Pennsylvania Medicaid PDL Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for Friday, December 23

The following is an update of selected state health policy developments in Pennsylvania for the week of December 19-23, 2022. (Some of the language used below is taken directly from state documents.)

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin informing providers about new procedures for dispensing 340B-purchased drugs to Medical Assistance beneficiaries and about the implementation of the program’s 340B drug exclusion list. Find the bulletin here. Find the policies this new bulletin replaces here.
DHS has extended its schedule for sending Remittance Advice documents, Medicaid payment checks, and electronic transfers of payments into early February. Find the updated schedule here.
DHS has announced that it will add several prescription drugs to the Medical Assistance program’s list of services and items requiring prior authorization: corticotropin; targeted systemic immunomodulators for atopic dermatitis, designated as preferred on the program’s preferred drug list (PDL); PCSK9 inhibitor lipotropics, designated as preferred on the PDL; and obesity treatment agents designated as preferred on the PDL. Learn more from this Pennsylvania Bulletin notice.
DHS has posted revisions of the participating drug company list for the Medicaid drug rebate program.
DHS has announced its intent to allocate funds in FY 2023 for several classes of inpatient disproportionate share hospital (DSH) payments (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled, qualifying inpatient acute-care general hospitals. It does not intend to otherwise change the qualifying criteria or payment methodology for these payments. See the announcement, including information about the different purposes for which Medicaid DSH payments will be made, in this Pennsylvania Bulletin notice.
DHS has circulated the following materials from the December 7 meeting of the Medical Assistance Advisory Committee meeting.

Department of Health

The Department of Health (DOH) has announced that Pennsylvania will receive $98 million in federal funding to enhance public health infrastructure, including staffing, health planning, and equity and data modernization efforts. A portion of the funding, from the CDC’s Public Health Infrastructure grant program will be allocated to 10 county and municipal health departments. Learn more from this Department of Health news release.
DOH has issued a health advisory informing providers to be aware of possible increases in group A streptococcal infections. The alert also informs providers about symptoms, testing, and treatment; provides instructions for laboratories that identify cases; and reminds providers and laboratories that they are required to report such cases to DOH. Find the alert here.
DOH has issued a health advisory with interim guidance for clinicians on how to prioritize antiviral flu treatment at a time when there is limited availability of the drug oseltamivir (Tamiflu). Find the advisory here.
DOH has revised long-term-care nursing facility regulations recently approved by the Independent Regulatory Review Commission to correct typographic errors. Find the revised, final regulations in this Pennsylvania Bulletin notice.

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 and in hospital ICUs remained steady over the past week but the number on ventilators rose 17 percent.
The CDC reports no change over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 21, 46 Pennsylvania counties were experiencing high rates of community transmission of COVID-19; 15 were experiencing substantial rates of community transmission; and six counties were experiencing a moderate rate of community transmission.
As 2022 draws to a close, Pennsylvania has now experienced 3.4 million confirmed, reported cases of COVID-19 and suffered nearly 49,000 deaths from the virus.

jsteinbock2022-12-23T21:11:29+00:00December 23rd, 2022|COVID-19, long-term care, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for Friday, December 9

The following is an update of selected state health policy developments in Pennsylvania for the week of December 5-9, 2022. (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Shapiro announced that he will appoint Uri Monson, the chief financial officer of the School District of Philadelphia, as Budget Secretary. He also announced Jennifer Selber will be appointed General Counsel and Larry Hailsham, Jr. will be Executive Deputy Chief of Staff. Selber currently serves as the Executive Deputy Attorney General of Pennsylvania in charge of the criminal division and Hailsham most recently served as the Shapiro campaign’s political director.

General Assembly

Democrats and Republicans continue to struggle over control of the state House. On Wednesday Representative Joanna McClinton (D-Philadelphia) was sworn in during an unannounced ceremony as majority leader. Republicans swiftly denounced the swearing-in as an “illegitimate power grab.” In addition, Representative Summer Lee (D-Allegheny County) and Representative Austin Davis (D-Allegheny County) formally submitted their resignations on Wednesday. At the same time they won re-election to those seats Ms. Summer was elected to Congress and Mr. Davis was elected Lieutenant Governor. Their resignations, along with the passing of Representative Tony DeLuca (D-Allegheny County), make the current breakdown in the state House 101 Republicans and 99 Democrats.
The state Senate released its 2023 session calendar through June. The calendar can be viewed here.

Department of Human Services

The Department of Human Services (DHS) has announced its intent to allocate $18.034 million in state and federal funds for FY 2023 Medicaid disproportionate share hospital payments (Medicaid DSH) to acute-care general hospitals that qualify as a trauma center. DHS also is amending the qualifying criteria and payment methodology for these payments for newly accredited trauma centers and hospitals seeking trauma center accreditation. See the announcement and learn more about the changes in the qualifying criteria and payment methodology in this Pennsylvania Bulletin notice. Public comments are due within 30 days.
DHS has issued a Medical Assistance Bulletin to inform providers about updates to the statewide Preferred Drug List (PDL) that take effect on January 9. Find the bulletin here.
DHS 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:
DHS has posted guidance for providers on procedure code/modifier combinations to be used when requesting home accessibility durable medical equipment and durable medical equipment repairs in the Medicaid fee-for-service program. Find the instructions here.
DHS is updating the Medical Assistance fee schedule for disposable breast milk collection and storage bags and breast pump replacement supplies. Learn about the new fees and new procedure codes to accompany them from this Pennsylvania Bulletin notice.
Beginning on December 16, providers will find a new question on the electronic provider enrollment application: “Will your provider agency be rendering Personal Care Services or Home Health Care Services that are subject to EVV [electronic visit verification]?” DHS has posted information for providers about what this question means and how they should approach answering it.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania rose nearly 30 percent in the past week, an increase possibly attributable to social gatherings over the Thanksgiving holiday. 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 remains relatively unchanged.
The CDC reports a 22 percent increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
As of December 7, 39 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 25 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission. This is almost identical to the previous week.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued an information bulletin explaining that as a result of a new Pennsylvania law passed last month, private and public treatment and rehabilitation facilities may not deny addiction treatment to individuals based solely on a negative result on a drug test. This policy takes effect on January 1. Learn more from this information bulletin.
The Department of Drug and Alcohol Programs has announced that it has awarded nearly $19 million in grant funding through its substance use disorder loan repayment program to help substance use disorder treatment professionals repay their outstanding qualifying educational loans. More than 280 practitioners, including case managers, counselors, licensed social workers, physician assistants, and registered nurses, shared in the funding. Learn more from this department news release.

State Board of Nursing

The State Board of Nursing proposes amending its process for reactivating nursing licenses. Learn more from this Pennsylvania Bulletin notice. Public comments on the proposed changes are due within 30 days.

jsteinbock2022-12-09T21:00:26+00:00December 9th, 2022|COVID-19, DSH hospitals, Medicaid supplemental payments, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2020 newsletter.

Included in this month’s edition are articles about:

the transition to a new Medicaid prescription drug list (PDL);
the rollout of a new electronic visit verification system for Medicaid-paid home health services; and
progress in the state’s effort to introduce major changes in its Medical Assistance transportation program (MATP).

Read about these subjects and more in the Pennsylvania Health Law Project’s January 2020 newsletter.

PA Safety Net Admin2020-02-05T06:00:12+00:00February 5th, 2020|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Introduces Medicaid PDL on January 1

Beginning tomorrow, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon: the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1. Here’s why.”

PA Safety Net Admin2019-12-31T06:00:53+00:00December 31st, 2019|Pennsylvania Medicaid policy|Comments Off

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law books The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Safety Net Admin2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Shifting PA Medicaid to a PDL

Pennsylvania’s planned shift to a preferred drug list for its Medicaid program is the subject of a new analysis of the projected impact of such a change.

Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.

During this year’s budget proceedings, Pennsylvania’s Human Services Code was amended to require an analysis of “the projected cost to the medical assistance managed care organization [sic] and the projected supplemental rebates that could be obtained” by moving to a PDL.

That analysis has now been completed. It concluded that the state

…will save $85 million annual through implementation of a Statewide PDL. The Statewide PDL will allow the Department [of Human Services] to receive an additional $261 million in pharmacy rebates, which will more than offset the estimated increase to managed care organization (MCO) expenditures of $176 million, considering their additional costs and loss of market share rebates.

The analysis commissioned by DHS is now available. To learn more about the implications of a state-wide PDL for the state, for Medicaid managed care organization, and for Medicaid beneficiaries, read “Fiscal Impact Analysis of Medical Assistance Program Uniform Statewide Preferred Drug List, 2019 Report.”

The PDL will take effect on January 1, 2020 and has been posted on a DHS web site here.

PA Safety Net Admin2019-10-09T06:00:03+00:00October 9th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

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