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PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its September 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

How Pennsylvania Medicaid beneficiaries who turn 21 during the COVID-19 emergency remain eligible for EPSDT services.
Pennsylvania Health Law Project navigators who can help direct people to COVID-19 testing and treatment.
A warning that without increased federal Medicaid matching money, states may seek to reduce Medicaid provider payments, increase beneficiary cost-sharing, or reduce services.

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

PA Safety Net Admin2020-10-08T06:00:21+00:00October 8th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its August 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

The Department of Human Services’ selection of new managed care plans to serve Pennsylvania Medicaid’s Community HealthChoices program.
The end of ensured continuity of long-term services and supports for participants in the Community HealthChoices program in northeastern Pennsylvania.
The availability of navigators to help connect people to COVID-19 testing and treatment.

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

PA Safety Net Admin2020-08-05T06:00:27+00:00August 5th, 2020|HealthChoices, long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

COVID-19 Update: March 18, 2020

The following is a summary of today’s major COVID-19-related developments.

Pennsylvania Updates

PACE Prescription Drug Program

Department of Health Secretary Rachel Levine announced that for individuals who participate in the state’s PACE program, which provides financial assistance on prescription drugs for low-income seniors, the state is waiving the current requirement that participants must use at least 75 percent of their supply of an individual drug before being eligible to renew their prescription. This does not apply to opioids and other controlled substances but participants who use those drugs can apply for a waiver from the 75 percent requirement.

In addition, PACE participants will not have to pay the cost of home delivery of their prescriptions.

COVID-19 Testing

Secretary Levine said that her department is working with hospitals on testing sites. The state is working with the county health departments in Philadelphia and Montgomery counties and the federal government to develop mass testing sites in those counties. Meanwhile, Quest and Labcorp are now doing COVID-19 testing and other commercial labs should be coming online soon. Hospitals, too, are developing their own testing capacity, and she specifically mentioned the Children’s Hospital of Philadelphia, Penn Medicine, UPMC, and the Allegheny Health Network as now having FDA-approved testing programs.

Ventilators

Secretary Levine announced that the state has its own stock of extra ventilators and is hoping to acquire more of them.

Hospital Beds

The state, Secretary Levine said, is waiving the requirement that hospitals notify the state before they increase their bed complement.

Unemployment Compensation

With unemployment claims in Pennsylvania up sharply, the state is streamlining its process for applying for benefits, waiving a one-week waiting period while it verifies unemployment and proof of a job search while also encouraging people to apply online. Read an account of the changes in this Pittsburgh Business Times article and find the official state notice here on the state’s unemployment compensation web page.

PA General Assembly Update

Today the Senate met briefly at the Capitol to pass temporary rules to allow its members to work and vote remotely should the need arise in the coming weeks/months. This is similar to the temporary rules adopted by the House earlier this week. In his floor remarks, Majority Leader Corman (R-Centre) committed to being as transparent as possible throughout this process with the public, press, administration, and House. He also committed to only move legislation forward during this remote time that is directly related to the pandemic. He noted that the time may come in the months ahead that the primary election or state budget could require the Senate’s attention in accordance with this remote voting authority.

Federal Updates

Senate Passes Emergency COVID-19 Aid Bill

Late this afternoon the Senate passed the COVID-19 aid bill that had already passed the House. President Trump is expected to sign it.

Elective Surgery

Today Vice President Pence urged hospitals to delay elective procedures. Centers for Medicare & Medicaid Services (CMS) administrator Verma said her agency will issue recommendations on such limits.

Practicing Medicine Across State Lines

The Department of Health and Human Services (HHS) is expected to issue regulations later today addressing the practice of medicine across state lines by doctors and medical professionals to meet the demands of caring for COVID-19 patients.

Section 1135 Waivers

The declaration of a national emergency included an invitation to states to apply for waivers of some federal regulations to facilitate caring for COVID-10 patients. As we wrote to you yesterday, Florida already has received such a waiver. Yesterday the California Hospital Association applied for such a waiver on behalf of the state’s hospitals and a published report suggests that almost every state is expected to apply for a section 1135 waiver.

Infection Control

The Centers for Disease Control and Prevention (CDC) has issued new infection prevention and control recommendations for patents with suspected or confirmed COVID-19. See those recommendations here.

The CDC also has issued guidelines that address health care workers returning to work after suffering from COVID-19 or who were suspected of suffering from or being exposed to it. Find those guidelines here.

HIPAA

Late yesterday HHS released a bulletin detailing the provisions of HIPAA that it will not be enforcing for covered hospitals that have implemented a disaster protocol. The waiver became effective on March 15, 2020. Find it here.

Telehealth

Yesterday the HHS Office of the Inspector General issued a policy statement regarding physicians and other practitioners that reduce or waive amounts owed by federal health care program beneficiaries for telehealth during the COVID-10 outbreak. Find that policy statement here and an accompanying fact sheet here.

On the same subject, the HHS Office of Civil Rights issued a notification of enforcement discretion for telehealth remote communications during the COVID-19 emergency. Find that document here.

JCAHO

Yesterday the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that it has suspended its surveying activities at least until the end of April.

PA Safety Net Admin2020-03-19T15:44:02+00:00March 19th, 2020|Coronavirus, COVID-19|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its February 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

Governor Wolf’s proposed FY 2021 Medicaid budget.
Challenges Pennsylvania Medicaid recipients have encountered obtaining services from their HealthChoices managed care plan and how to address them.
Implementation of the federal “public charge” regulation and whom it does – and does not – affect.

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

PA Safety Net Admin2020-03-05T06:00:11+00:00March 5th, 2020|Federal Medicaid issues, HealthChoices, Pennsylvania Medicaid, Pennsylvania proposed FY 2021 budget|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

DHS Unveils Strategic Plan

Pennsylvania’s Department of Human Services has a new strategic plan for 2019 through 2022.

While DHS’s area of endeavor is broad and goes beyond health care, Medicaid is an important aspect of its work and that importance is reflected in the plan, which includes descriptions of DHS’s ambitions in the following areas:

Provide every child with a strong foundation for physical and behavioral well-being
Bend the health care cost curve
Drive innovative whole-person care
Holistically assess needs and connect to resources
Address the social determinants of health
Expand health care beyond the doctor’s office and into the places people live, work, and play
Coordinate physical health care, behavioral health care, and long-term services and supports
Promote health equity
Lead the health care system toward value-based purchasing coordinated across payers
Serve more people in the community
Enhance access to health care and services that help Pennsylvanians lead healthy, productive lives
Coordinate services seamlessly across programs and agencies
Expand services and supports for individuals with mental illness
Expand services and supports for individuals with substance use disorder

Learn more about what Pennsylvania has in mind for its Medicaid program in the coming years, and for the Pennsylvania safety-net hospitals that serve so many participants in that program, by reading DHS’s new strategic plan for 2019 through 2022.

PA Safety Net Admin2019-11-14T06:00:50+00:00November 14th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|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

SNAP Takes Position on State Medicaid Funding After Hahnemann Closure

Pennsylvania’s Medicaid resources should follow now-closed Hahnemann University Hospital’s Medicaid patients as those patients turn to new providers, the Safety-Net Association of Pennsylvania declared in a position statement issued this week.

Safety-Net Association of Pennsylvania logo According to SNAP,

…the best way to protect access to care and prevent additional financial strain on Philadelphia hospitals is to ensure that all state resources reallocated in the wake of Hahnemann University Hospital’s closure follow the displaced patients.

In preparation for addressing this challenge, SNAP performed a data-based analysis of where Medicaid patients turned for care upon the closing of St. Joseph’s Hospital, like Hahnemann a high-volume Medicaid provider and located in the same community as Hahnemann, in 2016. This analysis identified where patients went when St. Joseph’s closed and in its position statement, SNAP urges state policy-makers to perform similar analyses and ensure that state Medicaid resources, especially supplemental payments made to hospitals that serve especially large numbers of Medicaid patients, be distributed to the hospitals that actually serve displaced Hahnemann patients. Such an approach, SNAP maintains, is the best way to ensure the future of the health care safety net in Philadelphia.

Learn more in the SNAP position statement “Protecting Philadelphia’s Health Care Safety Net From the Financial Implications of the Closing of Hahnemann University Hospital.”

PA Safety Net Admin2019-09-18T13:24:14+00:00September 18th, 2019|Medicaid supplemental payments, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

PA Senate to Take Up Medicaid Work Requirement

Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation.

This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits.

Harrisburg, PA capital building The proposal will be considered by the Senate Health and Human Services Committee.

The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them.

Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war over Medicaid work requirements.”

PA Safety Net Admin2019-09-17T06:00:13+00:00September 17th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off

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