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PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its February 2022 newsletter Health Law News.

Included in this month’s issue are articles about:

Changes in the Community HealthChoices program.
Pennsylvania’s plan for using American Rescue Plan money to address the shortage of health care workers.
A new enrollment period on Pennie, the state’s new health insurance exchange.
Medicaid coverage of home COVID-19 tests.

Read about these subjects and more in the Pennsylvania Health Law Project’s February 2022 newsletter.

jsteinbock2022-02-28T16:32:18+00:00March 1st, 2022|HealthChoices, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for the Week of February 7-11

The following is an update of selected state health policy developments in Pennsylvania for the week of February 7-11, 2022. (Some of the language used below is taken directly from state documents.)

Proposed State FY 2023 Budget

This week Governor Wolf proposed his state budget for FY 2023. Pennsylvania will go into FY 2023 with a budget surplus of approximately $3 billion and more than $2 billion in unspent federal American Rescue Plan Act (ARPA) funds. Health care highlights include a $91 million increase in Medicaid rates for skilled nursing facilities; a $37 million increase in funding for county mental health services; and $325 million in ARPA fund spending for long-term care recruitment and retention, health care workforce development, behavioral health workforce expansion, and loan forgiveness for critical care workers (highlighted here).

The proposed state funding for the Department of Human Services is nearly $4 billion more than the current fiscal year’s total, though much of that reflects increased spending attributable to the loss of enhanced federal matching funds. Proposed spending increases include:

rate increases for HealthChoices, Community HealthChoices, and CHIP managed care plans
increased Supplemental Nutrition Assistance Program benefits
increased supplemental payments to personal care homes
increased county mental health funding
reducing the waiting list for intellectual disability services
expanding court-appointed child special advocates
expanding access to evidence-based home visiting programs (for parents of young children).

The budget also assumes a slight decrease in Medicaid spending attributable to the expectation that once the COVID-19 public health emergency officially ends states will be required to redetermine eligibility for the program – they are not permitted to do this during the emergency in exchange for additional federal assistance – and that Pennsylvania’s Medicaid enrollment will then be reduced. The budget assumes a smaller increase in CHIP spending for the same reason.

For further information, find Wolf administration budget documents here and a summary of the proposed Department of Human Services budget here.

Governor Wolf

Governor Wolf signed House Bill 1082 into law on Wednesday following its unanimous passage by the House and Senate. Act 9 of 2022 directs the Department of Health to establish and maintain an “Early Detection and Diagnosis of Alzheimer’s Disease or a Related Disorder” toolkit that includes best practices and cognitive assessment tools, including the use of appropriate diagnostics, to assist the primary care workforce with the detection, diagnosis, treatment, and care planning for individuals with Alzheimer’s disease. It also makes a technical change in the definition of “High Medical Assistance hospital” in Act 2 (House Bill 253) to align it with the legislation’s original intent.

Governor Wolf signed Senate Bill 739 following its unanimous passage in the House and Senate. Act 10 of 2022 appropriates $25 million in American Rescue Plan Act funding to support Pennsylvania’s emergency management services (EMS) companies. A press release issued by the governor’s office can be viewed here.

General Assembly

The state House and Senate convened for voting session this week. The following is a selection of health-related bills that received consideration.
- House Bill 1440 passed on third and final consideration by a vote of 132 to 67. This bill provides for the regulation and licensure of medical imaging and radiation therapy professionals. It will now be sent to the Senate.
- House Bill 19, which creates professional licensure for behavior analysts, passed on third and final consideration by a vote of 134-66. The bill was received in the Senate and referred to the Consumer Protection and Professional Licensure Committee.

The House Health Committee convened on Monday, February 7 and favorably reported House Bill 1741, which allows for the prescribing and dispensing of off-label drugs to treat COVID-19, and House Bill 1693, which requires nursing home residents to be notified at the time of their admission that they have the option of having legal representation to assist with applying for Medicaid benefits.
The Senate Health & Human Services Committee met on Wednesday, February 9 and favorably reported Senate Bill 1057, which enables pharmacists to be reimbursed for administering COVID-19 antigen tests.
The House Appropriations Committee will begin budget hearings next Tuesday, February 15. The Senate Appropriations Committee will begin budget hearings the following week, on February 22. The hearing schedules can be viewed here.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin informing providers that Chartwell Pennsylvania will be the preferred specialty pharmacy in the Medicaid fee-for-service specialty pharmacy drug program effective July 1 and explaining to providers how to access drugs included in that program. The bulletin applies to pharmacies and prescribers enrolled in Medicaid that serve participants in the fee-for-service delivery system. Find the bulletin here.
DHS has updated the Medicaid program fee schedule to include a CPT code for dispensing the oral antiviral therapeutics Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) and molnupiravir capsules for treatment of COVID-19. Learn more, including the new CPT code, in this Pennsylvania Bulletin notice, which also includes information about submitting comments in response to this action. Such comments are due within 30 days.
DHS has released the minutes of the January 27 meeting of the Medical Assistance Advisory Committee meeting. Find them here.

Department of Health

The Department of Health (DOH) has updated its infection prevention and control recommendations for health care settings during the COVID-19 pandemic. The update reflects a recent revision in the CDC’s guidance. Find the state update here.

DOH has updated its information about state-sponsored COVID-19 testing sites in Berks, Blair, Centre, Clinton, Clearfield, Fayette, Monroe, Somerset, and Venango counties and its map of additional testing sites around the state. Learn more in this DOH news release.

COVID-19: By the Numbers

Daily COVID-19 case counts remain very high but fell significantly again over the past week. Pennsylvania’s seven-day average yesterday (February 10) was 5163 cases day; a week ago (February 3) its seven-day average was 8512 cases a day.
To date, Pennsylvania has experienced more than 2.7 million cases of confirmed or probable COVID-19.
The number of new COVID-19-related deaths also remains very high but declined slightly over the past week. Pennsylvania’s seven-day average yesterday (February 10) was 119 deaths a day; a week ago (February 3) its seven-day average was 135 deaths a day.
To date, more than 42,000 Pennsylvanians have died from COVID-19.
The Department of Health reports that the percentage of available adult ICU beds rose from 18.9 percent to 23.6 percent during the past week but the percentage of available pediatric ICU beds fell slightly, from 14.4 percent to 14 percent, over the same period of time.
The Department of Health also reports that that in approximately 17.3 percent of all staffed adult ICU beds are COVID-19 patients this week, down from 22.1 percent last week, and that 27.6 percent of all ventilators in the state are currently in use, down from 30.6 percent last week.
All 67 Pennsylvania counties continue to experience a high rate of COVID-19 transmission.
The decline in the number of new COVID-19 cases is reflected in a 36 percent decline over since February 1 in the number of Pennsylvanians hospitalized with the virus. The number of people on ventilators also has fallen 36 21 percent since the first of the month and the number in ICUs has fallen 37 percent.

Stakeholder Events

Human Immunodeficiency Virus Community Prevention Planning Committee – February 16 and 17

The Statewide HIV Planning Group will hold virtual public meetings on Wednesday, February 16 and Thursday, February 17, 2022 from 9:00 a.m. to 4:30 p.m. Learn more about the meetings and how to participate from this Pennsylvania Bulletin notice.

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

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

jsteinbock2022-02-11T21:54:18+00:00February 11th, 2022|Coronavirus, COVID-19, HealthChoices, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2023 budget|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2022 newsletter Health Law News.

Included in this month’s issue are articles about:

The implications of the federal extension of the COVID-19 public health emergency for the state’s Medicaid program.
Changes the state is planning for its HealthChoices program later this year.
The planned extension of Pennsylvania’s Medical Assistance for Workers with Disabilities Program.
An increase in the income limit for participation in the state’s PACENET program that provides financial assistance for prescription drug purchases for low-income seniors.

Read about these subjects and more in the Pennsylvania Health Law Project’s January 2022 newsletter.

jsteinbock2022-01-31T18:58:51+00:00February 1st, 2022|Coronavirus, COVID-19, HealthChoices, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for the Week of January 17-21

The following is an update of selected state health policy developments in Pennsylvania for the week of January 17-21, 2022. (Some of the language used below is taken directly from state documents.)

General Assembly

The Senate held voting sessions on Tuesday (1/18) and Wednesday (1/19) this week and passed, among other bills, Senate Bill 818, which aligns the procedures permitted in ambulatory surgery centers with those permitted by the Centers for Medicare & Medicaid Services (CMS) and eliminates the need for facilities to request an exception, and Senate Bill 861, which enters Pennsylvania into the EMS interstate compact. Both bills will now be sent to the state House.
The Senate Health and Human Services Committee convened on Tuesday and favorably reported Senate Bill 1019, which addresses COVID-19 regulatory waivers and suspensions.
The Senate Health and Human Services Committee will convene again next week on Tuesday, January 25 to consider the following bills:
- Senate Bill 152, which provides direction to the Department of Human Services on how to distribute funding intended for women’s health and family planning services.
- Senate Bill 956, a constitutional amendment that clarifies that there is not a right to an abortion or abortion funding in the state constitution.
- House Bill 1420, which directs the Department of Human Services to establish a public awareness campaign to provide information regarding the programs and services available for first responders, health care workers, and other frontline workers suffering from mental health issues related to the COVID-19 pandemic.

The Senate Aging and Youth Committee meeting previously scheduled for Tuesday, January 18 has been rescheduled for Monday, January 24 at 12:30 to consider the following bills:
- Senate Bill 936, which mandates the reporting and tracking of infants born with an addiction to opioids or other illegal substances within the state.
- House Bill 996, which requires the departments of Human Services and Health to establish protocols to permit residents of long-term-care facilities to receive visits by a member of the clergy during a disaster emergency.
- House Bill 1737, which enables a county children and youth agency to petition the court for an order to compel a drug screening when there is evidence that substance use may be a contributing cause of child abuse or neglect.

The House Professional Licensure Committee will convene on Monday, January 24 at 10:30 a.m. to consider the following bills:
- House Bill 19, which establishes professional licensure for behavioral analysts.
- House Bill 1440, which provides for the regulation and licensure of medical imaging and radiation therapy professionals.
- House Bill 1862, which preserves the COVID-19 regulatory waiver that authorizes physicians with an institutional license in a teaching hospital to serve patients at more than just two facilities in a health system.

Department of Human Services

The Department of Human Services has updated its schedule of Remittance Advice (RA) mailing dates and electronic RA delivery dates. The schedule now extends into early March.

DHS has published final notice of the assessment amount, assessment methodology, and estimated aggregate impact on nursing facilities that will be subject to an assessment under the Nursing Facility Assessment Program for FY 2022. Find that information in this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has issued a health alert outlining options for treating patients with the COVID-19 omicron variant.

DOH continues to establish new sites for COVID-19 testing, adding sites this week in Greene and Pike counties. Find information about these and other state-sponsored sites in this department news release; about plans for a new high-volume site in Hershey; and about another high-volume site in Delaware County.

DOH reports that the state has had 28,475 laboratory-confirmed flu cases and that such cases have been found in all 67 counties.

COVID-19: By the Numbers

Daily COVID-19 case counts remain very high but declined over the past week. Pennsylvania’s seven-day average yesterday (January 20) was 20,958 cases a day; a week ago (January 13) its seven-day average was 26,224 cases a day.
The number of new COVID-19-related deaths also remains very high but it, too, declined over the past week. Pennsylvania’s seven-day average yesterday (January 20) was 127 deaths a day; a week ago (January 13) its seven-day average was 120 deaths a day.
The Department of Health reports that from January 1, 2021 to January 4, 2022, 78 percent of reported COVID-19 cases were in unvaccinated or not fully vaccinated people; 85 percent of reported hospitalizations with COVID-19 as the primary diagnosis/cause of admission were in unvaccinated or not fully vaccinated people; and 84 percent of COVID-19-related deaths were in unvaccinated or not fully vaccinated people.
The Department of Health also reports that 31.8 percent of all staffed adult ICU beds are COVID-19 patients and 32.4 percent of all ventilators state-wide are in use.
All 67 Pennsylvania counties continue to experience a high rate of COVID-19 transmission.
The decline in the number of new COVID-19 cases is reflected in a seven percent decline over the past week in the number of Pennsylvanians hospitalized with the virus. The number of people on ventilators and in ICUs because of the disease held steady over the past week after two months of steeply increasing numbers.
As a result of the decline in hospitalizations, there are a slightly more unoccupied adult ICU and medical/surgical beds in the state this week. While the occupation rate of pediatric ICU beds increased just slightly, occupancy of pediatric and airborne isolation rates rose 7.6 percent and two percent, respectively, over the past week. There are still only 33 unoccupied pediatric ICU beds and 501 unoccupied adult ICU beds in the state.
On January 18 the Department of Health elaborated on some of these figures, reporting that 31.8 percent of all staffed adult ICU beds are occupied by COVID-19 patients and 32.4 percent of all ventilators state-wide are currently in use. Both numbers are almost identical to the previous week’s totals.
Media reports are mixed but suggest reason for optimism. Around the state,
- New cases are declining in Lancaster County but the decline in hospitalizations is more modest.
- The new case rate is falling significantly in the Lehigh Valley but hospitalizations are down only slightly. Even so, the city of Easton closed its city hall because of COVID-19 cases and exposures.
- Erie County hospitals have more COVID-19 patients than at any time since the pandemic began but fewer of them are dying and fewer of them are being treated in ICU beds. County health officials are concerned that many cases are not reflected in official counts.
- New case figures are stabilizing in Allegheny County but the number of infants and children hospitalized is rising.
- Both cases and hospitalizations are declining in Philadelphia and its surrounding suburban counties.

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 has issued a legislatively mandated report on the effects of the COVID-19 emergency on the state’s hospitals and health care facilities. The report notes that “Pennsylvania hospitals and health systems reported $214,055,540 in COVID-19 related expenses and revenue losses for the period July 2021 – September 2021. These expenses and revenue losses were attributable to coronavirus and used to prevent, prepare for, and respond to the coronavirus pandemic. Total COVID-19 related expenses and lost revenue reported by Pennsylvania hospitals and health systems through September 2021 (Jan 2020-September 2021) were $6,925,269,148.” The report does not reflect any offsetting state and federal funding intended to help providers with these expenses and losses. Find the report here.

Stakeholder Events

Medical Assistance Advisory Committee’s Consumer Subcommittee – January 26

The consumer subcommittee of the Medical Assistance Advisory Committee will meet virtually on Wednesday, January 26 at 1:00 p.m. Go here to register to participate.

Medical Assistance Advisory Committee – January 27

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 27 at 10:00 a.m. Go here to register to participate.

Medical Marijuana Advisory Board – January 27

The Medical Marijuana Advisory Board will hold a virtual meeting on Thursday, January 27 at 10:00 a.m. This meeting will be broadcast live through Commonwealth Media Services. Check www.medicalmarijuana.pa.gov and click on the Medical Marijuana Advisory Board tab for live streaming information on the day of the virtual meeting. Learn more from this Pennsylvania Bulletin notice.

Patient Safety Authority – January 27

The Patient Safety Authority will hold a virtual public meeting on Thursday, January 27 at 1:00 p.m. For information about how to join the meeting, see this Pennsylvania Bulletin notice.

Special Pharmaceutical Benefits Program Advisory Council – January 27

The Statewide Special Pharmaceutical Benefits Program Advisory Council will hold a public teleconference meeting on Thursday, January 27 at 10 a.m. To participate, call 412-648-8888 or 866-588-4789. The meeting ID is 487 872 318#. Learn more from this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 2

The DHS Medical Assistance Advisory Committee’s managed long-term services and supports subcommittee will meet virtually on Wednesday, February 2 at 10:00 a.m. Interested parties can join the meeting here or call in at 914-614-3221, access code 300-175-489.

Organ Donation Advisory Committee – February 3

The Organ Donation Advisory Committee will hold a virtual public meeting on Thursday, February 3 from 10 a.m. to 1:30 p.m. The purpose of this meeting is to review progress in the area of organ and tissue donation in Pennsylvania, recommend education and awareness activities, recommend priorities in expenditures from the Organ and Tissue Donation Awareness Fund, and advise the acting secretary on matters relating to the administration of this fund. Learn more about the meeting and how to participate in this Pennsylvania Bulletin notice.

Office of Long-Term Living – Financial Management Services Stakeholder Meeting – February 4

The DHS Office of Long-Term Living’s financial management services stakeholder group will hold a virtual public meeting on Friday, February 4 at 1:00 p.m. to discuss upcoming changes for the administration of financial management services under the Community HealthChoices, OBRA Waiver, and Act 150 programs. Go here to participate or join by phone at 1-408-418-9388.

Human Immunodeficiency Virus Community Prevention Planning Committee – February 16 and 17

The Statewide HIV Planning Group will hold virtual public meetings on Wednesday, February 16 and Thursday, February 17, 2022 from 9:00 a.m. to 4:30 p.m. Learn more about the meetings and how to participate from this Pennsylvania Bulletin notice.

jsteinbock2022-01-21T22:25:57+00:00January 21st, 2022|Coronavirus, COVID-19, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

Group Looks at Health Care for Children in PA

Pennsylvania Partnerships for Children has released a report detailing various aspects of the health of children in Pennsylvania.

Among the subjects addressed in the group’s report 2021 State of Children’s Health Care in Pennsylvania: Health Insurance During the COVID-19 Pandemic are the increase in the number of insured children in the state as a result of the current public health emergency; the impact of the pandemic on children receiving their childhood immunizations; the major role Medicaid and the Children’s Health Insurance Program (CHIP) play in insuring children in the state; the implications of the end of the declared public health emergency; and more.

The report also looks at steps that could be taken to reduce health care disparities in Pennsylvania.

Learn more from this news release and Pennsylvania Partnerships for Children’s new report 2021 State of Children’s Health Care in Pennsylvania: Health Insurance During the COVID-19 Pandemic.

jsteinbock2021-11-10T16:17:47+00:00November 9th, 2021|COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus|Comments Off

HealthChoices Procurement Again Mired in Litigation

For the past six years Pennsylvania has been trying to rebid its HealthChoices Medicaid managed care contracts but every time it does, the losing bidders sue the state and the procurement process grinds to a halt.

Three times since 2015 the state has issued requests for proposals from managed care companies and all three times at least one of the losing parties has responded to its defeat by filing a lawsuit.

This is happening, many believe, because the state’s Medicaid managed care contracts are so lucrative – a stark contrast with state Medicaid payments to providers, which are generally considered poor.

The matter is now in the state’s Commonwealth Court, and the stakes are great: the contracts are for five years, with a possible option for another three.

The Philadelphia Inquirer has taken a look at the challenges that have prevented Pennsylvania from awarding new HealthChoices Medicaid managed care contracts in the article “Insurers want Pa.’s Medicaid business so badly they keep suing the state.”

jsteinbock2021-07-07T19:42:10+00:00July 7th, 2021|HealthChoices, Pennsylvania Medicaid|Comments Off

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.

PA Safety Net Admin2021-05-06T11:13:13+00:00May 6th, 2021|Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

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.”

PA Safety Net Admin2021-03-24T06:00:57+00:00March 24th, 2021|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off

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.

PA Safety Net Admin2020-11-17T15:00:32+00:00November 4th, 2020|Coronavirus, COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

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

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