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PA Health Policy Update for November 14

The following is an update of selected state health policy developments in Pennsylvania from November 10 – November 14 (Some of the language used below is taken directly from state documents). 

Budget Update

After a stalemate lasting 135 days, the General Assembly has passed a comprehensive Fiscal Year (FY) 2025-2026 budget. The state House of Representatives passed Senate Bill 160 – the General Appropriations Act – by a vote of 156-47. Senate passed it by a vote of 40-9. 

In total, the FY 2025-2026 budget spends $50.1 billion, which represents a $2.3 billion or 4.7 percent increase over the prior fiscal year. It is nearly $1.4 billion less than the budget proposed by Governor Shapiro in February. The budget is balanced primarily by utilizing prior-year funding lapses and special fund balances in state agencies totaling $3 billion. Using these funds in the 2025-26 budget prevented draining the state’s emergency reserves in the Rainy Day Fund, while leaving more than $200 million in the fund’s balance.

The budget includes a new Working Families Tax credit program. However, it does not include many of the spending initiatives highlighted in the governor’s proposal, such as additional mass transit funding, taxation for skill games, minimum wage increases, or legalization and taxation of recreational adult use cannabis. Also part of the deal includes the Commonwealth ending its participation in the Regional Greenhouse Gas Initiative.

In addition to the General Appropriations Bill, the General Assembly also passed code bills related to the budget and its enactment. House Bill 416 is an amended Fiscal Code which includes various instructions to help effectuate passage of the budget bill. House Bill 749 is an update to the Human Services Code which includes several policy provisions below:

  • Regulatory alignment with federal rules on MA reimbursement for behavioral health in telehealth settings – the “Four Walls” Requirement,
  • Requires DHS to report to the General Assembly on SNAP recipient data and lottery winnings, resources, and vehicles owned by public assistance recipients
  • Crosschecking MA and SNAP beneficiaries with data from DOH’s Vital Records system and wage records from the Department of Labor & Industry
  • Requires DHS to study the feasibility of a brokerage model for nonemergency Medical Transportation Services
  • Allows indefinite suspension of MA benefits for incarcerated individuals while incarcerated, among other provisions.

General Assembly

On Monday, November 17th, the House Human Services Committee will hold an informational hearing on the federal SNAP changes in HR 1 and their impacts on Pennsylvania. The livestream link will be made available here.

The House Health Committee will meet on Tuesday Nov. 18th to consider HB 1652 and HB 1715. Both bills would amend the Newborn Child Testing Act to update newborn screening requirements to include Gaucher Disease (HB 1652) and Duchenne Muscular Dystrophy (HB 1715), respectively.

Department of Health

The Department issued a Health Alert Network notice urging providers’ awareness for Acute Flaccid Myelitis through late Fall.

DOH updated the residency criteria for the Chronic Renal Disease Program effective November 15, 2025. 

Department of Human Services

DHS is launching Human Services Helpers, a Substack that will cover updates on DHS programs, news from the agency, and how organizations and partners can help their communities.

The Department has announced it has restarted issuing full November Supplemental Nutrition Assistance Program (SNAP) benefit payments.

DHS shared a suicide prevention resource guide in recognition of National Suicide Prevention Month.

The Department released a Medical Assistance Bulletin with revisions to the MA Fee Schedule and prior authorization requirements.

The Department issued an updated Preferred Drug List which will be effective Jan. 1, 2026.

DHS released MA Bulletins on updated prior authorization policies for several drug classes in response to recommendations from the Pharmacy and Therapeutics Committee.

The Department released an updated Managed Care Directory. 

Stakeholder Meetings

The Department of Health’s Statewide HIV Planning Group will hold their public meeting on Wednesday Nov. 19th and Thursday November 20th both from 9am-3pm.

The DHS Medical Assistance Advisory Committee plans to meet December 4th at 10am. You can register for the meeting here.

The Patient Safety Authority will hold a virtual public meeting on Tuesday, December 9, 2025, at 1 p.m. Find registration and details here. 

Federal Update

Click here for a review of this week’s federal activities.

2025-11-14T21:03:25+00:00November 14th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget, Pennsylvania state budget issues|Comments Off on PA Health Policy Update for November 14
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PA Health Policy Update for November 7

The following is an update of selected state health policy developments in Pennsylvania from November 3 – November 7 (Some of the language used below is taken directly from state documents). 

General Assembly and Budget Update

After Pennsylvania’s judicial and local election this past Tuesday, four members of the PA House won local elected offices which will require special elections early next year following their respective swearing-in to those offices. As Rep. Lou Schmitt, winner of a county judicial race indicated, “People were focused on the election… Now that the election is out of the way, people can go back to policy.” The House and Senate will have the opportunity to do so when both chambers are set to return on November 17th.

On Monday, November 10th at 10am, the Senate Democratic Policy Committee will hold a public hearing on supporting home care workers and consumers. The hearing can be streamed live here.

Department of Health

The Department’s Special Pharmaceutical Benefits Program released their approved covered drug list in their October Advisory Council meeting which will take effect on December 1st. The Department also updated its list of Medicare Part C and D plans with premium payment agreements with SPBP for 2026. 

Department of Human Services

DHS has issued helpful guidance and information to assist individuals in understanding the federal SNAP work requirements instituted earlier this fall.

DHS released MA Bulletins on updated prior authorization policies for several drug classes in response to recommendations from the Pharmacy and Therapeutics Committee.

State Board of Medicine

The State Board of Medicine shared Education and Volunteer Services proposed regulations to add new mandatory education requirements and clarify the process for a volunteer license. 

Stakeholder Meetings

The Department of Health’s Statewide HIV Planning Group will hold their public meeting on Wednesday Nov. 19th and Thursday November 20th both from 9am-3pm.

DOH’s Infant Hearing Screening Advisory Committee will meet on Thursday Nov. 13th from 10am – Noon.

The DHS Medical Assistance Advisory Committee plans to meet December 4th at 10am. You can register for the meeting here. 

Federal Update

Click here for a review of this week’s federal activities.

2025-11-07T20:33:35+00:00November 7th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania state budget issues|Comments Off on PA Health Policy Update for November 7
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PA Health Policy Update for September 12

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

Budget Update 

The state budget impasse continues, more than ten weeks past the constitutional deadline. Senate Majority Leader Pittman told reporters this week that he is “encouraged by the meaningful work at the negotiating table” but there is no agreement on a final budget at this time. Various potential budget-related bills continue to be positioned in order for a completed budget to be passed within a few days of a budget deal being reached.  The Senate stands in recess to the call of the President Pro Tempore and the House stands adjourned until Monday, September 22, 2025 unless sooner recalled by the Speaker.

General Assembly

The Senate met for voting session this week. The following is a summary of health care related legislative activity:

  • The Senate passed SB 381 that would prohibit the use of commonwealth funding for certain animal testing activities in research facilities. The bill will be sent to the House for consideration.
  • The Senate Consumer Protection and Professional Licensure committee favorably reported SB 507 with amendments. The bill provides for licensure of certified midwives, allows them to prescribe treatment for opioid use disorder, and seeks to modernize the collaborative agreement structure for midwives.

Independent Regulatory Review Commission 

The Independent Regulatory Review Commission (IRRC) issued comments on the State Board of Nursing’s proposed regulations for the certified registered nurse anesthetists. See IRRC’s comments in this Pennsylvania Bulletin notice. The nursing board is required to address IRRC’s comments and questions when issuing its final form regulations.

Department of Human Services 

The Department of Human Services (DHS) updated its list of Remittance Advices with information on a new ADA claim form that should be used for dental claims with dates of service after November 1, 2025. See the alert here.

DHS issued its 2024 Annual Report from the Bureau of Human Services Licensing, which licenses personal care homes and assisted living residences. The report shows data on the number of facilities, patient census and demographics, and facility incidents and complaints. Click here for the full report.

The Office of Long-Term Living is accepting statements of interest from new and existing Living Independence for the Elderly (LIFE) program operators to serve 12 counties that do not yet have LIFE program services available for seniors age 55 and older. Click here to view the announcement in the Pennsylvania Bulletin with instructions on how to request information about the application and evaluation process.

DHS issued an Medical Assistance Bulletin with updates to the Dental Fee Schedule. These updates include revised frequency and unit limitations for several codes as well as a change in age limits for two codes. These changes are considered effective as of August 1, 2025. 

Around the State  

  • An article from the Penn Capital Star explores the ways in which health care providers in Pennsylvania are already responsibly using artificial intelligence (AI) amid discussions from lawmakers to introduce legislation to regulate AI use in health care.
  • ABC27 describes the geographic split that may be compounding the political split between legislative leaders as the budget impasse wears on. With caucus leaders from opposite sides of the commonwealth and regional transit funding issues at the core of negotiations, “There’s no question geography of the membership and leadership members has played a role,” said Senate Minority Leader Jay Costa (D-Allegheny).
  • Though it is not an unusual financing move for many school districts, the Philadelphia district this week voted to borrow up to $1.55 billion (WHYY) to support services during the state budget impasse. Because of the lack of state and federal funds, this year’s borrowed amount is $1 billion more compared to previous years, costing millions more in interest payments for the district.

Stakeholder Meetings

Medical Assistance Advisory Committee (MAAC) – Sept. 25

The DHS Medical Assistance Advisory Committee will meet virtually on September 25, 2025, at 10:00am. To register, click here.

Department of Drug and Alcohol Programs Emerging Drug Trends Symposium – Nov. 18 

DDAP will host its 2025 Emerging Drug Trends Symposium on November 18 from 7:00am to 4:00pm at the Penn Harris Hotel & Conference Center in Camp Hill, PA. Attendees will discuss the latest drug use and overdose trends in PA, shifting overdose patterns and drug supply, and evidence-based best practices. Click here to register for this free event.

2025-09-12T21:51:32+00:00September 12th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off on PA Health Policy Update for September 12
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PA Health Policy Update for September 5

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

Fiscal Year 2025-26 Budget Update 

There was no legislative activity surrounding the state budget this week. Governor Shapiro sent a compromise budget proposal to Senate Republican leadership last week, but they have yet to take any action. The Senate is scheduled to return to session next week on September 8, but that date could be pushed back if an agreement is not ready.

The House stands adjourned until September 22.

Department of Health

The Department of Health (DOH) issued interpretative guidance to clarify staffing regulations for hospitals, allowing for flexible physician coverage models while maintaining patient safety and regulatory compliance. It focuses on on-site, on-call, and telemedicine-based physician coverage requirements. Review the full document here. 

Department of State

The State Board of Pharmacy met this week and voted to approve four new entities as “competent authorities” to issue guidelines for licensed pharmacists under 49 PA Code § 27.403 on the use of injectable immunizations. This action was taken in anticipation of changes from the Centers for Disease Control’s upcoming vaccine committee meeting and will permit pharmacists to continue providing COVID-19 vaccinations, which had been paused by some providers. Find a news release about the voting meeting here.

Department of Human Services 

The Department of Human Services (DHS) updated its list of Remittance Advices with an updated participating drug company list for the Medicaid Drug Rebate Program. Find the updated list here.

The Offices of Long-Term Living and Medical Assistance Programs issued a Medical Assistance bulletin alerting providers that it will begin issuing electronic visit verification (EVV) alerts to providers whose EVV manual entry percentages exceed 15 percent for the previous quarter. These alerts will be sent directly by DHS for fee-for-service claims and the department will transmit a list of noncompliant providers to the appropriate managed care organizations for awareness and follow up.

The Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) Letter jointly developed by CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA). This SHO provides guidance to states on the best practices for implementing the continuum of crisis services. It describes specific Medicaid and CHIP authorities and flexibilities to support the full continuum of crisis response services and suggests strategies for measuring and monitoring crisis response services. 

Pennsylvania Health Care Cost Containment Council (PHC4)

PHC4 released a new interactive map displaying access to care in different counties, called MAPPED 2. This resource includes hospitals, ambulatory surgery centers, and nursing homes. It was designed to help patients, legislators, and health care providers learn more about the health care landscape of Pennsylvania. 

Around the State  

  • A Philadelphia judge has directed SEPTA to immediately reverse all service cuts imposed last month. WHYY reports on the decision in this article.
  • The Penn Capital Star reported on the state pharmacy board’s decision this week to permit additional professional organizations to issue guidance for immunizations.
  • An article from the Altoona Mirror details the financial strain and difficult decisions that are facing county providers and non-profits now that the state budget is two months late. 

Stakeholder Meetings

DHS Statewide Positive Approaches & Practices Conference – September 17

This quarterly meeting is jointly hosted by The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP). It aims to provide the most recent research and resources for people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities to live an everyday life. The meeting is held virtually from 10am to 3pm. For details and registration, click here.

Dual Diagnosis Professional Conference Series – September 18

Jointly hosted by OMHSAS and ODP, this presentation will review the clinical clues for identifying the effects of fetal alcohol spectrum disorder, suggestions for screening, current research, and statistics. The meeting is held virtually from 9am to 12:30pm. Click here to register.

2025-09-05T19:11:23+00:00September 5th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2026 budget|Comments Off on PA Health Policy Update for September 5
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PA Health Policy Update for June 13

The following is an update of selected state health policy developments in Pennsylvania from June 9 – 13.  (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. The following is an overview of selected health care-related legislative activity that occurred this week.

  • The Senate unanimously passed Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed. The bill also places certain disclosure requirements on pharmacies related to the retail and generic versions of prescribed medications. The bill was subsequently received in the House and referred to the Veterans Affairs and Emergency Preparedness Committee.
  • The House of Representatives passed House Bill 1549, which increases the state’s minimum wages, by a party-line vote. The bill will now be sent to the Senate for consideration.
  • The House of Representatives passed House Bill 1460, which provides for more oversight of health care entity merger and acquisition activities. The bill will now be sent to the Senate for consideration.
  • The House of Representatives passed House Bill 1088, which expands maternal blood pressure monitoring coverage. The bill will now be sent to the Senate for consideration.
  • The Senate Consumer Protection & Professional Licensure Committee met on Wednesday, June 11 and favorably reported, among other bills, Senate Bills 535 & 536, which amend the Osteopathic and Medical Practice Acts to enable genetic counselors to order genetic tests as appropriate.
  • The Senate Health & Human Services Committee met on Wednesday, June 11 and favorably reported, among other bills, the following.
    • Senate Bill 461, which seeks to improve testing and insurance coverage for Lyme disease testing.
    • Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028.
    • House Bill 27, which requires operating rooms to utilize surgical smoke evacuation systems.
    • House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP).

A recording of the meeting is viewable here.

  • The House Human Services Committee met on Tuesday, June 10 and favorably reported House Bill 1100, which creates a grant program to provide eligible public-school entities with funding to acquire and distribute menstrual hygiene products, and House Bill 1590, which supports Pennsylvania’s implementation of a new federal Medicaid flexibility that waives the longstanding “four walls” requirement for outpatient behavioral health clinics. A recording of the hearing is viewable here.
  • The House Health Committee met on Tuesday, June 10 and favorably reported House Bill 1442, which places requirements on coroners to report Sudden Unexpected Death in Epilepsy (SUDEP), and House Bill 1527, which extends the Rate Disease Advisory Council’s sunset date to 2028. A recording of the meeting is viewable here.
  • The House Aging & Older Adult Services Committee met on Tuesday, June 10 for an informational hearing on the Older Adult Protective Services Act (OAPSA) and financial exploitation of older adults. A recording of the hearing is viewable here.
  • The Legislative Budget & Finance Committee (LBFC) met on Wednesday, June 11 and released its report on the effect of home and community-based workforce shortages on commonwealth-supported Medicaid waiver programs. The full report is viewable here and highlights from the report are viewable here. 

The state House of Representatives will reconvene in Harrisburg for voting on Monday, June 16. The Senate is recessed until Monday, June 23.

Department of Human Services

  • The Department of Human Services (DHS) has announced it will hold another listening session in its “Food is Medicine Stakeholder Engagement Series,” which is part of the Bridges to Success: Keystones of Health demonstration waiver. The next session, which will focus on medically tailored meals, will take place on June 16 at 1:00 p.m. Find additional information and registration details here.
  • DHS has issued a Medical Assistance Bulletin to inform providers about updates to the Statewide Preferred Drug List (PDL) related to glucose sticks made at the April 23 Pharmacy & Therapeutics (P&T) Committee meeting. The PDL changes are effective July 7, 2025.
  • DHS has announced changes to the Medical Assistance (MA) program fee schedule. The department is adding and end-dating codes as a result of the 2025 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The changes are effective for dates of service on and after June 16, 2025. Find additional information in this Pennsylvania Bulletin notice.
  • DHS has released a document with revisions to the participating drug companies list for the Medicaid Drug Rebate Program.
  • DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of July. Find the updated calendar here.
  • DHS has issued a Remittance Advice Alert regarding action needed to continue submitting claims and eligibility requests electronically with PROMISe™. 

Department of Health

The Department of Health (DOH) has published notice of intent to issue a final notice to temporarily schedule any material, compound, mixture, or preparation which contains any quantity of the several Nitazene substances. This final notice to temporarily schedule will place this group of substances in Schedule I under The Controlled Substance, Drug, Device and Cosmetic Act. 

Independent Fiscal Office

The Independent Fiscal Office (IFO) has published a budget brief highlighting Pennsylvania Medicaid enrollment and funding trends from FY 2018-19 through the administration’s proposal for FY 2025-26. It also provides projections of the impact for certain Medicaid provisions included in the federal reconciliation bill passed by the U.S. House of Representatives. 

Insurance Department 

The Pennsylvania Insurance Department (PID) has announced that the largest health insurers operating in the commonwealth are taking steps to expand coverage for medications used to treat postpartum depression and related maternal mental health conditions. Find additional information in this press release. 

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has shared an opportunity from the Health Resources and Services Administration (HRSA),  the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program. The program offers up to $250,000 in student loan repayment for eligible professionals who commit to six years of full-time work providing direct SUD treatment or recovery support at an approved facility. The program is open to a range of providers, including medical, behavioral health, and peer support professionals. Applications are due July 10, 2025. 

Around the State  

  • Spotlight PA has published an article on the potential impact of the budget reconciliation bill being considered by the U.S. Congress on the state’s Medicaid program. 
  • The Wall Street Journal has written an article about the Pennsylvania General Assembly’s efforts to enact legislation creating more scrutiny over health care entity transactions involving private equity. 
  • LancasterOnline covered Senate Appropriations Committee Chairman Scott Martin’s comments about the state budget unpredictability created federal budget discussions. 

Stakeholder Meetings

Pharmaceutical Assistance Advisory Board – June 16

The Department of Aging has announced the Pharmaceutical Assistance Advisory Board will hold a virtual meeting on Monday, June 16 from 1:00 p.m. to 2:30 p.m. Find information on how to participate in this Pennsylvania Bulletin notice. 

Patient Safety Authority – June 17

The Patient Safety Authority has announced it will hold a meeting of the Authority’s board on Tuesday, June 17 at 1:00 p.m. The meeting will be held virtually and is open to the public. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Preventative Health Services Block Grant Advisory Committee – June 17

The Preventative Health and Health Services Block Grant Advisory Committee will hold a public meeting on Tuesday, June 17 from 9:30 a.m. to 10:30 a.m. The purpose of the meeting is to present the Federal Fiscal Year 2025 Workplan and budget information. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

2025-06-13T19:46:49+00:00June 13th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations|Comments Off on PA Health Policy Update for June 13
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PA Health Policy Update for May 16

The following is an update of selected state health policy developments in Pennsylvania from May 12 – 16.  (Some of the language used below is taken directly from state documents). 

Election Update

Pennsylvania’s 2025 Primary Election will be held next Tuesday, May 20. On the ballot there are judicial candidates seeking to fill vacancies on the Commonwealth and Superior Courts, along with municipal races. Find additional election information on the Department of State’s website here.  

Governor Shapiro 

On Thursday, May 15 Governor Shapiro visited Crozer-Chester Medical Center, which is ceasing operations, in Delaware County to highlight efforts to support impacted workers, maintain emergency medical services, and “hold private equity firms accountable.” Find additional information in this press release. 

General Assembly

The state House of Representatives and Senate convened for voting session this week. The following is an overview of selected legislative activity that occurred.

  • The House of Representatives passed an amended House Bill 561, which while still prioritizing non-narcotic medication-assisted treatment (MAT) expands Act 80 to include all FDA-approved MAT. The bill will now be sent to the Senate for consideration. 
  • The House of Representatives passed House Bill 79, which establishes uniform hospital-based financial assistance forms and requirements. The bill will now be sent to the Senate for consideration. 
  • The House of Representatives passed House Bill 433, which eliminates out-of-pocket costs for diagnostic imaging related to breast cancer. The bill will now be sent to the Senate for consideration. 
  • The House of Representatives passed House Bill 309, which amends the Osteopathic Medical Practice Act to allow team physicians traveling internationally with their club or national team to treat their own players on site during games without needing a Pennsylvania medical license. The bill will now be sent to the Senate for consideration. 
  • The House Health Committee met on Wednesday, May 14 and favorably reported House Bill 704, which establishes the “Pennsylvania Neurodegenerative Disease Research Program.” A recording of the hearing is viewable here. 
  • The House Aging & Older Adult Services Committee held a joint hearing with the House Health Committee on Wednesday, May 14 regarding Pennsylvania’s registered nurse aide program. A recording of the hearing is viewable here. 
  • The Senate Banking & Insurance Committee met on Tuesday, May 13 and favorably reported Senate Resolution 27, which directs the Legislative Budget and Finance Committee to study the feasibility of establishing a no-fault catastrophic loss fund to provide payment for claims brought as the result of birth-related neurological injuries. A recording of the hearing is viewable here. 
  • The House Human Services Committee met on Tuesday, May 13 and favorably reported House Bill 1429, which requires a study on the feasibility of implementing chip-enabled electronic benefit cards (EBT) for the Supplemental Nutrition Assistance Program (SNAP). A recording of the hearing is viewable here. 
  • The Senate Veterans Affairs & Emergency Preparedness Committee met on Monday, May 12 and favorably reported, among other bills, Senate Bill 95, which permits EMS providers to leave naloxone with a caregiver of a patient who overdosed.

The House of Representatives and the Senate are now recessed until Monday, June 2. 

Department of Human Services

  • The Department of Human Services (DHS) has announced it will hold a listening session on May 19 from 1:00 – 2:30 p.m. entitled, “Food is Medicine: Screening and Referral.” This is part of DHS’ Keystone of Health Section 1115 demonstration waiver initiative. The listening session is intended for representatives from health care and other settings that interact with consumers that may be eligible for Food is Medicine programs. Find additional information and register here.
  • DHS has announced that the Office of Mental Health and Substance Abuse Services (OMHSAS) is conducting a survey, which will be the first step to begin the development of one proposed chapter of licensing regulations for inpatient psychiatric services in psychiatric units of general hospitals, private psychiatric hospitals, and extended acute care services located within those inpatient settings. The survey is for all stakeholders, including licensed providers, and will remain open until May 26. Find the survey here.
  • DHS has issued a Medical Assistance Bulletin with the U.S. Department of Health & Human Services’ (HHS) Centers for Disease Control and Prevention (CDC) 2025 recommended child and adolescent immunization schedule.
  • DHS has also issued a Medical Assistance Bulletin to advise dental providers enrolled in the Medical Assistance (MA) program that will accept the 2024 American Dental Association (ADA) claim form effective May 1, 2025.
  • DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of June. Find the updated calendar here.
  • DHS has announced the implementation of the 2025 Federal Poverty Income Guidelines (FPIG), which were issued by HHS and published at 90 FR 5917 on January 17, 2025. Find additional information in this Pennsylvania Bulletin notice. 

Around the State

  • Spotlight PA has written an article about private equity, its role in health care companies, and the scrutiny its drawing from critics. Spotlight also wrote an article about health systems’ opposition to initiatives aimed at implementing more stringent health care transaction oversight.  
  • The Pittsburgh Post-Gazette has published an article about Medicaid cuts being contemplated by Congress and their potential impact on providers in Fayette County. 
  • The Associated Press covered Governor Shapiro’s remarks about the potential impact of Medicaid proposals being considered by Congress. 
  • The Philadelphia Inquirer has reported about this what is anticipated to be this year’s biggest election issue, the retention of three sitting Pennsylvania Supreme Court justices. 

Stakeholder Meetings

DHS – Consumer Sub-MAAC – May 21

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on May 21 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – May 22

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on May 22 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

DOH – Spinal Cord Research Committee – May 23

The Spinal Cord Research Advisory Committee will hold a public meeting on Friday, May 23 from 10:00 a.m. to 11:00 a.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

2025-05-16T19:25:46+00:00May 16th, 2025|Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for May 16
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PA Health Policy Update for April 18

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

Governor Shapiro 

An arsonist attacked the Governor’s Residence in Harrisburg on Sunday, April 13, which forced the Governor and his family, who were present at the time of the attack, to be evacuated. The suspect has been arrested and formally charged with attempted murder, terrorism, and other charges. Find additional details, and the Governor’s statement on political violence, in this press release. 

General Assembly

  • The state House of Representatives and Senate were recessed this week. The House of Representatives will return to Harrisburg on Tuesday, April 22. The Senate will remain recessed until Monday, May 5.
  • The House Majority Policy Committee held an informational meeting on Monday, April 14 examining the impact of the life science sector on advanced manufacturing and health care workforce development. Find additional details and a recording of the meeting here.
  • The House Majority Policy Committee also held an informational meeting on Tuesday, April 15 examining midwifery modernization and maternal health deserts in Pennsylvania. Find additional details and a recording of the meeting here.
  • The House Insurance Committee has scheduled an informational meeting on Wednesday, April 23 at 9:15 a.m. to examine infertility care in Pennsylvania. The meeting will be held in Room 523 of the Irvis Building and livestreamed here. 

Department of Human Services

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers enrolled on the Medical Assistance (MA) program of updates to the MA program fee schedule, including the addition of new procedure codes and the end-dating of certain codes based on provider request and clinical review. These changes will take effect May 1.
  • DHS has issued a Medical Assistance Bulletin to advise federally qualified health centers (FQHCs) and rural health clinics (RHCs) of the procedure codes, modifiers, and places of service to utilize when billing for covered services provided to Medicaid beneficiaries.
  • DHS Secretary Val Arkoosh along with other health-related cabinet officials participated in the Western Pennsylvania Regional Rural Healthcare Summit to discuss opportunities and challenges communities face accessing health care services. Find more information in this press release.
  • DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of May. Find the updated calendar here. 

Department of Health 

  • The Department of Health has announced that an individual from another state tested positive for measles while visiting Lancaster County after a trip to Texas, creating a potential for exposure to others. Find additional details and information about measles from DOH here.
  • The Newborn Screening and Follow-up Technical Advisory Board had voted to recommend the addition of Metachromatic leukodystrophy (MLD), a lysosomal storage disorder, to the commonwealth newborn screening panel effective January 1, 2026. Find additional information in this Pennsylvania Bulletin notice.
  • DOH has announced it will hold four public comment sessions to provide stakeholders an opportunity to comment on the development of the 2026 State Plan for the Pennsylvania Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program). Find additional information and details on how to participate in this Pennsylvania Bulletin notice. 

Around the State  

Crozer Health’s ongoing challenges, as well as efforts to transition certain service lines were the subject of an article published by The Philadelphia Inquirer.  

PA has published an article about measles, the increasing cases nationally, and growing vaccine hesitancy. 

Stakeholder Meetings

DHS – Pharmacy & Therapeutics (P&T) Committee – April 23

The Department of Human Services (DHS) has cancelled the April 23 Drug Utilization Board meeting and will instead hold an ad hoc P&T Committee meeting. Find registration information and details here. 

DHS – Consumer Sub-MAAC – April 23

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 23 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – April 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 24 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

The Patient Safety Authority – April 29

The Patient Safety Authority board will hold a public meeting on Tuesday, April 29 at 10:30 a.m. The meeting will be held in person and virtually. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – May 2

The Brain Injury Advisory Board will hold a public meeting on Friday, May 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, 6340 Flank Drive, Harrisburg, PA 17112 in the Cumberland conference room. Find additional details in this Pennsylvania Bulletin notice.

2025-04-18T17:47:31+00:00April 18th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for April 18
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PA Health Policy Update for April 11

The following is an update of selected state health policy developments in Pennsylvania from April 7 – 11.  (Some of the language used below is taken directly from state documents). 

General Assembly

The state House of Representatives convened in Harrisburg this week. The following is an overview of selected health care-related legislative activity.

  • The House of Representatives passed House Bill 640, 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 of Representatives passed House Bill 409, which requires health care providers to inform patients that they will be receiving their test results in their electronic health record, or that they can request to receive the results in the mail. The bill will now be sent to the Senate for consideration.
  • The House Aging & Older Adult Services Committee held an informational meeting on Monday, April 7 to examine potential updates to the Older Adult Protective Services Act (OAPSA). A recording of the meeting is viewable here.
  • The House Human Services Committee met on Tuesday, April 8 and favorably reported House Bill 561, which expands Act 80 to include all FDA-approved medication assisted treatment, and House Bill 1117, which updates language defining DDAP’s duties and responsibilities. A recording of the meeting is viewable here.
  • The House Insurance Committee met on Tuesday, April 8 and favorably reported House Bill 433, which eliminates out-of-pocket costs for diagnostic imaging related to breast cancer. A recording of the meeting is viewable here.
  • The House Health Committee met on Wednesday, April 9 and favorably reported, among other legislation, the following pertinent bills. A recording of the meeting is viewable here.
    • House Bill 69, which expands the existing Cancer Drug Repository program to other prescription drugs.
    • House Bill 79, which establishes uniform hospital-based financial assistance forms and requirements.
    • House Bill 1104, which caps the costs of obtaining electronic medical records.

The House of Representatives and the Senate have now recessed. The House will reconvene Tuesday, April 22 and the Senate will reconvene Monday, May 5. 

Department of Human Services 

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to remind physicians, physician assistants (PAs), and certified registered nurse practitioners (CRNPs) enrolled in Medicaid that they are able render topical fluoride varnish (TFV) services to Medicaid beneficiaries.
  • DHS has issued a reminder to all participating Medicaid providers of the need to complete a “MA 112 Form” after the birth of a child to a mother enrolled in Medicaid in order to notify the mother’s respective county assistance office (CAO).  The “MA 112 Form” should be completed and submitted within three working days of the child’s birth.
  • DHS has published final notice of its funding allocation for FY 2024-25 for several classes of inpatient disproportionate share hospital (DSH) and supplemental payments to Medicaid-enrolled, qualifying inpatient acute care general hospitals. Find additional information in this Pennsylvania Bulletin notice. 

Around the State  

  • CBS News has published an article about the continued challenges facing Crozer Health in Delaware County. An attorney for Prospect Medical Holdings, the parent company of Crozer, indicated Crozer would start transitioning certain service lines to other providers.
  • Pennsylvania’s home care industry and its need for additional funding was the focus of an article by Politics PA this week.
  • The Pennsylvania Capital-Star has published an article about increasing measles cases in the state and some counties’ lagging vaccination rates. 

Stakeholder Meetings

DOH – WIC State Advisory Board – April 22

The WIC State Advisory Board will hold a public meeting on April 22 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. The meeting will be held in person and virtually. Find additional details and information on how to participate in this Pennsylvania Bulletin notice. 

DHS – Pharmacy & Therapeutics (P&T) Committee – April 23

The Department of Human Services (DHS) has cancelled the April 23 Drug Utilization Board meeting and will instead hold an ad hoc P&T Committee meeting. Find registration information and details here. 

DHS – Consumer Sub-MAAC – April 23

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 23 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – April 24

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on April 24 at 10:00 a.m. The meeting will be held virtually. Click here for additional information. 

DOH – Renal Disease Advisory Committee – April 25

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, April 25 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 and information on how to participate in this Pennsylvania Bulletin notice.

The Patient Safety Authority – April 29

The Patient Safety Authority board will hold a public meeting on Tuesday, April 29 at 10:30 a.m. The meeting will be held in person and virtually. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

2025-04-11T22:36:44+00:00April 11th, 2025|Governments, Medical Assistance Bulletin, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for April 11
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PA Health Policy Update for January 10

The following is an update of selected state health policy developments in Pennsylvania January 6 – 10.  (Some of the language used below is taken directly from state documents). 

General Assembly 

The General Assembly convened on Tuesday, January 7 to officially commence the 2025-2026 legislation session. Members of the state House of Representatives and Senate who were newly elected or re-elected were sworn in. In addition, the two chambers elected their respective presiding officers, adopted rules, and established standing committees.

At the conclusion of Tuesday’s legislative business, the House and Senate recessed until Monday, January 27. Following are their respective 2025 session calendars.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) has approved the remainder of the commonwealth’s request for a five-year section 1115 demonstration – Bridges to Success: Keystones of Health for Pennsylvania. You will recall Pennsylvania received approval from CMS back in November to implement multi-year continuous eligibility for Medicaid-eligible children through age six and one year of continuous coverage for Medicaid-eligible citizens returning from a state correctional facility. The Department of Human Services (DHS) has stated it, “will work through the state budget process to determine next steps for potential implementation.” Find CMS’ approval letter to DHS here. 

Department of Human Services 

  • DHS has issued updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of prescriptions for Anticonvulsants submitted for prior authorization. Find additional information in this Medical Assistance Bulletin.
  • DHS has issued a Medical Assistance Bulletin to advise providers that it has updated the Admissions Notice Packet (MA 401) form due to an increase in the personal needs allowance (PNA) deduction amount. This bulletin applies to nursing facilities, intermediate care facilities, and long-term care facilities enrolled in the Medical Assistance program. 

Insurance Department

The Pennsylvania Insurance Department (PID) has announced that 259 Pennsylvanians successfully appealed denied health service claims through PID’s new Independent External Review process. Of the total health service denials submitted for review in 2024, 50.1 percent were overturned.

PID has also shared information related to its efforts to increase health insurance transparency through several reports available to the public, including its annual Transparency in Coverage Report for ACA Health Plans, which outlines data on claims, denials, and appeal information, and its inaugural ACA and Qualified Health Plans (QHP) Summary. Find additional information in this press release.

Around the State

  • WHYY has written about the Pennsylvania Insurance Department’s external review program which received 517 health service denial appeals in 2024. 259 of those denials were overturned. 
  • City & State Pennsylvania has published an article about the General Assembly’s first session day of 2025. 
  • The Pittsburgh Post-Gazette has written an article about a study released by Pennsylvania Partnerships for Children that kids largely stayed insured despite uncertainties during the Medicaid eligibly redetermination process following the conclusion of the COVID-19 public health emergency. 

Stakeholder Meetings

DOH – WIC Advisory Board – January 14

The WIC State Advisory Board will hold a meeting on January 14 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 details on how to participate in this Pennsylvania Bulletin notice.

DHS – Consumer Sub-MAAC – January 22

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on January 22 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – January 23

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on January 23 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

DOH – Special Pharmaceutical Benefits Advisory Council – January 30

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a public teleconference meeting on Thursday, January 30 from 10:00 a.m. to 12:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

2025-01-10T20:27:58+00:00January 10th, 2025|Federal Medicaid issues, Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid|Comments Off on PA Health Policy Update for January 10
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PA Health Policy Update for January 3

The following is an update of selected state health policy developments in Pennsylvania December 23 – January 3.  (Some of the language used below is taken directly from state documents). 

General Assembly 

The state House of Representatives and Senate will convene on Tuesday, January 7 at 12:00 p.m. to swear in newly elected and re-elected members for the 2025-2026 legislative session. 

Department of Human Services 

  • The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to advise providers that the department is adding doula services to the Medical Assistance (MA) program fee schedule and will pay enrolled certified perinatal doulas beginning January 1, 2025.
  • The Office of Mental Health & Substance Abuse Services (OMHSAS) has issued a bulletin announcing the Peer Support Services (PSS) and PSS Provider Handbook has been updated to reflect the requirements for PSS. The revisions better clarify which requirements apply to OMHSAS licensure and which apply to MA payments. Additional updates include staff qualifications and requirements for certified peer specialists and their supervisors and telehealth requirements.
  • DHS has provided final notice of its intent to adjust the managed care assessment fixed fee. Effective January 1, 2025, the fee will be $30.47 per member per month. The aggregate fiscal impact for this change in FY 2024-2025 will be $208.6 million dollars in additional assessment revenue. 

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has issued comments to the Department of Human Services (DHS) regarding the transition to the Patient-Driven Payment Model (PDMP) for non-public and county nursing facilities. Find additional information in this Pennsylvania Bulletin notice.   

Revenue Collection Update 

The Department of Revenue has announced Pennsylvania collected $3.8 billion in General Fund revenue in December, which was $87.2 million, or 2.3 percent, less than anticipated. Fiscal year-to-date General Fund collections total $20.2 billion, which is $97.1 million, or 0.5 percent, below estimate.

Around the State  

  • Spotlight PA has written an article about the scrutiny, and at times, lack of transparency over how counties across Pennsylvania are spending billions of dollars in opioid settlement money.
  • Writing for The Philadelphia Inquirer, Harold Brubaker has published an article about Pennsylvania’s new law limiting noncompete agreements for health care practitioners. Brubaker also wrote an article about the success and challenges of Pennsylvania-based biopharmaceutical companies in 2024. 
  • The Pittsburgh Post-Gazette has reported that Sharon Regional Medical Center announced an agreement has been made with Tenor Health Partners to take over operations at the hospital, avoiding the anticipated January 6th closure. 

Stakeholder Meetings

DOH – HIV Planning Group – January 15

The Statewide HIV Planning Group will hold a public meeting on Wednesday, January 15 and Thursday, January 16 from 9:00 a.m. to 4:30 p.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – January 17

The Renal Disease Advisory Committee will meet on Friday, January 17 at 10:00 a.m. to discuss new and ongoing issues relating to the treatment of chronic renal disease and the department’s programs related to care and treatment. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Preventive Health Services Block Grant Advisory Committee – January 27

The Preventative Health and Health Services Block Grant Advisory Committee will hold a public meeting on Monday, January 27 from 9:00 a.m. to 11:00 a.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – February 7

The Brain Injury Advisory Board will hold a public meeting on Friday, February 7 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

 

2025-01-03T18:57:52+00:00January 3rd, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off on PA Health Policy Update for January 3
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  • 2020 Safety-Net Association of Pennsylvania

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