in this Pennsylvania Bulletin notice.

DHS has issued several Medical Assistance Bulletins related to prior authorization guideline changes. Following are the various bulletins.

DHS has issued a Medical Assistance Bulletin with Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program periodicity schedule and coding matrix.

DHS has issued a Remittance Advice Alert to regarding the department’s delay in implementing Version 38.0 and 39.0 of the APR DRG classification system for Medical Assistance (MA) program enrolled general acute-care hospitals.

DHS has published revisions to the Participating Drug Company List for the Federal Medicaid Drug Rebate program.

Department of Health

The Department of Health (DOH) has published answers to frequently asked questions about new long-term care facility regulations that come into effect on July 1, 2023.

DOH has provided a staffing ratio calculation tool to assist long-term care facilities planning for compliance with new regulatory requirements as of July 1. Use of the tool is not required but may be useful when calculating the required number of nursing hours as well as the staff ratios. Click here for instructions, which opens in a Word document, and here for the tool, which opens as an Excel spreadsheet.

DOH has issued a Health Advisory (2023 – PAHAN – 707) to share information and notify clinicians, public health authorities, and the public about locally acquired malaria cases and concern for a potential rise in imported malaria cases associated with increased international travel during the summer.

DOH has issued a Health Advisory (2023 – PAHAN – 706) to request that clinicians continue to test for influenza in patients with respiratory illness throughout the summer due to the severity of recent human infections with avian influenza A(H5N1).

Stakeholder Events

PHC4 – Council Meeting – July 6

The Pennsylvania Health Care Cost Containment Council (PHC4) will meet on Thursday, July 6 at 10:00 a.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Specialty Pharmaceutical Benefits Program – July 20

The next Specialty Pharmaceutical Benefits Program Advisory Council meeting will be held virtually on Thursday, July 20 from 10:00 a.m. to 12:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DHS – Medical Assistance Consumer Subcommittee – July 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will meet on Wednesday, July 26 at 1:00 p.m. Click here to register to participate.

DHS – Medical Assistance Advisory Committee – July 27

The MAAC will meet on Thursday, July 27 from 10:00 a.m. to 12:00 p.m. Click here to register to participate.

DOH – Newborn Screening and Follow-Up Technical Advisory Board – July 27

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 27 from 10:00 a.m. until 1:00 p.m. The meeting will be conducted in person. The agenda will include discussions about Board member terms; updates from the Bureau of Family Health; and updates from the Lysosomal Storage Disorders/X-ALD, Cystic Fibrosis, Hemoglobinopathy and Critical Congenital Heart Defects subcommittees. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-06-30T20:28:31+00:00June 30th, 2023|Medicaid Eligibility Redetermination , Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania proposed FY 2024 budget|Comments Off

PA Health Policy Update for June 23

The following is an update of selected state health policy developments in Pennsylvania from June 20 – 23. (Some of the language used below is taken directly from state documents.)

Medicaid Continuous Coverage Unwinding

The Department of Human Services (DHS) is maintaining an online dashboard with Medicaid continuous coverage unwinding data. The data on this dashboard tracks the renewal process by county and zip code. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

General Assembly

The House and Senate returned to Harrisburg this week for voting session. The following are selected health-related proceedings.

The Senate voted to confirm Governor Josh Shapiro’s nominees for the Department of Drug and Alcohol Programs, Dr. Latika Davis-Jones, and Pennsylvania Insurance Department, Michael Humphreys. A recording of the Senate Health and Human Services Committee confirmation hearing can be viewed here. A recording of the Senate Banking and Insurance Committee confirmation hearing can be viewed here.

The General Assembly passed SB 262, which requires the Maternal Mortality Review Committee to publish severe maternal mortality data. The bill will now be sent to the governor.

The House unanimously passed HB 1209 and HB 1407, which enable Pennsylvania to meet its obligations under the 1998 Master Settlement Agreement (MSA) with tobacco product manufacturers and ensure the state is able to continue receiving funds from the tobacco settlement for health-related programs.

The Senate adopted SR 46 to establish the Task Force on Women Veterans’ Health Care to study the health care and access issues facing women veterans.

The Senate Health & Human Services Committee held a voting meeting on Tuesday, June 20 at 10:30 a.m. to consider the following bills.
- SB 683, which requires an acute-care hospital to include testing for fentanyl if the hospital conducts a urine drug screening to assist in the diagnosis of a patient’s condition. The bill was reported as amended, to include xylazine.
- SB 768, which makes changes to the Pennsylvania Rural Health Redesign Center Authority (RHRCA) Act, including financing of the authority and board membership. The bill was reported as committed.
- SB 817, which creates a primary care workforce initiative for Federally Qualified Health Centers (FQHCs). The bill was reported as committed.

A recording of the meetings can be viewed here.

The House Human Services Committee held a voting meeting Wednesday, June 22 at 11:30am to consider HB 850, which requires the Departments of Health and Human Services to apply for a waiver if the U.S. Department of Agriculture’s Food and Nutrition Service creates and makes a waiver available to the states that would allow those receiving SNAP and WIC to use those programs for menstrual hygiene products. The bill was reported as amended. A recording of the meeting can be viewed here.

The House and Senate will return to Harrisburg for voting session Monday, June 26.

Department of Human Services

The Department of Human Services (DHS) issued a Medical Assistance Bulletin to inform Medical Assistance (MA) providers that DHS has added CPT code 0174A to the MA Program Fee Schedule for the administration of an additional bivalent dose of the COVID-19 vaccine manufactured by Pfizer, Inc.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through July. Find the updated calendar here.

DHS has announced the proposed Nursing Facility Assessment Program details for FY 2023-24, including the proposed assessment amount, the proposed assessment methodology, and the estimated aggregate impact on nursing facilities that will be subject to the assessment under the Nursing Facility Assessment Program. Find additional information in this Pennsylvania Bulletin notice.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has published volume one of its annual analysis of the financial performance of Pennsylvania’s acute-care hospitals. The analysis found that hospital total margins across the state decreased 7.59 percentage points in FY 22. Go here to find a PHC4 news release describing the agency’s report, the report itself, and a link to downloadable data from the report.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) submitted comments to the Department of Human Services on their regulation #14-543: Protective Services for Adults.

Stakeholder Events

DOH – Medical Marijuana Advisory Board – June 28

The Medical Marijuana Advisory Board will meet on June 28 from 10:30 a.m. to 12:30 p.m. to discuss Medical Marijuana Program updates. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PID – 1332 Waiver Reinsurance Program Public Forum – June 28

The Pennsylvania Insurance Department (PID) has announced it is accepting public comment on its 1332 State Innovation Waiver Reinsurance Program beginning June 1 and ending June 30. PID will also hold an in-person forum for public comment on Thursday, June 28 from 1:00 p.m. to 2:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Specialty Pharmaceutical Benefits Program – July 20

The next Specialty Pharmaceutical Benefits Program Advisory Council meeting will be held virtually on Thursday, July 20 from 10:00 a.m. to 12:00 p.m. Go here for details on how to participate.

DOH – Newborn Screening and Follow-Up Technical Advisory Board – July 27

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 27 from 10:00 a.m. until 1:00 p.m. The meeting will be conducted in person. The agenda will include discussions about Board member terms; updates from the Bureau of Family Health; and updates from the Lysosomal Storage Disorders/X-ALD, Cystic Fibrosis, Hemoglobinopathy and Critical Congenital Heart Defects subcommittees. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2023-06-23T21:27:26+00:00June 23rd, 2023|Medicaid Eligibility Redetermination , Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for April 28

The following is an update of selected state health policy developments in Pennsylvania from April 24 -28. (Some of the language used below is taken directly from state documents.)

Medicaid Eligibility Redetermination

Medicaid unwinding has officially begun, and recipients will begin to receive their renewal packets and additional communications from the Department of Human Services 90 days prior to their individual renewal date. Individuals can view their renewal dates in COMPASS and can begin the renewal application online up to 60 days early. Additional updates and resources about the Medicaid eligibility renewal process may be found here.

General Assembly

The state House and Senate returned to Harrisburg on April 24 for voting session. Below is coverage of selected health-related committee proceedings.

- The Senate Consumer Protection and Professional Licensure Committee held a public hearing Monday, April 24 at 10:00am on professional licensing delays in health care. A recording of the hearing can be viewed here.

- The House Insurance Committee held a voting meeting on Monday, April 24 to consider, among other bills, SB 8 which requires insurers to cover all costs associated with genetic counseling and genetic testing for the BRCA1 and BRCA2 gene mutation if a person is diagnosed with breast or ovarian cancer or has a family history of breast or ovarian cancer, and also requires insurers to cover all costs associated with a supplemental breast screening by MRI or Ultrasound for women at increased risk of breast cancer. The bill advanced from committee and received a unanimous vote on final passage in the House. SB 8 will move to the Governor’s desk for his consideration upon signature in the Senate.

- The Senate Veteran Affairs and Emergency Preparedness Committee held a voting meeting to consider SB 81, which codifies the ability for EMS providers to leave a dose of Naloxone with an on-scene caregiver. The bill now moves to the full Senate for consideration. A recording of the meeting can be viewed here.

- The House Health Committee held an informational meeting Wednesday, April 26 on unregulated intoxicants and psychoactive substances. A recording of the hearing can be viewed here.

- The House Human Services Committee held a voting meeting Wednesday, April 26 to consider the following bills.
  - HB 409, which would establish a mental health care services clearinghouse. The bill was reported without amendment.
  - HB 754, which would provide a standard notice to each nursing home resident and their designated representatives at the time of their admission that they have the option of having legal representation to assist with the application for Medicaid benefits. The bill was re-referred to the House Health Committee.

A recording of the meeting can be viewed here.

- The House Professional Licensure Committee held an informational meeting on the Bureau of Professional and Occupational Affairs. A recording of the meeting can be viewed here.

The state House and Senate will return to Harrisburg for voting session Monday, May 1. Following are selected health-related proceedings.

- The House Health Committee will hold a public hearing Tuesday, May 2 at 9:30am on HB 106, the Patient Safety Act, which sets nursing ratios. The hearing will be held in Room 523 of the Irvis Office Building and can be live streamed here.

- The Senate Health and Human Services Committee is holding a voting meeting on Tuesday, May 2 at 11:00 to consider among other bills:
  - SB 100, Establishing the Lyme Disease and Related Tick-Borne Illness Diagnosis and Treatment Act.
  - SB 262, Amends the Maternal Mortality Review Committee Act regarding reportable events.
  - SB 414, Expanding access to Sexual Assault Nurse Examiners (SANE).
  - SB 500, Provides for Medicaid Coverage for Pasteurized Donor Human Milk.
  - SB 549, Requires consent for pelvic, rectal, and prostate exams.
  - SB 555, Reducing the loaded mileage requirements for EMS Medicaid reimbursement.

The meeting will be held in Room 8E of the East Wing and will be livestreamed here.

Department of Health

The Department of Health issued a Health Alert (PAHAN – 693-04-28) with updated recommendations regarding the Monovalent and Bivalent mRNA COVID-19 vaccines.

Department of Human Services

The Department of Human Services (DHS) issued a press release highlighting how the Shapiro administration has reduced the backlog for Medicaid provider enrollment from 34,682 applicants waiting more than 30 days to less than 8,500. The press release notes the backlog has been reduced by 75 percent in the administration’s first 100 days.

DHS has shared the following presentations used at the Medical Assistance Consumer Subcommittee meeting on April 26

DHS has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of April.

DHS has issued Provider Quick Tip (#263) with an update notifying providers that the electronic submission process for Office of Medical Assistance Fee-for-Service (FFS) and the Office of Long Term Living’s 180-day exception requests and other claims requiring documentation is available in the PROMISe Portal.

DHS has shared the following presentations used at the Medical Assistance Advisory Committee (MAAC) meeting on April 27

Stakeholder Events

PHC4 –Executive Committee & Council Meeting – May 4

The Pennsylvania Health Care Cost Containment Council (PHC4) has scheduled an executive committee meeting at 9:30 a.m. and a council meeting at 10:00 a.m. on May 4, 2023. Go here for additional information and details on how to register 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 Admin2023-04-28T20:48:32+00:00April 28th, 2023|long-term care, Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Uncategorized|Comments Off

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 48^th 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.

jsteinbock2023-01-20T21:47:06+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

PA Health Policy Update for Friday, December 16

The following is an update of selected state health policy developments in Pennsylvania for the week of December 12-16, 2022. (Some of the language used below is taken directly from state documents.)

Department of Human Services

The Department of Human Services has issued Medical Assistance Bulletins addressing requirements for prior authorization and the type of information that will be needed, as of January 9, to evaluate the medical necessity of prescriptions for:

Department of Health

The Department of Health (DOH) is working to implement Act 128 of 2022, which requires temporary health care services agencies to register with DOH. Under the act, temporary health care services agencies are agencies that provide temporary health care personnel (RNs, LPNs, nurse aides, or direct care staff) to long-term-care nursing facilities, personal care homes, or assisted living residences. DOH has developed a survey for long-term-care facility administrators so it can compile information about temporary health care services agencies operating in Pennsylvania. Long-term-care facility officials can go here to complete the brief survey.
DOH has issued an alert advising providers of an outbreak of measles in neighboring Ohio, informing providers about the symptoms they should look for among possible measles patients and how to prevent, test for, and treat measles. The alert also reminds providers that they are required to report measles cases to the state. Learn more from this health alert.
DOH has issued an alert updating providers on its latest guidance for treating COVID-19. The alert notes that the most common strains of the virus cannot be treated by the monoclonal antibodies that were effective against earlier strains and that the federal government currently authorizes no such products for use in treating COVID-19 patients. Despite this, selected anti-viral therapeutics are still available to treat such patients. Learn more from this health alert.

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, on ventilators because of the virus, and in hospital ICUs rose, but just slightly, over the past week.
The CDC reports a modest increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 14, 52 Pennsylvania counties were experiencing high rates of community transmission of COVID-19; 14 were experiencing substantial rates of community transmission; and one county was experiencing a moderate rate of community transmission. This represents deterioration from the previous week, when 39 Pennsylvania counties experienced high rates of community transmission of COVID-19, 25 experienced substantial rates of community transmission, and three experienced moderate rates of community transmission.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs recommends that businesses that provide addiction treatment and supports consider training employees and volunteers regularly on preparing for and responding to an active shooter incident. Learn more from this message from the department to stakeholders.

Pennsylvania Health Care Cost Containment Council

PHC4 has released “Hospital Performance Report – October 2020 through September 2021 Data,” which presents information about the performance of Pennsylvania acute-care hospitals for 13 common medical conditions. Among the factors reported are hospital-specific mortality, 30-day readmission ratings, case volume, and hospital charges for patients between October 1, 2020 and September 30, 2021. The report also looks at changes in statewide rates over time. For additional information see PHC4’s news release; a report summary; an introduction to the report; a summary of key findings; downloadable data sets; technical notes; and data about Medicare payments.

jsteinbock2022-12-16T21:54:49+00:00December 16th, 2022|COVID-19, Medical Assistance Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

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.

jsteinbock2022-12-05T13:53:45+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

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.