Pennsylvania Medicaid Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for December 6

The following is an update of selected state health policy developments in Pennsylvania November 25 – December 6. (Some of the language used below is taken directly from state documents).

Governor Shapiro

The Shapiro administration has held two recent roundtable discussions with maternal health stakeholders to inform the development of the administration’s Maternal Health Strategic Plan, which will address high rates of maternal mortality and ensure pregnant women in Pennsylvania receive necessary prenatal and postpartum care. Find additional information in this press release.

General Assembly

The state House of Representatives and Senate have released their respective 2025 session calendars. Find the House’s calendar here and the Senate’s calendar here.

Department of Human Services

The Department of Human Services (DHS) has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of October.

Department of Health

The Department of Health (DOH) has released a Respiratory Virus Outbreak Toolkit for long-term care facilities, including personal care homes and assisted living residences. The purpose of the toolkit is to provide recommendations for facilities before and during a respiratory virus outbreak.

DOH has published guidelines and fees that a health care provider or facility may charge in response to a request for production of medical charts or records. Find additional information in this Pennsylvania Bulletin notice. This notice updates the prior notice published on December 9, 2023.

Revenue Collection Update

The Department of Revenue has announced Pennsylvania collected $2.9 billion in General Fund revenue in November, which was $87.2 million, or 2.9 percent, less than anticipated. Fiscal year-to-date General Fund collections total $16.4 billion, which is $9.9 million, or 0.1 percent, below estimate.

Around the State

With the conclusion of the 2023-2024 legislative session, City & State Pennsylvania has published an article highlighting the session’s accomplishments, as well as its unfinished business.

NBC’s local affiliate 21 WFMJ has reported on efforts to keep Sharon Regional Medical Center open.

Spotlight PA has published an article about the range of health care workers who provide maternal care in Pennsylvania and their various roles.

Stakeholder Events

Patient Safety Authority – December 12

The Patient Safety Authority Board will meet on Thursday, December 12 at 1:00 p.m. The meeting will be held virtually. Find details on how to participate here and a draft agenda here.

Department of Aging – Pharmaceutical Assistance Board – December 16

The Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, December 16 from 2:00 to 3:30 p.m. For connection information or any questions, please contact Megan McDaniel (memcdaniel@pa.gov).

PA Safety Net Admin2024-12-06T20:21:33+00:00December 6th, 2024|Financial, Meetings and notices, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for October 18

The following is an update of selected state health policy developments in Pennsylvania October 14 – 18. (Some of the language used below is taken directly from state documents).

Governor Shapiro

Governor Shapiro has signed the following bills into law this week.

House Bill 155, now known as Act 96 of 2024, removes the requirement that direct care workers be interviewed in-person for a position.
House Bill 2084, now known as Act 101 of 2024, establishes a license for prescription drug virtual manufacturers.
House Bill 2127, now known as Act 102 of 2024, allows hospitals, birthing centers, physicians, and midwives or nurse-midwives to provide patients with a fact sheet regarding postpartum depression and counseling resources.
Senate Bill 668, now known as Act 109 of 2024, permits certified nurse aides to become certified medication aides in long-term care facilities, assisted living residences, and personal care homes.
Senate Bill 840, now known as Act 111 of 2024, creates an Alzheimer’s Disease and related disorders division within the Department of Aging and establishes an Alzheimer’s, Dementia and Related Disorders Advisory Committee.

General Assembly

The state House of Representatives and Senate are scheduled to return to Harrisburg on Monday, October 21 for session. This is the last scheduled session week prior to the November 5 General Election.

The House Children & Youth Committee will meet on Tuesday, October 22 at 10:00 a.m. in Room 515 of the Irvis Office Building to consider House Bill 1600, which expands oversight of juvenile justice facilities, and House Bill 2461, which establishes an Ebony Alert system.

The House Children & Youth Committee will also meet on Wednesday, October 23 at 10:00 a.m. in Room 515 of the Irvis Office Building for an informational meeting the CCAP Complex Case Task Force report and the DHS Blueprint report.

The Senate Aging & Youth and Banking & Insurance Committees will hold a joint hearing on Wednesday, October 23 at 9:00 a.m. on protecting senior citizens, with a focus on House Bill 2064 and possible revisions to the Older Adult Protective Services Act. The meeting will be held in Hearing Room 1 of the North Office Building.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) that DHS will continue the alternative payment methodology and pay the Medical Assistance (MA) program fee schedule rate for the administration of the novel coronavirus (SARS-CoV-2) vaccine during a SARS-CoV-2 vaccine-only visit.

DHS has shared the agenda for the next Medical Assistance Advisory Committee (MAAC) meeting on Thursday, October 24. Find additional details on how to participate in Stakeholder Events below.

DHS has changed the provider application URL domain name. The new URL is: https://promise.dhs.pa.gov/portal/provider/Home/tabid/135/Default.aspx.

Department of Health

The Department of Health (DOH) has reminded long-term care providers that its annual questionnaire of long-term care facilities must be completed and submitted to the department electronically by Friday, October 25, 2024. Any questions regarding the questionnaire may be directed to RA-dohbhssurveys@pa.gov.

Around the State

Spotlight PA published an article about the increasing number of long-term care facility closures in the commonwealth.

Pennsylvania pharmacists are receiving less money for drugs dispensed to Medicaid patients, the Pennsylvania Capital-Star reports.

Stakeholder Events

DHS – Consumer Sub-MAAC – October 23

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on October 23 at 1:00 p.m. The meeting will be held in the Forest Room of the Keystone Building (400 North Street, Harrisburg, PA 17120). Click here for additional information.

DHS – Medical Assistance Advisory Committee – October 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on October 24 at 10:00 a.m. The meeting will be held in the Forest Room of the Keystone Building (400 North Street, Harrisburg, PA 17120). Click here for additional information.

DOH – Special Pharmaceutical Benefits Program (SPBP) Advisory Council – October 24

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a hybrid public meeting on Thursday, October 24, 2024, from 10 a.m. to 3 p.m. Find more information in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – November 1

The Brain Injury Advisory Board (Board) will hold a public meeting on Friday, November 1, 2024, from 10 a.m. to 3 p.m. Find additional information in this Pennsylvania Bulletin notice.

PA Safety Net Admin2024-10-21T20:36:11+00:00October 18th, 2024|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off

PA Health Policy Update for October 4

The following is an update of selected state health policy developments in Pennsylvania from September 30 – October 4. (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. Following is a selection of relevant health care-related legislative activity.

The House of Representatives passed House Bill 2295 and House Bill 2294, which allow a physician assistant to work with either an allopathic or osteopathic physician without having to obtain a license from both medical boards. The bills were subsequently received in the Senate and referred to the Consumer Protection & Professional Licensure Committee.

The House Labor & Industry Committee met on Monday, September 30 and favorably reported, among other bills, House Bill 2548, which requires employers to provide paid sick leave. A recording of the hearing is viewable here.

The House Aging & Older Adult Services Committee met on Monday, September 30 for a public hearing on House Bill 2320, which addresses Medicaid dependency and timely reimbursement for long-term nursing home care. A recording of the hearing is viewable here.

The House Insurance Committee met on Monday, September 30 and favorably reported, among other bills, House Bill 2562, which prohibits annual and lifetime health care coverage limits. A recording of the hearing is viewable here. The Insurance Committee also met on Tuesday, October 1 for a public hearing on House Bill 1663 and the utilization of artificial intelligence (AI) in health insurance claims processes. A recording of the hearing is viewable here.

The Senate Aging & Youth Committee met on Tuesday, October 1 and favorably reported, among other bills, Senate Bill 1303, which lowers the influenza vaccine offering from age 65 and older, down to age 50 and older. A recording of the hearing is viewable here.

The Senate Health & Human Services Committee met on Tuesday, October 1 and favorably reported the following bills.
- House Bill 155, which allows two-way video calls to satisfy the face-to-face requirement for job interviews for direct care workers.
- House Bill 1608, which requires coverage of doula services in the Medical Assistance program.
- House Bill 2084, which establishes a license for virtual prescription drug manufacturers.
- House Bill 2127, which allows hospitals, birthing centers, physicians, and midwives or nurse-midwives to provide patients with information about postpartum depression and counseling resources.

A recording of the Senate Health & Human Services Committee is viewable here.

The House Health Committee met on Wednesday, October 2 and favorably reported the following bills.

- House Bill 2094, which establishes certain limitations on filial responsibility for outstanding medical bills.
- House Bill 2549, which requires an autopsy to include an inquiry to determine whether the death was a direct result of a seizure or epilepsy.
- Senate Bill 840, which creates an Alzheimer’s Disease and related disorders division within the Department of Aging and establishes an Alzheimer’s, Dementia and Related Disorders Advisory Committee.
- Senate Bill 1080, which allows licensed practical nurses to make death pronouncements in the hospice setting.

A recording of the Health Committee meeting is viewable here.

- The Human Services Committee met on Wednesday, October 2 for a public hearing on House Bill 2560, which makes statutory changes to ensure Pennsylvania is in compliance with CMS’ “four walls” requirement. Immediately following, the Human Services Committee held a voting meeting on House Bill 2560 and House Bill 2533, which creates a 988 public education campaign. A recording of the meetings is viewable here.

The state House of Representatives and Senate will convene again for voting session Monday, October 7 through Wednesday, October 9.

Department of Human Services

The Department of Human Services (DHS) has announced a Request for Applications (RFA) seeking managed care organizations to administer services for the Children’s Health Insurance Program (CHIP) program.

DHS has announced its intent to increase rates paid in its Behavioral HealthChoices program, which provides access to mental health, substance use disorder, and other behavioral health services for Medicaid recipients. Once approved by CMS, the new rates to the Behavioral HealthChoices Managed Care Organizations (MCOs) will be retroactive to July 1, 2024 for their current 2024 contract agreements.

DHS announced an increase in the assessment fee that managed care organizations (MCOs) will pay per member per month as a means to generate federal matching funds to support the capitation payments. The increase, which becomes effective in January, is expected to generate an additional $223.531 million in assessment revenue for FY 2024-2025.

DHS has shared the following presentations from the Medical Assistance Advisory Committee (MAAC) Consumer Subcommittee meeting on September 25.

The Independent Regulatory Review Commission (IRRC) approved the DHS Psychiatric Rehabilitation Services regulations that were first proposed in 2022. With this revision, the regulations expand eligibility for psychiatric rehabilitation services to include individuals 14 years of age or older but under 18 years of age and expand the diagnoses that allow individuals to access PRS without going through the exception process. Find more information in this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has issued a Health Advisory (PA-HAN 772) regarding health care and long-term care facility preparedness for the 2024-2025 respiratory virus season.

DOH has issued a Health Advisory (PA-HAN 771) with information about the outbreak of monkeypox virus (MPXV) in the Democratic Republic of the Congo and prevention strategies for U.S. travelers visiting countries with an outbreak.

DOH has issued a Health Advisory (PA-HAN 770) announcing that has received adequate supplies of Benzathine Penicillin G (Bicillin L-A®) and is now lifting the restrictions for the administration of Bicillin L-A® for individuals who are diagnosed with or suspected of having syphilis.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has issued a licensing alert regarding DDAP’s implementation of the updated federal regulations for the certification of Opioid Treatment Programs (OTPs).

Revenue Collection Update

The Department of Revenue has announced Pennsylvania collected $4.2 billion in General Fund revenue in September, which was $33.7 million, or 0.8 percent, less than anticipated. Fiscal year-to-date General Fund collections total $10.1 billion, which is $20.2 million, or 0.2 percent, above estimate.

Stakeholder Events

DOH – Infant Hearing Screening Advisory Committee – October 10

The Infant Hearing Screening Advisory Committee will hold a public meeting on Thursday, October 10 from 9:00 a.m. to 11:00 a.m. The meeting will be held in person and virtually. Find additional information on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – October 18

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, October 18 from 10:00 a.m. to 12:00 p.m. The meeting will be held in person and virtually. Find additional information in this Pennsylvania Bulletin notice.

DOH – Special Pharmaceutical Benefits Program (SPBP) Advisory Council – October 24

DOH – Brain Injury Advisory Board – November 1

The Brain Injury Advisory Board (Board) will hold a public meeting on Friday, November 1, 2024, from 10 a.m. to 3 p.m. Find additional information in this Pennsylvania Bulletin notice.

PA Safety Net Admin2024-10-07T15:57:14+00:00October 4th, 2024|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Health Policy Update for September 13

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

Governor Shapiro

Governor Shapiro signed two executive orders this week related to gun violence prevention and affordable housing.

Governor Shapiro signed Executive Order 2024-02 updating an executive order issued by former Governor Tom Wolf and re-establishing the Pennsylvania Office of Gun Violence Prevention within the Pennsylvania Commission on Crime and Delinquency (PCCD). Find more details in this press release.

Governor Shapiro signed Executive Order 2024-03 directing the administration to create Pennsylvania’s first comprehensive housing action plan to address the state’s housing shortage, address homelessness, and expand affordable housing options. Find more details in this press release.

General Assembly

The state Senate will convene for voting session Monday, September 16 through Wednesday, September 18. The House of Representatives will remain recessed until Monday, September 30.

The Senate Aging & Youth and Banking & Insurance Committees will meet on Wednesday, September 18 at 10:00 a.m. in Room 156 of the Main Capitol for a joint informational hearing on protecting seniors from financial exploitation.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to announce changes to the Medical Assistance fee schedule, including changes resulting from clinical review, provider request, and recommendations from the Advisory Committee on Immunization Practices (ACIP) and the U.S. Food and Drug Administration (FDA). These changes are effective for dates of service on or after September 9, 2024.

DHS has issued a Medical Assistance Bulletin to advise providers of updates to the Medical Assistance program fee schedule for certain family planning and family planning-related services. The updates are effective for dates of service on or after July 1, 2024.

DHS has announced updates to the Medical Assistance program fee schedule for ophthalmology services. The updates are effective for dates of service on or after September 15, 2024. Find additional information in this Pennsylvania Bulletin notice.

DHS has announced its intent to allocate $258 million for FY 2024-2025 inpatient disproportionate share hospital (DSH) payments. Find additional information in this Pennsylvania Bulletin notice.

DHS has published final notice of its intent to increase funding for a class of supplemental payments for qualifying acute care general hospitals for FY 2023-2024 that treat a high volume of opioid use disorder patients in their emergency rooms. Find additional details in this Pennsylvania Bulletin notice.

DHS has released an updated Medicaid Managed Care Organization (MCO) Directory.

Department of Health

The Department of Health (DOH) has announced it will host a webinar next Monday, September 16 at 10:00am to discuss the details of new respiratory illness data submission that is required by CMS beginning in October. This event is meant for compliance staff, emergency management staff, IT professionals, and hospital leadership. DOH will explain its plans to continue using PA HIMS (currently Juvare’s EMResource) and automatic upload processes to meet these requirements. Click here to register to attend.

The Shapiro administration has announced that all school districts, intermediate units, career and technical centers, and brick-and-mortar charter schools will receive funding to provide free period products to students. Funding will be proportional to the total number of students enrolled in a school and based on a rate of $1.75 per student. Schools may use the funding for period product purchases made between July 1, 2024, and June 30, 2025. Find additional information here.

Department of Drug & Alcohol Programs

The Department of Drug and Alcohol Programs (DDAP) has announced the availability of more than $26 million in funding to expand drop-in center services for individuals with substance use disorders (SUD) across Pennsylvania. DDAP will award approximately 14 grants of up to $1,875,000 each. Eligible applicants, including existing community organizations, Single County Authorities, and DDAP-licensed treatment providers, can find the grant application here. Find more details in this press release.

DDAP joined individuals in recovery, advocacy organizations, and providers this week to kick off National Recovery Month in Pennsylvania. Throughout September, DDAP will be holding several other recovery-focused events. Find those events and additional recovery resources offered by DDAP here.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has conducted a review of existing regulations at the request of legislative standing committees, including the House Health and Aging & Older Adult Services Committees. The review covered rulemakings from 10 different agencies, including 40 prior rulemakings, 103 additional Chapters of regulations, and two subchapters. IRRC’s final report, including its recommendations, can be found here.

Stakeholder Events

DOH – Medical Marijuana Advisory Board – September 18

The Medical Marijuana Advisory Board has provided notice that it will meet on Wednesday, September 18 and Wednesday, November 13 from 10:30 a.m. to 12:30 p.m. The meetings will be held in the Capitol Media Center with an option for board members to participate virtually. These meetings will be broadcast live for the public through Commonwealth Media Services. Find additional details here.

DHS – Consumer Sub-MAAC – September 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 25 at 1:00 p.m. The meeting will be held virtually. Register to participate here.

DHS – Medical Assistance Advisory Committee – September 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on September 26 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

PA Safety Net Admin2024-09-13T19:50:01+00:00September 13th, 2024|Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for August 30

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

Governor Shapiro

The Shapiro administration, including leadership from the Departments of Human Services, Health, Drug & Alcohol Programs, and the Pennsylvania Insurance Department, has announced it is beginning the process of developing a state-wide maternal health strategic plan, which will address high rates of maternal mortality and ensure pregnant women in Pennsylvania receive necessary prenatal and postpartum care. Find additional information in this press release.

General Assembly

The state House of Representatives and Senate are recessed until Monday, September 23 and Monday, September 16, respectively.

Department of Human Services

The Department of Human Services (DHS) has provided final notice of the fee schedule rates for targeted support management and services funded through the Consolidated, Community Living, Person/Family Directed Support (P/FDS), and Adult Autism Waivers and Department-established fees for residential ineligible services. The rates for community-based services and residential services are effective July 1, 2024. The rates for Agency With Choice Financial Management Services and Life Sharing will be effective October 1, 2024.

The Office of Mental Health and Substance Abuse Services (OMHSAS) has shared a comprehensive resource guide for National Suicide Prevention month. The guide offers examples of activities that organizations and/or communities can do to raise awareness of the importance of suicide prevention, including ideas for events, trainings, social media, sample local government proclamations, etc.

DHS has published its annual list of each inpatient acute care general hospital, rehabilitation hospital and private psychiatric hospital qualifying for a disproportionate share payment from July 1, 2023 to June 30, 2024 and each hospital’s respective disproportionate share payment percentage. Find the comprehensive list in this Pennsylvania Bulletin notice.

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

Department of the Auditor General

Auditor General Tim DeFoor has released a report with results from the department’s performance audit of the Physical HealthChoices Medicaid program and its contracted pharmacy benefit manager (PBM), PerformRx, LLC. The report found Pennsylvania paid $7 million more than it should have for Medicaid prescription drug benefits during 2022. The report attributes the overspending to a lack of oversight by the Department of Human Services (DHS).

Department of State

The Department of State has announced beginning August 26 out-of-state physicians licensed by a state or territory participating in the Interstate Medical Licensure Compact (IMLC) who obtain a corresponding “letter of qualification” will be permitted to apply to the Pennsylvania state boards of Medicine and Osteopathic Medicine for expedited licensure to practice in the Commonwealth. Find additional information in this press release.

Around the State

Spotlight PA has published an article about the growing number of vaccine exemptions in Pennsylvania schools and the concerning potential for measles outbreaks.

The Auditor General’s report on the Department of Human Services (DHS) oversight of pharmacy benefit managers (PBMs) was covered in an article published by the Associated Press.

Another article by Spotlight PA highlights efforts to address the rural health care workforce crisis, including a legislative proposal being championed by Rep. Kathy Rapp (R) and Rep. Dan Frankel (D) that would provide grant funding to assist with the hiring of health care practitioners at rural facilities.

Stakeholder Events

DOH – Health Research Advisory Committee – September 12

The Health Research Advisory Committee will hold a public meeting on Thursday, September 12 from 1:00 p.m. to 2:00 p.m. The meeting will be held at the Nesquehoning Recreational Center (335 West Railroad Street, Nesquehoning, PA 18240). Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Tobacco-Free Recovery Statewide Conference – October 9

The Pennsylvania Statewide Tobacco-Free Recovery Initiative will hold its fourth annual “Tobacco-Free Recovery is Recovery” conference on Wednesday, October 9. The conference will be held virtually. Find registration information here.

DOH – PDMP Board Meeting – October 22

The Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board has changed the time and location of its October 22 meeting. The meeting, which will begin at 10:30 a.m., will be held in person at the Capitol Media Center (State Capitol, Room 01, East Wing, Harrisburg, PA 17126). Find additional information in this Pennsylvania Bulletin notice.

PA Safety Net Admin2024-08-31T02:41:10+00:00August 30th, 2024|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for August 23

The following is an update of selected state health policy developments in Pennsylvania from August 19 – 23. (Some of the language used below is taken directly from state documents).

General Assembly

The state House of Representatives and Senate are recessed until Monday, September 23 and Monday, September 16, respectively.

When they return, the Senate Aging and Youth and Banking and Insurance Committees announced they will meet on September 18 at 9:00 a.m. for a joint hearing on protecting seniors from financial exploitation.

Department of Health

The Department of Health (DOH) has issued a memo to hospitals outlining the department’s plan to comply with the federal government’s renewed data reporting requirements for COVID-19 and other respiratory illnesses. CMS will require weekly reporting beginning November 1 and facilities have the option for DOH to facilitate reporting on their behalf. In the memo, the Bureau of Emergency Preparedness and Response strongly encourages facilities to utilize this reporting pathway. More information, including required data elements and a data dictionary is forthcoming.

The DOH policy office has temporarily paused its efforts to collect input on potential amendments to the hospital licensure regulations. The department commenced a stakeholder engagement process earlier this month that was designed to solicit feedback from various stakeholders, including hospitals. DOH will reconvene stakeholder meetings in the fall or winter to inform proposed regulations to be released in Spring 2025.

DOH issued a health advisory (PA HAN 766) related to recent Oropouche virus activity in travelers who have visited the Amazon basin and other areas of South America.

Department of Human Services

The Department of Human Services (DHS) announced the results of the reprocurement of the Community HealthChoices program for plan years beginning in 2025 through at least 2029. Similar to today’s program, the selected applicants are identical for each of the five CHC operating zones and include Aetna Better Health of Pennsylvania, Health Partners Plans, PA Health and Wellness, UPMC For You, and Vista Health Plan (AmeriHealth). The plans will begin a readiness review with DHS shortly which will include an examination of their provider network adequacy. Find the DHS announcement here.

DHS issued a Medical Assistance provider bulletin to advise providers of changes to the manual edit thresholds for electronic visit verification records in both personal care and home health services effective with dates of service on and after January 1, 2025.

DHS updated its list of remittance advice dates to include September 2024.

The DHS Office of Mental Health and Substance Abuse Services (OMHSAS) encourages providers to participate in a survey of provider readiness to introduce additional tobacco interventions as part of the Pennsylvania Statewide Tobacco-Free Recovery Initiative (PA STFRI) funded by the CDC. The Public Health Management Corporation conducted a similar survey in 2021, and this 15-minute survey will be a useful measure of the initiative’s progress. Click here to access the survey, which will close on August 31.

Stakeholder Events

DOH – HIV Community Prevention Planning Committee – August 29 – CANCELLED

The statewide Human Immunodeficiency Virus (HIV) Planning Group has cancelled its public meeting on Thursday, August 29 from 9:00 a.m. to 4:30 p.m.

PA Safety Net Admin2024-08-23T20:40:15+00:00August 23rd, 2024|Medical Assistance Bulletin, Meetings and notices|Comments Off

PA Health Policy Update for July 26

The following is an update of selected state health policy developments in Pennsylvania from July 15 – 26. (Some of the language used below is taken directly from state documents).

Governor Shapiro

Governor Shapiro has signed several bills into law, including the following health care bills.
- House Bill 1664 (Act 58 of 2024), which prohibits insurers from restricting their method of payment to participating health care providers so that the only payment method is by credit card.
- House Bill 1633 (Act 74 of 2024), which establishes restrictions on non-compete covenants for certain health care practitioners.
- House Bill 1853 (Act 75 of 2024), which requires the Department of Health to meet annually with licensed nursing facilities in an effort to improve communication and collaboration around facility surveys.
- House Bill 1993 (Act 77 of 2024), which seeks to reform certain practices by pharmacy benefit managers (PBMs) that have an adverse impact on pharmacies and patients.
- House Bill 2200 (Act 79 of 2024), which makes certain changes to Pennsylvania statute that will enable the state to join, among others, the medical and nursing interstate licensure compacts.

Governor Shapiro joined Insurance Commissioner Michael Humphreys, members of the General Assembly, and local pharmacists in Lawrence County this week to tout the recent enactment of House Bill 1993, which establishes increased oversight of pharmacy benefit managers (PBMs). Read more in this press release.

The Shapiro administration has published its semi-annual agenda of regulations under development or consideration across the various state agencies under the governor’s jurisdiction, including the Departments of Health and Human Services. Find the comprehensive regulatory agenda in this Pennsylvania Bulletin notice.

General Assembly

The state House of Representatives and Senate are recessed until Monday, September 23 and Monday, September 16, respectively.

Department of Human Services

The Department of Human Services (DHS) has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through August 2024. Find the updated calendar here.

DHS has issued Provider Quick Tip #85 with eligibility and enrollment information for the Breast & Cervical Cancer Prevention & Treatment (BCCPT) program, which provides eligible individuals treatment for confirmed cases of breast and cervical cancer or precancerous conditions of the breast or cervix.

The Office of Long-Term Living (OLTL) has shared an important announcement from the U.S. Food and Drug Administration (FDA) about a recall of Clonazepam orally disintegrating tablets due to mislabeling.

DHS has shared the following presentations used at the Medical Assistance Advisory Committee (MAAC) meeting on July 25.

Department of Health

The Department of Health (DOH) has reminded providers who operate mobile clinics to complete a brief survey, which can be found here. The results of the survey will help DOH better understand the breadth of mobile services provided across the state, identify interest in collaboration among mobile service providers to share best practices and identify unmet needs/resources, and to identify opportunities to promote and support the mobile clinics, including opportunities for expansion of services.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has issued a Licensing Alert to notify licensed treatment facilities and recovery houses of the new process for submitting licensing regulation exceptions and facility requests to DDAP.

Around the State

The Citizen’s Voice has published an article about Pennsylvania’s Cancer Drug Repository Program and barriers to its utilization.

The Patriot-News has written an article about President Joe Biden’s decision to withdraw from the U.S. presidential race and what it means for Governor Shapiro.

Governor Shapiro’s signing of House Bill 1993, which establishes increased oversight of pharmacy benefit managers (PBMs), and its potential impact on local pharmacies and patients was featured in an article published by the Times Leader.

The Pittsburgh Business Times has published an article about the challenges confronting rural health care and efforts to find solutions.

PA Safety Net Admin2024-07-26T20:18:58+00:00July 26th, 2024|Medical Assistance Advisory Committee, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for July 12

The following is an update of selected state health policy developments in Pennsylvania from July 8 – 12. (Some of the language used below is taken directly from state documents).

FY 2024-2025 Budget Update

Late Thursday evening the General Assembly passed Senate Bill 1001 – the General Appropriations Act – to fund Pennsylvania’s FY 2024-2025 budget. Governor Shapiro promptly signed Senate Bill 1001, as well as the various enabling pieces of legislation necessary to implement the budget, which marked the completion of the FY 2024-2025 budget process, more than 10 days after the commonwealth’s constitutionally mandated deadline.

In total, the FY 2024-2025 budget spends $47.6 billion, which represents a $2.7 billion, or 6.6 percent, increase over the prior fiscal year. It is nearly $700 million less than Governor Shapiro’s initial budget proposal. The FY 2024-2025 budget increases spending for K-12 and higher education. It also makes targeted investments in health and human services. The budget doesn’t include any tax increases or the Governor’s proposal to legalize cannabis. The final budget does include Governor Shapiro’s economic development proposal to create the Pennsylvania Strategic Investments to Enhance Sites (PA SITES) program and authorize up to $500 million in new funding to invest in site development, preparation, and readiness for businesses to locate or expand in Pennsylvania.

The following are key budget-related pieces of legislation.

General Assembly

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

The Senate passed House Bill 1993, which seeks to reform certain practices by pharmacy benefit managers (PBMs) that have an adverse impact on pharmacies and patients, by a vote of 48-1. The House of Representatives subsequently voted to concur with the Senate’s amendments and sent the bill to Governor Shapiro for his signature.

The Senate passed House Bill 1633, which establishes restrictions on non-compete covenants for certain health care practitioners, on third and final passage. The House of Representatives subsequently voted to concur with the Senate’s amendments and sent the bill to Governor Shapiro for his signature.

The House of Representatives voted to concur with the Senate’s amendments to House Bill 1664, which prohibits insurers from restricting their method of payment to participating health care providers so that the only payment method is by credit card. The bill will now be sent to Governor Shapiro for his signature.

The Senate passed House Bill 1853, which requires the Department of Health to meet annually with licensed nursing facilities in an effort to improve communication and collaboration around facility surveys, on third and final consideration. The bill will now be sent to Governor Shapiro for his signature.

The House of Representatives passed House Bill 2339, which establishes hospital price transparency reporting and disclosure requirements. The bill also stipulates penalties for noncompliance. The bill, which passed by a vote of 168-34, will now be sent to the Senate for consideration.

The House of Representatives also passed House Bill 2344, which imposes more reporting requirements and additional oversight on health care facility mergers and acquisitions, on third and final consideration. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 1425, which directs the Department of Human Services to develop a five-year plan to offer evidence-based maternal home visiting programs for eligible families. The bill will now be sent to the Senate for consideration.

The House and Senate have recessed until Monday, September 23 and Monday, September 16, respectively.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that DHS will increase fees for certain ophthalmology services on the Medical Assistance (MA) program fee schedule, effective for dates of services on and after August 1, 2024.

DHS has published the transcript and a recording of the July 2 meeting of the Long-Term Services and Supports Subcommittee.

Centers for Medicare and Medicaid Services

The Centers for Medical and Medicaid Services (CMS) has proposed amending the Medicaid clinic services regulation, which currently permits Medicaid payment for clinic services furnished outside of the four walls of a clinic only to individuals who are unhoused, to authorize federal reimbursement for services furnished outside the four walls of a freestanding clinic by IHS/Tribal clinics. In addition, at state option, federal reimbursement also would be available for services provided by behavioral health clinics and services provided by clinics located in rural areas. For clinics located in rural areas, CMS is not proposing a specific definition of rural but is seeking public comment on different alternative definitions for consideration in final rulemaking.

Stakeholder Events

DOH – Organ Donation Advisory Committee – August 8

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 8 from 10:30 a.m. to 1:30 p.m. The meeting will be held in person and virtually. Find additional information on how to participate in this Pennsylvania Bulletin notice.

DHS – Consumer Sub-MAAC – July 24

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on July 24 at 1:00 p.m. The meeting will be held in person. It will be located in the Forest Room of the Keystone Building – 400 North St., Harrisburg, PA 17120.

DHS – Medical Assistance Advisory Committee – July 25

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on July 25 at 10:00 a.m. The meeting will be held in person. It will be located in the Forest Room of the Keystone Building – 400 North St., Harrisburg, PA 17120.

PA Safety Net Admin2024-07-12T20:34:18+00:00July 12th, 2024|Federal Medicaid issues, Financial, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

PA Health Policy Update for July 5

The following is an update of selected state health policy developments in Pennsylvania from July 1 – 5. (Some of the language used below is taken directly from state documents).

FY 2024-2025 Budget Update

The Commonwealth of Pennsylvania is five days into the new Fiscal Year (FY) and still doesn’t have an enacted budget, but legislative leaders remain optimistic that an agreement will be reached in the near term. The state House of Representatives and Senate, who recessed briefly for the Fourth of July, are currently scheduled to return on Saturday, July 6 to continue work on the FY 2024-2025 budget and its related bills.

Governor Shapiro

Governor Shapiro signed House Bill 1754 into law on Monday. Now known as Act 39 of 2024, this legislation requires public and private insurers to cover biomarker testing. Find additional information in this press release.

On Wednesday Governor Shapiro signed Senate Bill 739 into law. Now known as Act 42 of 2024, this piece of legislation provides for coverage of telemedicine services. Find additional information in this press release.

General Assembly

The state House of Representatives and Senate held voting session Monday, July 1 through Wednesday, July 3. The following is an overview of selected health care-related legislative activity that occurred.

The Senate confirmed Dr. Debra Bogen as Secretary of the Department of Health by a vote of 42 – 8 on Monday, July 1. Dr. Bogen has been serving as Acting Secretary since the beginning of the Shapiro administration. Find additional information in this press release.

The Senate passed House Bill 2200, which makes certain changes to Pennsylvania statute that will enable the state to join, among others, the medical and nursing interstate licensure compacts. The bill will now be sent to Governor Shapiro for his signature.

The Senate passed House Bill 1664, which prohibits insurers from restricting their method of payment to participating health care providers so that the only payment method is by credit card. The bill will now be sent back to the House for concurrence.

The Senate passed Senate Bill 1080, which allows licensed practical nurses to make death pronouncements in the hospice setting. The bill was received in the House and referred to the Health Committee.

The House of Representatives passed House Bill 2429, which establishes an inmate reentry program operated by the Department of Human Services to provide substance use disorder treatment and case management services prior an inmate’s release from a correctional institution. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 2283, which requires operating rooms to utilize surgical smoke evacuation systems. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 2175, which creates a permanent Office of Child Advocate. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 2012, which establishes a state antitrust statute and expands notification requirements for health care facilities when there is a merger, acquisition, etc. The bill will now be sent to the Senate for consideration.

The House and Senate are currently scheduled to return to Harrisburg for voting session Saturday, July 6.

Department of Human Services

The Department of Human Services (DHS) has published its annual list of exceptional Durable Medical Equipment (DME) for nursing facilities. Find the list and additional information in this Pennsylvania Bulletin notice.

DHS has published two notices in the Pennsylvania Bulletin related to the implementation and reauthorization of the Philadelphia hospital assessment, including the establishment of a new class of supplemental payments and the discontinuation of certain DSH and supplemental payments.

- DSH and Supplemental Payments to Qualifying Hospitals
- Supplemental Payments to Qualifying Hospitals

DHS has published updates to the Medical Assistance (MA) program fee schedule for ophthalmology services, effective for dates of service on and after August 1, 2024. Find additional information in this Pennsylvania Bulletin notice.

DHS has issued a number of Medical Assistance bulletins relating to prior authorization for pharmacy services.

Department of Health

The Department of Health (DOH) has requested providers who operate mobile clinics complete a brief survey, which can be found here. The results of the survey will help DOH better understand the breadth of mobile services provided across the state, identify interest in collaboration among mobile service providers to share best practices and identify unmet needs/resources, and to identify opportunities to promote and support the mobile clinics, including opportunities for expansion of services.

Revenue Collection Update

The Department of Revenue has announced Pennsylvania ended Fiscal Year (FY) 2023-2024 with $45.5 billion in General Fund collections. That total is $862.9 million, or 1.9 percent, above estimate.

Stakeholder Events

DOH – WIC Advisory Board – July 9

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Advisory will meet on July 9 from 1:00 p.m. to 2:00 p.m. The purpose of the meeting is to collaborate to gather suggestions of strategies for increasing participation and improving the WIC program to better support participants. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2024-07-08T20:21:52+00:00July 5th, 2024|Financial, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

PA Health Policy Update for June 28

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

FY 2024-2025 Budget Update

Governor Shapiro and legislative leaders continue to work on a final Fiscal Year (FY) 2024-2025 budget agreement. The state House of Representatives and Senate have both recessed until Monday, July 1; however, in remarks late Thursday afternoon, Senate Majority Leader Joe Pittman and Minority Leader Jay Costa both signaled optimism that an agreement would be reached in the near future.

General Assembly

The state House of Representatives and Senate were in Harrisburg for session this week. The following is an overview of selected health care-related legislative activity.

The Senate unanimously passed House Bill 1754, which requires public and private insurers to cover biomarker testing. The bill was subsequently sent to Governor Shapiro’s desk for his signature.

The House of Representatives passed Senate Bill 739, which provides for coverage of telemedicine services, by a vote of 194-8. The Senate subsequently concurred with the House’s amendments and sent the bill to Governor Shapiro’s desk for his signature.

The House of Representatives passed House Bill 1993, which seeks to reform certain practices by pharmacy benefit managers (PBMs) that have an adverse impact on pharmacies and patients, by a vote of 194-8. The bill will now be sent to the Senate for consideration.

The Senate unanimously passed Senate Bill 965, which provides Medicaid coverage for rapid whole genome sequencing under certain conditions. The bill was subsequently received in the House and referred to the Health Committee.

The Senate unanimously passed on Senate Bill 840, which creates an Alzheimer’s Disease and related disorders division within the Department of Aging and establishes an Alzheimer’s, Dementia and Related Disorders Advisory Committee. The bill was subsequently received in the House and referred to the Health Committee.

The House unanimously passed House Bill 2403, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP). The bill will now be sent to the Senate for consideration.

The House unanimously passed House Bill 2400, which creates an Alzheimer’s Disease and related disorders division within the Department of Aging and establishes an Alzheimer’s, Dementia and Related Disorders Advisory Committee. The bill will now be sent to the Senate for consideration.

The House passed House Bill 2198, which caps the fees for obtaining electronic medical records, by a vote of 137-65. The bill will now be sent to the Senate for consideration.

The House passed House Bill 2268, which provides coverage for speech therapy for stuttering, by a vote of 181-21. The bill will now be sent to the Senate for consideration.

The House passed House Bill 1140, which expands access to contraceptives, by a vote of 133-69. The bill will now be sent to the Senate for consideration.

The House Children & Youth Committee met on Tuesday, June 25 and favorably reported House Bill 1425, which directs the Department of Human Services to develop a five-year plan to offer evidence-based maternal home visiting programs for eligible families. A recording of the meeting is viewable here.

The House Health Committee met on Wednesday, June 26 and favorably reported House Bill 2344, which imposes more reporting requirements and additional oversight on health care facility mergers and acquisitions, and House Bill 2382, which establishes a rural health care grant program to incentive licensed health care practitioners to practice in rural areas. Find a recording of the meeting here.

The Senate Health & Human Services Committee met on Thursday, June 27 and reported with “no recommendation” the nomination of Dr. Debra Bogen for Secretary of the Department of Health. Find a recording of the confirmation hearing here.

The House and Senate are currently recessed for the weekend. Both chambers will return to Harrisburg on Monday, July 1. The House will convene at 12:00 p.m. and the Senate will convene at 3:00 p.m.

Department of Human Services

The Department of Human Services (DHS) has announced 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 beginning in FY 2024-2025. Find additional information in this Pennsylvania Bulletin notice.

DHS has announced the proposed annual case-mix per diem payment rates for FY 2024-2025 for non-public and county nursing facilities that participate in the Medicaid program. Find additional information in this Pennsylvania Bulletin notice.

DHS has issued Provider Quick Tip #263 with information about the availability of an electronic submission process for long-term care (LTC) 180-day exception requests and other claims requiring documentation.

DHS has issued a Remittance Advice Alert notifying providers of changes to the electronic funds transfer (EFT) procedure effective June 28, 2024.

DHS has released an updated Medicaid Managed Care Organization (MCO) Directory.

Department of Health

The Department of Health (DOH) has released an updated staffing calculation tool to assist nursing home providers with compliance with new standards that come into effect on July 1, 2024.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release a report that includes state-wide data and facility-specific information about the financial health of Pennsylvania’s general acute care hospitals for fiscal year 2023. Financial Analysis, Volume One, is the first in a three-part series of financial reports produced annually by PHC4.

Stakeholder Events

Pennsylvania Health Care Cost Containment Council – July 10 and 11

The Pennsylvania Health Care Cost Containment Council (PHC4) has scheduled an executive committee meeting on July 10 at 11:30 a.m. and a council meeting on July 11 at 10:00 a.m. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – HIV Community Prevention Planning Committee – July 10 and 11

The Statewide HIV Planning Group will hold public meetings on Wednesday, July 10 and Thursday, July 11. The meetings will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Newborn Screening & Follow-Up Advisory Board – July 18

The Newborn Screening and Follow-Up Technical Advisory Board, established under the Newborn Child Testing Act, will hold a public meeting on Thursday, July 18 from 10:00 a.m. to 1:00 p.m. The meeting will be conducted in person. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – July 19

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, July 19 from 10:00 a.m. to 12:00 p.m. The purpose of the meeting is to discuss new and ongoing issues relating to treatment of chronic renal disease and the Department of Health’s programs related to care and treatment. Find additional details here.

DHS – Special Pharmaceutical Benefits Program Advisory Council – July 25

The next Special Pharmaceutical Benefits Program (SPBP) Advisory Council Meeting will be held virtually on Thursday, July 25 at 10:00 a.m. Please let us know if you would like the virtual meeting details.

DOH – Brain Injury Advisory Board – August 2

The Brain Injury Advisory Board will hold a public meeting on Friday, August 2 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 here.

PA Safety Net Admin2024-06-28T20:16:51+00:00June 28th, 2024|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

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