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Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its April 2021 newsletter.

Included in this month’s edition are articles about:

  • The impact of the American Rescue Plan on health insurance eligibility.
  • The impact of the American Rescue Plan on “Pennie,” Pennsylvania’s health insurance marketplace.
  • Federal updates on nursing home visitation.
  • Medicare coverage of COVID-19 testing and vaccines.
  • Using the Medical Assistance Transportation program to get the COVID-19 vaccine.
  • Advancing maternal health care coverage in Pennsylvania.

Read about these subjects and more in the Pennsylvania Health Law Project’s April 2021 newsletter.

2021-05-06T11:13:13+00:00May 6th, 2021|Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project Newsletter

COVID Drives Major Increase in PA Medicaid Enrollment

Medicaid enrollment in Pennsylvania has risen nearly 14 percent in the past year as rising unemployment resulting from COVID-19 drives people to turn to the state for health insurance.

As a result, Pennsylvania has added nearly 400,000 people to its Medicaid rolls in the past year.  Today, 3.2 million Pennsylvanians are enrolled in the state’s program, although among them are approximately 250,000 who would have been dropped from the program except for a federal requirement that the state not drop people from the program in exchange for a major increase in federal aid for the state’s program.

As a result of the increase, the state’s Department of Human Services, which runs its Medicaid program, has asked the legislature for nearly $1 billion in supplemental funding to help finance its services for this expanded enrollment through the rest of the state’s FY 2021 year.

Learn more about the past year’s increase in Medicaid enrollment, who the new enrollees are, and how the state is accommodating them in the Philadelphia Inquirer article “A huge spike in Medicaid enrollment in Pa. shows how devastating the coronavirus has been.”

2021-03-24T06:00:57+00:00March 24th, 2021|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off on COVID Drives Major Increase in PA Medicaid Enrollment

PA Health Law Project Newsletter

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

Included in this month’s edition are articles about:

  • How the renewal of the federal COVID-19 public health emergency declaration extends key Medicaid protections.
  • State planning for children with complex needs.
  • State efforts to connect people to COVID-19 testing and care.
  • An upcoming webinar about challenging Medicaid and Community HealthChoices waiver service denials.

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

2020-11-17T15:00:32+00:00November 4th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off on PA Health Law Project Newsletter

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.

2020-10-08T06:00:21+00:00October 8th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid|Comments Off on PA Health Law Project Newsletter

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.

2020-08-05T06:00:27+00:00August 5th, 2020|HealthChoices, long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off on PA Health Law Project Newsletter

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.

House Chamber of the State HousePA 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.

Safety-Net Association of Pennsylvania logoInfection 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.

2020-03-19T15:44:02+00:00March 19th, 2020|Coronavirus, COVID-19|Comments Off on COVID-19 Update: March 18, 2020

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.

2020-03-05T06:00:11+00:00March 5th, 2020|Federal Medicaid issues, HealthChoices, Pennsylvania Medicaid, Pennsylvania proposed FY 2021 budget|Comments Off on PA Health Law Project Newsletter

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.”

 

2019-12-31T06:00:53+00:00December 31st, 2019|Pennsylvania Medicaid policy|Comments Off on PA Introduces Medicaid PDL on January 1

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.

2019-11-14T06:00:50+00:00November 14th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off on DHS Unveils Strategic Plan

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 booksThe 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.

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