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PA Health Policy Update for June 20

The following is an update of selected state health policy developments in Pennsylvania from June 16 – 20.  (Some of the language used below is taken directly from state documents). 

Governor Shapiro 

The Shapiro administration has shared a document with stakeholders outlining the potential impact of H.R. 1, the reconciliation package currently being considered by the U.S. Congress. The assessment primarily addresses the impact on Medicaid coverage. It does not include a detailed overview of the provisions in the reconciliation package related to provider taxes or state directed payments, from which Pennsylvania receives significant funding. 

General Assembly

The state House of Representatives convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity that occurred.

  • The House Health Committee met on Monday, June 16 and favorably reported, among other bills, House Bill 1234, which expands the Medical Assistance program to cover blood pressure monitors for home use as a pregnancy-related service on a per pregnancy basis. 
  • The House Professional Licensure Committee met on Tuesday, June 17 and favorably reported House Bills 80 and 482, which enable Pennsylvania to join the Audiology and Speech-Language Pathology Interstate Compact and the National Occupational Therapy Licensure Compact respectively, and Senate Bill 115, which requires the Department of Human Services to offer a skills competency exam in lieu of  high school diploma or GED requirements for individuals seeking employment as direct care staff in personal care homes or assisted living residences. 
  • The House Insurance Committee met on Tuesday, June 17 and favorably reported House Bill 1445, which prohibits an insurer from denying what would otherwise be a service covered by the policy simply because the health care service was received in a school setting. 

The state House of Representatives and Senate will reconvene in Harrisburg for voting on Monday, June 23.

Department of Human Services 

The Department of Human Services (DHS) has announced the proposed annual case-mix per diem payment rates for state Fiscal Year (FY) 2025-26 for non-public and county nursing facilities that participate in the Medical Assistance (MA) program. Find additional information in this Pennsylvania Bulletin notice. 

DHS has issued Provider Quick Tip #263 regarding the electronic submission process for Office of Medical Assistance Programs’ (OMAP) fee-for-service (FFS) and the Office of Long-Term Living’s (OLTL) and LTC 180-day exception requests and other claims requiring documentation in the Promise Portal. 

Department of Health

The Department of Health (DOH) has announced the Newborn Screening and Follow-up Technical Advisory Board is adding Metachromatic Leukodystrophy (MLD) screening, effective January 1, 2026, to the supplemental conditions mandated for screening and follow-up by commonwealth submitters and follow-up by the commonwealth newborn screening program. Find additional information in this Pennsylvania Bulletin notice.

DOH has published notice of the clinical laboratories approved for the following services.

Independent Fiscal Office 

The Independent Fiscal Office (IFO) has published a document outlining the impact of the Medicaid provisions included in the federal reconciliation bill passed by the U.S. House of Representatives. The document also includes a budget brief highlighting Pennsylvania Medicaid enrollment and funding trends from FY 2018-19 through the Shapiro administration’s proposal for FY 2025-26. 

Insurance Department 

The Pennsylvania Insurance Department (PID) has announced that most health insurers are requesting significant premiums increases for plan year 2026. On average, insurers are asking for a 19 percent increase to premiums in the individual market, and a 13 percent increase to premiums in the small group market. 

Around the State  

  • State Senate Majority Leader Joe Pittman (R-Indiana) has stated he, “sees no practical way that a budget will be completed on June 30.” His comments and the significant increase in funding for the Medicaid program were the subject of an article by the Pennsylvania Capital-Star. 
  • The Pew Charitable Trusts has published an article about the share of state budgets spent on Medicaid and which states have increased their own resources on Medicaid.
  • A CBS3 report has highlighted insurance denials and called attention to the Pennsylvania Insurance Department’s external review process for claim denials.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – June 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 25 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – June 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 26 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

PHC4 – Council Meeting – July 3

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced it will hold a council meet on July 3 at 10:00 a.m. PHC4 will also hold an Education Committee meeting on June 25. Find additional information in this Pennsylvania Bulletin notice. 

DOH – Newborn Screening Advisory Board – July 24

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 24 from 10:00 a.m. until 12:00 p.m. The meeting will be conducted in person only. Find additional details and information on how to participate in this Pennsylvania Bulletin notice. 

DOH – Health Research Advisory Committee – July 30

The Health Research Advisory Committee will hold a public meeting on Wednesday, July 30 from 10:00 a.m. to 11:00 a.m. The meeting will be held at the Nesquehoning Recreational Center. Find additional details on how to participate in this Pennsylvania Bulletin notice. 

DOH – Brain Injury Advisory Board – August 1

The Brain Injury Advisory Board will hold a public meeting on Friday, August 1 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person at the Pennsylvania Training and Technical Assistance Network. Find additional details on how to participate in this Pennsylvania Bulletin notice.

2025-06-23T19:51:18+00:00June 20th, 2025|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for June 20
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PA Health Policy Update for June 13

The following is an update of selected state health policy developments in Pennsylvania from June 9 – 13.  (Some of the language used below is taken directly from state documents). 

General Assembly

The state House of Representatives and Senate convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity that occurred this week.

  • The Senate unanimously passed Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed. The bill also places certain disclosure requirements on pharmacies related to the retail and generic versions of prescribed medications. The bill was subsequently received in the House and referred to the Veterans Affairs and Emergency Preparedness Committee.
  • The House of Representatives passed House Bill 1549, which increases the state’s minimum wages, by a party-line vote. The bill will now be sent to the Senate for consideration.
  • The House of Representatives passed House Bill 1460, which provides for more oversight of health care entity merger and acquisition activities. The bill will now be sent to the Senate for consideration.
  • The House of Representatives passed House Bill 1088, which expands maternal blood pressure monitoring coverage. The bill will now be sent to the Senate for consideration.
  • The Senate Consumer Protection & Professional Licensure Committee met on Wednesday, June 11 and favorably reported, among other bills, Senate Bills 535 & 536, which amend the Osteopathic and Medical Practice Acts to enable genetic counselors to order genetic tests as appropriate.
  • The Senate Health & Human Services Committee met on Wednesday, June 11 and favorably reported, among other bills, the following.
    • Senate Bill 461, which seeks to improve testing and insurance coverage for Lyme disease testing.
    • Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028.
    • House Bill 27, which requires operating rooms to utilize surgical smoke evacuation systems.
    • House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP).

A recording of the meeting is viewable here.

  • The House Human Services Committee met on Tuesday, June 10 and favorably reported House Bill 1100, which creates a grant program to provide eligible public-school entities with funding to acquire and distribute menstrual hygiene products, and House Bill 1590, which supports Pennsylvania’s implementation of a new federal Medicaid flexibility that waives the longstanding “four walls” requirement for outpatient behavioral health clinics. A recording of the hearing is viewable here.
  • The House Health Committee met on Tuesday, June 10 and favorably reported House Bill 1442, which places requirements on coroners to report Sudden Unexpected Death in Epilepsy (SUDEP), and House Bill 1527, which extends the Rate Disease Advisory Council’s sunset date to 2028. A recording of the meeting is viewable here.
  • The House Aging & Older Adult Services Committee met on Tuesday, June 10 for an informational hearing on the Older Adult Protective Services Act (OAPSA) and financial exploitation of older adults. A recording of the hearing is viewable here.
  • The Legislative Budget & Finance Committee (LBFC) met on Wednesday, June 11 and released its report on the effect of home and community-based workforce shortages on commonwealth-supported Medicaid waiver programs. The full report is viewable here and highlights from the report are viewable here. 

The state House of Representatives will reconvene in Harrisburg for voting on Monday, June 16. The Senate is recessed until Monday, June 23.

Department of Human Services

  • The Department of Human Services (DHS) has announced it will hold another listening session in its “Food is Medicine Stakeholder Engagement Series,” which is part of the Bridges to Success: Keystones of Health demonstration waiver. The next session, which will focus on medically tailored meals, will take place on June 16 at 1:00 p.m. Find additional information and registration details here.
  • DHS has issued a Medical Assistance Bulletin to inform providers about updates to the Statewide Preferred Drug List (PDL) related to glucose sticks made at the April 23 Pharmacy & Therapeutics (P&T) Committee meeting. The PDL changes are effective July 7, 2025.
  • DHS has announced changes to the Medical Assistance (MA) program fee schedule. The department is adding and end-dating codes as a result of the 2025 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The changes are effective for dates of service on and after June 16, 2025. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has released a document with revisions to the participating drug companies list for the Medicaid Drug Rebate Program.
  • DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of July. Find the updated calendar here.
  • DHS has issued a Remittance Advice Alert regarding action needed to continue submitting claims and eligibility requests electronically with PROMISe™. 

Department of Health

The Department of Health (DOH) has published notice of intent to issue a final notice to temporarily schedule any material, compound, mixture, or preparation which contains any quantity of the several Nitazene substances. This final notice to temporarily schedule will place this group of substances in Schedule I under The Controlled Substance, Drug, Device and Cosmetic Act. 

Independent Fiscal Office

The Independent Fiscal Office (IFO) has published a budget brief highlighting Pennsylvania Medicaid enrollment and funding trends from FY 2018-19 through the administration’s proposal for FY 2025-26. It also provides projections of the impact for certain Medicaid provisions included in the federal reconciliation bill passed by the U.S. House of Representatives. 

Insurance Department 

The Pennsylvania Insurance Department (PID) has announced that the largest health insurers operating in the commonwealth are taking steps to expand coverage for medications used to treat postpartum depression and related maternal mental health conditions. Find additional information in this press release. 

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has shared an opportunity from the Health Resources and Services Administration (HRSA),  the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program. The program offers up to $250,000 in student loan repayment for eligible professionals who commit to six years of full-time work providing direct SUD treatment or recovery support at an approved facility. The program is open to a range of providers, including medical, behavioral health, and peer support professionals. Applications are due July 10, 2025. 

Around the State  

  • Spotlight PA has published an article on the potential impact of the budget reconciliation bill being considered by the U.S. Congress on the state’s Medicaid program. 
  • The Wall Street Journal has written an article about the Pennsylvania General Assembly’s efforts to enact legislation creating more scrutiny over health care entity transactions involving private equity. 
  • LancasterOnline covered Senate Appropriations Committee Chairman Scott Martin’s comments about the state budget unpredictability created federal budget discussions. 

Stakeholder Meetings

Pharmaceutical Assistance Advisory Board – June 16

The Department of Aging has announced the Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, June 16 from 1:00 p.m. to 2:30 p.m. Find information on how to participate in this Pennsylvania Bulletin notice. 

Patient Safety Authority – June 17

The Patient Safety Authority has announced it will hold a meeting of the Authority’s board on Tuesday, June 17 at 1:00 p.m. The meeting will be held virtually and is open to the public. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Preventative Health Services Block Grant Advisory Committee – June 17

The Preventative Health and Health Services Block Grant Advisory Committee will hold a public meeting on Tuesday, June 17 from 9:30 a.m. to 10:30 a.m. The purpose of the meeting is to present the Federal Fiscal Year 2025 Workplan and budget information. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

2025-06-13T19:46:49+00:00June 13th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off on PA Health Policy Update for June 13
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PA Health Policy Update for May 23

The following is an update of selected state health policy developments in Pennsylvania from May 19 – 13.  (Some of the language used below is taken directly from state documents). 

Primary Election Update 

Voters went to the polls on Tuesday, May 20 for Pennsylvania’s 2025 Primary Election. On the ballot there were judicial candidates seeking to fill vacancies on the Commonwealth and Superior Courts, along with municipal races. Find the Department of State’s unofficial election results here.  

General Assembly

The state House of Representatives and Senate were recessed this week. Both chambers are scheduled to return to Harrisburg on Monday, June 2. 

Department of Human Services 

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin with Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix. This bulletin applies to all providers enrolled in the Medical Assistance program who provide EPSDT screens for Medical Assistance (MA) beneficiaries. 

Board of Nursing 

The State Board of Nursing has announced that it has adopted temporary regulations, which can be found here, necessary to implement the Nurse Licensure Compact. The temporary regulations are effective upon their publication in the Pennsylvania Bulletin. Additional information about the Nurse Licensure Compact is available on the Department of State’s website here. 

Insurance Department 

The Pennsylvania Insurance Department (PID), along with the Department of Health, the Department of Human Services, and the Department of Drug and Alcohol Programs (DDAP), has announced the  launch of a women’s health survey to identify challenges and questions women have about their health insurance benefits, and to remind women about preventive health services that are available to them at no cost through their insurance. 

Independent Fiscal Office 

The Independent Fiscal Office (IFO) has released its initial revenue estimate for FY 2025-26. The IFO has estimated Pennsylvania’s General Fund revenues will total $47 billion in FY 2025-26. The IFO has also revised the current fiscal year’s deficit to $3.6 billion, an increase of $280 million. Find the full report here and the IFO’s presentation here. 

Around the State 

  • The Tribune-Review has published an article about the potential spike in the number of Pennsylvanians without health insurance that will occur if the reconciliation bill passed by the U.S. House this week moves forward. 
  • Spotlight PA has continued to report about state legislative efforts to implement additional oversight of health care facility mergers and acquisitions. 
  • The mayoral elections that featured prominently in Tuesday’s Primary Election were the focus of an article by City & State Pennsylvania. 
  • Spotlight PA has published an article about the Commonwealth and Superior Court candidates advancing to November’s General Election. 

Stakeholder Meetings

DHS – Long-Term Services & Supports Subcommittee – June 4

The Long-Term Services and Supports (LTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold its next public meeting on June 4 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

2025-05-23T20:21:35+00:00May 23rd, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for May 23
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PA Health Policy Update for the Week of February 14-18

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

General Assembly

House Chamber of the State HouseThe state House Appropriations Committee began its FY 2023 budget hearings this week.  The Senate Appropriations Committee will begin hearings next week.  Hearings will conclude on March 17.  A complete schedule of the hearings can be found here.  The following is a selection of health-related budget hearings.

  • Department of Health/Department of Drug and Alcohol Programs (House Appropriations Committee) – Thursday, March 3 at 10:00 a.m.
  • Department of Human Services (Senate Appropriations Committee) – Tuesday, March 8 at 10:00 a.m.
  • Department of Health (Senate Appropriations Committee) – Wednesday, March 9 at 10:00 a.m.
  • Department of Human Services (House Appropriations Committee) – Wednesday, March 9 at 10:00 a.m.
  • Department of Drug and Alcohol Programs (Senate Appropriations Committee) – Wednesday, March 16 at 2:30 p.m.

Department of Human Services

Department of Health

  • Two additional state-directed health care strike teams and another long-term care regional support team are providing requested assistance for hospitals and skilled nursing facilities caring for patients with COVID-19.  Clinical staff are supporting staff at Geisinger Wyoming Valley and Lehigh Valley Hospital – Cedar Crest.  These teams are on a two-week deployment and vary in size and scope based on the daily needs of the facilities and include registered nurses and respiratory therapists provided through a staffing firm.  Another team is working with the Pleasant Valley Manor nursing home in Monroe County, providing clinical and non-clinical support staff to allow for more rapid discharge of patients from area hospitals and freeing additional acute-care space to meet COVID-19 demands.  Supplemental staff includes RNs, LPNs, and CNAs; Pennsylvania National Guard is providing non-clinical staffing to support the facility’s existing staff and the Pennsylvania Emergency Management Agency is assisting with coordination.  Learn more from this Department of Health news release.
  • The Department of Health (DOH) has updated its information about state-sponsored COVID-19 testing sites throughout Pennsylvania, including new sites in McKean, Susquehanna, Washington, and York counties.  Go here for information about locations and hours and for a link to a map with other testing sites across the state.
  • DOH has issued an alert providing guidance to long-term-care facilities on response to exposure and outbreaks of COVID-19.  This guidance incorporates recent changes made by the CDC.
  • DOH has issued guidance on core infection prevention and control measures for long-term-care facilities during the COVID-19 pandemic and incorporates recent updates made by the CDC.  This guidance also supplements previous guidance issued by DOH.
  • DOH has reminded long-term-care facilities that they can order the oral antiviral treatments molnupiravir and Paxlovid from the strategic reserve specifically for residents of those facilities and other congregate settings and has updated an FAQ about the program.
  • DOH has published a health alert about a significant increase in the number of cases of syphilis in Pennsylvania in 2021 and offering testing and treatment recommendations for providers.  Find the alert here.

COVID-19:  By the Numbers

  • Daily COVID-19 case counts remain very high but fell significantly again over the past week.  Pennsylvania’s seven-day average yesterday (February 17) was 3159 cases day; a week ago (February 10) its seven-day average was 5163 cases a day.
  • The number of new COVID-19-related deaths also remains high but declined again over the past week.  Pennsylvania’s seven-day average yesterday (February 17) was 83 deaths a day; a week ago (February 10) its seven-day average was 109 deaths a day.
  • The Department of Health reports that the percentage of available adult ICU beds fell from 23.6 percent to 22 percent during the past week and the percentage of available pediatric ICU beds fell from 14 percent 8.5 percent over the same period of time, leaving just 33 unoccupied pediatric ICU beds in the state.
  • The Department of Health also reports that approximately 12.7 percent of all staffed adult ICU beds in the state are occupied by COVID-19 patients this week, down from 17.3 percent last week, and that 26.6 percent of all ventilators in the state are currently in use, down from 27.6 percent last week.
  • All 67 Pennsylvania counties continue to experience a high rate of COVID-19 transmission.
  • The decline in the number of new COVID-19 cases is reflected in a 53 percent decline since February 1 in the number of Pennsylvanians hospitalized with the virus.  The number of people on ventilators also has fallen 49 percent since the first of the month and the number in ICUs has fallen 48 percent over that same period.

Around the State

As the number of COVID-19 cases, hospitalizations, and deaths continues to decline across Pennsylvania, newspapers are reporting on changes in their own coverage areas.  Among them:

Insurance Department

Jessica Altman has resigned as commissioner of the Pennsylvania Insurance Department; her last day on the job will be February 25.  Current department chief of staff Mike Humphreys will serve as acting commissioner.  Learn more from this Wolf administration news release.

Pennsylvania Higher Education Assistance Agency (PHEAA)

PHEAA’s PA Student Loan Relief for Nurses Program makes available to qualified applicants student loan relief of up to $2,500 for each year of work (beginning with 2020) for no more than three years, with a maximum benefit of $7,500.  To learn more about eligibility, benefits, and how to apply, go here.  Applications are due March 1.

Stakeholder Events

Medical Assistance Advisory Committee Consumer Subcommittee – February 23

The Medical Assistance Advisory Committee’s consumer subcommittee will meet virtually on Wednesday, February 23 at 1:00 p.m.  Go here to register to participate.

Medical Assistance Advisory Committee – February 24

The Medical Assistance Advisory Committee will meet virtually on Thursday, February 24 at 10:00 a.m.  Go here to register to participate.  Find the meeting agenda here.

DHS – Managed Long-Term Services and Supports Subcommittee – March 1

The Medical Assistance Advisory Committee’s managed long-term services and support (MLTSS) subcommittee will meet virtually on Tuesday, March 1 at 10:00 a.m.  Go here to register to participate.

2022-02-18T22:01:36+00:00February 18th, 2022|COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania proposed FY 2023 budget|Comments Off on PA Health Policy Update for the Week of February 14-18
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Wolf Administration Weighs Addressing Balance Billing

The Wolf administration is floating a proposal that would end medical balance billing in situations in which out-of-network providers are involved in the delivery of care patients receive from providers they believe to be in their health insurer’s provider network.
Such situations typically arise when patients receive inpatient care at hospitals they know to be within their insurer’s provider network but some of the professionals involved in providing that care are not part of that network.
insurance deptThe results can be large bills for services their insurers do not cover.
The Pennsylvania Insurance Department has published draft legislation to address such balance billing and is seeking public comment on the proposal. See that draft legislation here.

2016-02-18T06:00:29+00:00February 18th, 2016|Uncategorized|Comments Off on Wolf Administration Weighs Addressing Balance Billing
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PA Insurance Commissioner to Hold Hearing on Balance Billing

insurance deptPennsylvania Insurance Commissioner Teresa Miller will hold a public hearing next month to begin exploring the practice of balance billing.
According to a department news release, the hearing will

…be an opportunity to begin exploring options to make sure consumers are informed about their care and do not face these unexpected bills without recourse, as well as to identify some possible consumer-friendly solutions to the issue. Miller believes this hearing will be a substantive first step in tackling the issue of balance billing, and giving consumers more peace of mind and predictability in coverage.

The hearing will be held on October 1 in Harrisburg.
For more information about balance billing and the issues the Insurance Department hopes to begin addressing at this hearing, see this news release.
 

2015-09-14T06:00:37+00:00September 14th, 2015|Uncategorized|Comments Off on PA Insurance Commissioner to Hold Hearing on Balance Billing
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  • P: (717) 234-6970

  • 2020 Safety-Net Association of Pennsylvania

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