Pennsylvania Medical Assistance Bulletin Archives - Page 4 of 5

PA Health Policy Update for April 14

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

General Assembly

The House and Senate Appropriations Committees concluded their budget hearings this week.
- On Tuesday, April 11, the Department of Human Services appeared before the House Appropriations Committee. A recording of the hearing can be viewed here and here.
- On Wednesday, April 12, the Department of Human Services appeared before the Senate Appropriations Committee. A recording of the hearing can be viewed here and here.
- On Thursday, April 13, the Department of Health appeared before the Senate Appropriations Committee. A recording of the hearing can be viewed here.

The House Health Committee held an informational hearing Wednesday, April 12 on prescription drug affordability boards. A recording of the hearing can be viewed here.

The House Democratic Policy Committee held a public hearing Thursday, April 13 on black maternal health. A recording of the hearing can be viewed here.

The House Aging and Older Adult Services Committee held an informational hearing Thursday, April 13 on PACE/PACENET, the State Long-Term Care Ombudsman and AARP. A recording of the hearing can be viewed here.

The House Aging and Older Adult Services Committee will hold an informational hearing Thursday, April 20 at 1:00pm on The State Master Plan on Aging. The hearing will be held in Room G-50 of the Irvis Office Building and can be livestreamed here.

The House Children and Youth Committee will hold a public hearing Thursday, April 20 at 10:00am on overcrowding in Pennsylvania’s Juvenile Detention Facilities. The hearing will be held in Room 515 of the Irvis Office Building and can be livestreamed here.

The state House and Senate are currently recessed. They will return to Harrisburg on Monday, April 24.

Department of Health

The Department of Health posted new documents related to the implementation of the long-term care nursing facilities regulations that become effective July 1, 2023:

Guidance for long term care regulations (effective July 1, 2023)
LTC Licensure Regulations Provider Updates – Presentation
LTC Licensure Regulations Provider updates – slides

View these and other guidance documents on the dedicated webpage here.

The Department of Health issued a health advisory with information about the Pennsylvania Childhood Blood Lead Act that took effect on January 2, 2023, and requires certain blood lead assessment and testing for children and pregnant women. Find more information in the health advisory.

Department of Human Services

The Department of Human Services (DHS) issued a Medical Assistance Bulletin with the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention’s (CDC) Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023. This bulletin replaces the 2022 recommended vaccine schedule.

DHS issued Provider Quick Tip #41, which is an updated Medical Assistance (MA) Desk Reference with provider contacts.

DHS issued a Medical Assistance Bulletin to inform MA providers that DHS added Current Procedural Terminology (CPT) codes 0164A (Moderna, Inc.) and 0173A (Pfizer, Inc.) to the MA Program Fee Schedule for the administration of additional bivalent doses of the novel coronavirus (SARS-CoV-2) vaccines.

DHS issued a Medical Assistance Bulletin to inform providers of updates to the Emergency Medical Condition Information Eligibility form.

Around the State

The Pennsylvania Capital Star reported on the House Appropriations Committee’s examination of Governor Shapiro’s proposed FY 2023-24 budget for DHS.

The Scranton Times Tribune wrote about the continued nursing shortage in Pennsylvania and its impact on the health care system.

Spotlight PA published, “Pa. Medicaid reenrollment: What you need to know to keep your health insurance or find other options.”

Stakeholder Events

DHS – Drug Utilization Review (DUR) Board – April 26

The DUR Board will meet Wednesday, April 26 from 9:00 a.m. to 4:00 p.m. Go here for additional information and details on how to participate.

DHS – Medical Assistance Consumer Subcommittee – April 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee is scheduled to meet on April 26, 2023, at 1:00 pm. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – April 27

The Medical Assistance Advisory Committee is scheduled to meet on Thursday, April 27 at 10:00 a.m. Go here to register to participate.

Patient Safety Authority – April 27

The Patient Safety Authority’s board will meet virtually on Thursday, April 27 at 1:00 p.m. Go here for additional information and details on how to participate.

DOH – Special Pharmaceutical Benefits Program – May 4

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a public meeting on Thursday, May 4, 2023, from 10 a.m. to 3 p.m. The SPBP Advisory Council will provide program guidance and recommendations to the Department’s SPBP in regard to the following: drug formulary; covered lab services; drug utilization review; clinical programs; eligibility; and program management. Go here for additional information and details on how to participate.

DHS – Managed Long-Term Services and Supports Subcommittee – May 12

The Managed Long-Term Services and Supports (MLTSS) Subcommittee will hold a meeting on Friday, May 12 from 10:00 a.m. – 1:00 p.m. in the Department of Education Building’s Honors Suite, 1st floor, at 333 Market Street in Harrisburg, or via webinar. You may register for the webinar here.

DHS – Dual Diagnosis Conference – May 18

The Office of Developmental Programs and Office of Mental Health and Substance Abuse Services will host a state-wide Dual Diagnosis Conference virtually on May 18, 2023. The conference will include a variety of perspectives for supporting individuals who have experienced trauma. You may register here.

Pennsylvania Long-Term Care Council – 2023 Meeting Dates

The Pennsylvania Long-Term Care Council released an update list of its remaining meetings for the 2023 calendar year. Additional details may be viewed here.

PA Safety Net Admin2023-04-14T20:25:48+00:00April 14th, 2023|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Uncategorized|Comments Off

PA Health Policy Update for March 31

The following is an update of selected state health policy developments in Pennsylvania from March 27 to March 31. (Some of the language used below is taken directly from state documents.)

General Assembly

The House Health Committee met on Wednesday, March 29 and favorably reported, among other bills, House Bill 155, which removes the requirement that direct-care workers be interviewed in person for a position, and House Bill 507, which requires medical schools, teaching hospitals, and medical institutions to receive explicit patient consent for all procedures and exams performed under anesthesia by medical students or for training purposes.

The Departments of Health, Aging, and Drug & Alcohol Programs appeared before the House Appropriations Committee for their respective budget hearings this week. A recording of the hearings can be viewed here.

The House and Senate Appropriations Committees will continue budget hearings the week of April 10. A complete schedule for the House Appropriations Committee can be viewed here, and a complete schedule for the Senate Appropriations Committee can be viewed here.

The state House and Senate are currently recessed. They will return to Harrisburg on Monday, April 24 following the conclusion of budget hearings.

Department of Health

The Department of Health (DOH) is evaluating a future purchase and distribution of devices that can eliminate viruses, bacteria, mold and other pathogens from air and surfaces simultaneously. DOH would purchase and distribute the devices free of charge to small businesses, non-profit entities, and other facilities throughout the Commonwealth to mitigate the spread of COVID-19, flu, and other diseases. Long-term care facilities that are interested in receiving a device if this program moves forward should complete this application.  The application is being used to gauge interest in receiving a device and those who complete the application are not guaranteed to receive one.

In response to the Norfolk Southern train derailment in East Palestine, Ohio, DOH announced the establishment of a community-based health resource network this week to connect Pennsylvania residents impacted by the derailment with local health care providers for long-term assistance.

Department of Human Services

The Office of Medical Assistance Programs (OMAP) issued a bulletin to advise providers of additions and updates to the Medical Assistance (MA) Program Fee Schedule and the issuance of updated physician and general hospital provider handbook pages regarding the prior authorization procedures for proton therapy services. These changes are effective for dates of services on and after April 1, 2023.

The Office of Mental Health & Substance Abuse Services (OMHSAS) issued a memorandum to address stakeholder concerns about the impact of ending OMHSAS’ bulletin suspensions regarding signature requirements specific to consent for treatment, service verification, and treatment plans on March 31, 2023, and clarifying the use of audio-only for telehealth in the delivery of services licensed by OMHSAS.

Board of Nursing

The State Board of Nursing published Interpretations Regarding the Administration of Drugs-Statement of Policy in the Pennsylvania Bulletin. This statement of policy clarifies that registered nurses may administer a specific amount of conscious sedation medication during minor therapeutic and diagnostic procedures upon a written order of either a physician or a CRNP when either a physician or CRNP is present during the administration. This statement of policy is expected to eliminate confusion about CRNPs’ authority to order and supervise registered nurses’ administration of conscious sedation under certain circumstances.

Around the State

The Pennsylvania Capital-Star reported Pennsylvania long-term care facilities will share $14.2 million from the Centers for Disease Control & Prevention (CDC). The funds are intended to support workforce development, staff retention, and infrastructure improvements.

The Pittsburgh Post-Gazette wrote about the Pennsylvania Department of Health’s budget hearing this week and noted the focus on the state’s response to the East Palestine, Ohio train derailment and Pennsylvania’s post-COVID public health landscape.

A report issued by Kaufman Hall noted that hospital finances continue to struggle in the face of macroeconomic headwinds but they appear to be beginning to stabilize. Fierce Healthcare details the challenges hospitals continue to confront here.

Stakeholder Events

DOH – Medical Marijuana Advisory Board – April 12

The Medical Marijuana Advisory Board will meet on April 12, 2023, from 10:30 a.m. to 12:30 p.m. Go here for additional information and details on how to participate.

DHS – Drug Utilization Review (DUR) Board – April 26

The DUR Board will meet Wednesday, April 26 from 9:00 a.m. to 4:00 p.m. Go here for additional information and details on how to participate.

DHS – Medical Assistance Consumer Subcommittee – April 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee is scheduled to meet on April 26, 2023, at 1:00 pm. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – April 27

The Medical Assistance Advisory Committee is scheduled to meet on Thursday, April 27 at 10:00 a.m.  Go here to register to participate.

PA Safety Net Admin2023-04-05T18:10:50+00:00March 31st, 2023|COVID-19, Medical Assistance Advisory Committee, Medical Assistance Bulletin, Meetings and notices|Comments Off

PA Health Policy Update for January 20

The following is an update of selected state health policy developments in Pennsylvania from January 14-20. (Some of the language used below is taken directly from state documents.)

Governor Shapiro

Josh Shapiro was sworn in as Pennsylvania’s 48^th governor on Tuesday. Much of the governor’s inaugural speech focused on preserving democracy. He also highlighted the need for unity and emphasized bringing people together. Find a transcript of the governor’s speech here.
On Wednesday Governor Shapiro issued his first executive order, which prioritizes work experience, skill, and competency for state jobs and highlights that 92 percent of the state’s jobs do not require a four-year college degree.
Information about the Shapiro administration’s health-related agency nominees can be found here and a complete list of the Shapiro administration appointments made to date can be found here.

General Assembly

The state Senate convened for voting session this week and the House briefly convened for non-voting session. Both chambers are now recessed. The Senate is scheduled to return on Monday, February 27 while the House has yet to release a session calendar.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin rescinding Medical Assistance Bulletin 01-22-78, titled “340B Drug Pricing Program – Dispensing 340B Purchased Drugs,” which was issued on December 22, 2022. Instead, Medical Assistance Bulletin 99-13-08, titled “340B Drug Pricing Program Provider Requirements and Billing Instructions – Pharmacy Services,” remains in effect. Go here to see the new bulletin rescinding the December 22 version.
DHS has extended its calendar for Remittance Advice (RA) notifications and the delivery of electronic payments and checks into early March. Find the updated calendar here.
DHS has issued a Medical Assistance Bulletin informing providers that it has added CPT codes 0124A, 0154A (Pfizer) and 0134A, 0144A (Moderna) to its fee schedule for the administration of a bivalent booster dose COVID-19 vaccine. Find the bulletin here.
DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has written to stakeholders informing them that it has extended until March 31 its requirement that providers capture consent to treat, service verifications, and approval of treatment plans for Medicaid-funded behavioral health services delivered via telehealth. At the end of this period providers must have an electronic capability to secure auditable electronic signatures for consent and service verification. Learn more from OMHSAS’s message to stakeholders.
DHS has informed stakeholders that Jennifer (Jen) Smith has joined the department as deputy secretary for OMHSAS. Smith previously served as Secretary of the Department of Drug and Alcohol Programs. Learn more from DHS’s message to stakeholders.
DHS has posted information about an electronic submission process for Medicaid fee-for-service 180-day exception requests and other claims requiring documentation that will soon be available in the PROMISE portal. Find that information here.
DHS has updated its Medicaid managed care organization directory.
DHS has published its peer groups, peer group medians, and peer group prices for non-public nursing facilities, including hospital-based nursing facilities and special rehabilitation facilities. DHS used these peer groups, peer group medians, and peer group prices to determine case-mix rates for non-public nursing facilities for FY 2023. Learn more from this Pennsylvania Bulletin notice.
DHS has published its final annual case-mix per diem payment rates for FY 2023 for non-public and county nursing facilities that participate in the Medical Assistance program. Learn about those rates from this Pennsylvania Bulletin notice.

Department of Health

The Department of Health (DOH) has updated its telemedicine interpretive guidance for hospitals. Find the updated guidance here.
DOH has updated its FAQ on innovative care models for hospitals. Find the updated FAQ here. The changes, which address critical access hospitals and small rural hospitals, are highlighted in red.
DOH has updated its criteria and guidance for establishing an outpatient emergency department. The changes, which address critical access hospitals, small rural hospitals, and rural emergency hospitals, are highlighted in red. Find the updated guidance here.
DOH also has updated its matrix on how facilities can qualify as an innovative hospital model. Find the updated matrix here. Changes again are highlighted in red.
DOH has issued guidance requiring prospective new owners of skilled nursing facilities to inform facility residents, representatives, and employees of the possibility of a change of ownership of the facility. Learn more from this DOH guidance.

COVID-19: By the Numbers

The number of new COVID-19 cases reported daily in Pennsylvania declined 27 percent over the past week and the number of new daily deaths, after a 50 percent increase a week ago, returned this week to its level of recent months.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 declined nearly 14 percent last week after an 11 percent decline the previous week; the number on a ventilator because of the virus rose nine percent; and the number in hospital ICUs fell six percent.
The CDC reports a five percent decrease in the seven-day average of new hospital admissions in Pennsylvania because of COVID-19 over the past week.
As of January 18, four Pennsylvania counties are experiencing a moderate rate of community transmission of COVID-19; eight counties are experiencing a substantial rate of community transmission; and the remaining 55 counties are experiencing high rates of community transmission.

Health Care Cost Containment Council (PHC4)

PHC4 is beginning the verification process for hospital self-pay records for fiscal year 2021. Its self-pay data reconciliation web application on the PHC4 portal enables hospitals to reconcile their self-pay records, which eventually will be provided to DHS to be used as a part of its calculation of the extraordinary expense portion under Act 77 (the state’s 2001 tobacco settlement law). Find PHC4’s letter to hospitals here and the portal for self-pay records here.

Stakeholder Events

Medical Assistance Advisory Committee – Consumer Subcommittee – January 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, January 25 at 1:00. Go here to register to participate virtually.

Medical Assistance Advisory Committee – January 26

The Medical Assistance Advisory Committee will meet virtually on Thursday, January 26 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – January 26

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, January 26 at 10:00. To learn more about the committee, the location of the meeting, and how to join the meeting virtually, see this Pennsylvania Bulletin notice.

Patient Safety Authority – January 26

The Patient Safety Authority will meet virtually on Thursday, January 26 at 1:00. For information about how to participate in this meeting, see this Pennsylvania Bulletin notice. Registration is required.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – January 31

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will meet virtually on Tuesday, January 31 at 9:30. For more information about the board and how to join the meeting, see this Pennsylvania Bulletin notice.

Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – February 1

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will hold a public meeting on Wednesday, February 1 at 10:00. Interested parties may attend in person or virtually. Go here for further information about the meeting, its location, and how to participate virtually.

Department of Health – Organ Donation Advisory Committee Meeting – February 2

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting on Thursday, February 2 at 10:00. The purpose of the 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 Department of Health on matters involving administration of that fund. Interested parties may attend in person or virtually. For further information about the meeting and how to attend, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – February 3

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Harrisburg on Friday, February 3 at 10:00. Meeting materials will be sent out before the meeting and will also be available on the board’s web and at the meeting location. For further information about the meeting and its location, see this Pennsylvania Bulletin notice.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – March 9

The Department of Drug and Alcohol Programs will offer a training program for adolescent service providers on two dates: March 9 and May 16, both at 8:30. This training on adolescent ASAM criteria, to be delivered virtually, is designed for participants who already understand the foundational aspects of the ASAM criteria. The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies. Continuing education credits are available. Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice. Please note that the March 9 and May 16 sessions will be identical.

Department of Drug and Alcohol Programs – Adolescent ASAM Criteria – May 16

The Department of Drug and Alcohol Programs is offering training on adolescent ASAM criteria, to be delivered virtually, for participants who already understand the foundational aspects of the ASAM criteria. The purpose of this training is to explore and discuss the adolescent-specific aspects of the ASAM criteria and offer participants a practical focus through lecture, real-world clinical vignettes, and case studies. The program will be held on May 16 at 8:30. Continuing education credits are available. Learn more about the program, including requirements for participation and how to join, from this Department of Drug and Alcohol Programs notice. Please note that this program is identical to one offered on March 9.

jsteinbock2023-01-20T21:47:06+00:00January 20th, 2023|340b, COVID-19, long-term care, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for Friday, November 4

The following is an update of selected state health policy developments in Pennsylvania for the week of October 31 to November 4, 2022. (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf signed 66 bills into law this week and vetoed one, Senate Bill 736. The following is a selection of health care-related bills signed into law by the governor.

House Bill 220, which is now Act 101 of 2022, specifies that a person does not need to test positive for drugs to begin addiction treatment.
House Bill 1393, which is now Act 111 of 2022, seeks to prevent overdose deaths by legalizing fentanyl test strips for personal use.
House Bill 2293, which is now Act 128 of 2022, requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.
House Bill 2527, which is now Act 135 of 2022, expands Pennsylvania’s “Good Samaritan” law to cover all opioid reversal medicines approved by the FDA.
House Bill 2800, which is now Act 143 of 2022, amends the Medical Practice Act to address an issue related to the licensure of prosthetists, orthotists, pedorthists, and orthotic fitters in Pennsylvania.
Senate Bill 225, which is now Act 146 of 2022, streamlines and standardizes the process for prior authorization of medical services. The Insurance Department has issued a news release about this new law.
Senate Bill 522, which is now Act 150 of 2022, requires all pregnant women and children in Pennsylvania to receive blood tests to detect lead poisoning.

General Election

The 2022 general election will be held on Tuesday, November 8. Pennsylvanians will be voting for one U.S. Senate seat, 17 U.S. House of Representatives seats, governor, half of the 50 state Senate seats, and all 203 state House seats.

Department of Health

The Department of Health (DOH) has updated its guidance to hospitals’ response to COVID-19 to reflect the October 31 expiration of the COVID-19 state regulatory waivers and flexibilities. Find the updated guidance here. At the same time, the Department of Human Services (DHS) has updated its list of regulations that have been suspended in response to the COVID-19 public health emergency. Find the updated list here and scroll down to see the latest regulation suspensions that have expired; they are highlighted in red.
DOH has issued a health advisory about the increase in the number of cases of respiratory syncytial virus (RSV) nationally and in the state. The alert describes the virus, outlines testing and treatment recommendations, and asks providers to report laboratory-confirmed RSV cases to DOH through Pennsylvania’s electronic reportable disease surveillance system, PA-NEDSS. It also urges providers to report outbreaks or clusters of severe respiratory illness, regardless of etiology, to the state and local health departments. Find the advisory here.
DOH has issued a news release outlining the changes in the state’s regulations for skilled nursing facilities that have been approved by Pennsylvania’s Independent Regulatory Review Commission and now await review by the state’s Attorney General.
DOH has released a request for applications for its Long-Term Care Quality Investment Pilot, which will distribute approximately $11.7 million in federal funds to long-term-care facilities, including skilled nursing facilities, personal care homes, assisted living facilities, and intermediate-care facilities for the purpose of building resilience. These funds are designed to be invested in key areas such as workforce development and retention, infection prevention control, emergency preparedness, and improvements to facility infrastructure. To apply for this funding, facilities must participate in the state’s LTC RISE program’s quality improvement projects and cannot be located in Philadelphia. Find the state’s request for applications here and learn about LTC RISE here. The application deadline is December 31.

Department of Human Services

The Department of Human Services (DHS) announced that Pennsylvania has received approval from the federal Centers for Medicare & Medicaid Services (CMS) to extend its postpartum coverage period for mothers and birthing people eligible for Medicaid because of their pregnancy from 60 days to 12 months. Learn more from this DHS news release.
DHS has extended into early January of 2023 its Remittance Advice calendar for mailing checks and electronically sending Medicaid payments. Find the updated calendar here.
In response to the passage and signing of House Bill 1630 (now Act 98), which addresses, among other things, the delivery of some mental health and substance use services, DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS) has written to stakeholders to advise them of some of the new law’s implications and to list the sections of the Pennsylvania Code the new law repeals. Find the OMHSAS message to stakeholders here.
DHS has issued a Medical Assistance Bulletin advising providers who are not a recognized provider type under the Medical Assistance program that they now may enroll in the program for the purpose of billing for cost-sharing for services provided to beneficiaries who receive both Medicare and Medicaid. This bulletin also provides information on how to complete and submit an enrollment application. Find the bulletin here.
DHS has added a procedure code to the Medical Assistance fee schedule for the administration of a booster dose of the Moderna COVID-19 vaccine. Learn more from this Pennsylvania Bulletin notice.
DHS has issued Medical Assistance Bulletins addressing requirements for prior authorization and the type of information needed to evaluate the medical necessity of prescriptions for:

These requirements take effect on January 9, 2023.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases reported in Pennsylvania over the past week rose 12 percent after a decline of 12 percent the week before; the number of deaths rose slightly. The state is averaging more than 1800 new reported cases a day and about 19 daily deaths.
According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19 and on ventilators because of the virus remains relatively steady but the number in hospital ICUs (172) is at its highest level since early March.
The CDC reports a modest increase in the seven-day rolling average of new daily COVID-19 hospital admissions after a 15 percent decrease last week.
As of November 4, 54 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 13 are experiencing substantial rates of community transmission; and Cameron County is experiencing a moderate rates of community transmission.

Stakeholder Events

Department of Health – State Child Death Review Team – November 9

The Department of Health’s State Child Death Review Team will hold a public meeting in Harrisburg on Wednesday, November 9 at 10:00. The state’s Child Death Review Program provides training and technical assistance to local Child Death Review teams. This meeting will focus on suicide deaths. For information about the location of the meeting and the Child Death Review Team, see this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee – December 7

The managed long-term services and supports subcommittee of DHS’s Medical Assistance Advisory Committee will meet in Harrisburg on Wednesday, December 7 at 10:00. Interested parties can join the meeting in person or via webinar. For information about the location of the meeting and how to join virtually, see this DHS notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – December 7

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, December 7 at 1:00. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – December 8

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, December 8 at 10:00. Go here to register to participate.

jsteinbock2022-11-04T20:15:28+00:00November 4th, 2022|COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus|Comments Off

PA Health Policy Update for Friday, October 21

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

General Assembly

The state Senate convened for session this week. The following is an overview of selected health-related legislation that received consideration.

The Senate passed on third and final consideration Senate Bill 1330, which requires insurance coverage for genetic counseling and genetic testing for the BRCA1 and BRCA2 gene mutation if a person is diagnosed with breast or ovarian cancer or has a family history of breast or ovarian cancer. The bill was received in the House and referred to the Insurance Committee.
The Senate passed Senate Bill 1225, which provides enhanced coverage of MRIs and ultrasounds for women with certain risk factors. The bill was received in the House and referred to the Insurance Committee.
The Senate Health & Human Services Committee met on Tuesday, October 18 and favorably reported the following bills.
- Senate Resolution 352 requires the Joint State Government Commission to study the specific data, calculations, and mechanisms the Department of Human Services uses to determine the capitation rate paid to drug and alcohol treatment providers in Pennsylvania.
- Senate Bill 359 requires the Secretary of DHS to apply for a waiver that would extend Medicaid coverage for pregnancy-related and postpartum medical assistance for up to ten additional months.
- Senate Bill 1136 amends the Vital Statistics Law to expressly include the Legislative Budget and Finance Committee as a government entity and to clarify that it may have access to vital statistics for research purposes.
- Senate Bill 1358 places certain restrictions on non-compete clauses for health care practitioners and requires patient notification.
- House Bill 293 allows FDA-approved anti-obesity drugs to be considered a compensable service under the state’s Medicaid program.
- House Bill 1443 permits certain diagnostic laboratory services to be directly marketed to Pennsylvania consumers.
- House Bill 1630 and Senate Bill 917 grant the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid.
- House Bill 2293 requires the registration and oversight of contract health care service agencies that provide temporary employment in certain health care facilities.
- House Bill 2357 prohibits the preparation, manufacture, sale, or distribution of unsafe kratom products and the sale or distribution of kratom products to individuals younger than 21 years of age.
- House Bill 2530 ends the practice of prudent pay in DHS’s Office of Developmental Programs.
The Senate Consumer Protection & Professional Licensure met on Tuesday, October 18 and favorably reported, among other bills, House Bill 2800, which amends the Medical Practice Act to address an issue related to the licensure of prosthetists, orthotists, pedorthists, and orthotic fitters in Pennsylvania.

The Senate Aging & Youth Committee met on Tuesday, October 18 and favorably reported House Bill 2425, which requires the Department of Health or Department of Human Services to report allegations of older adult abuse to local area agencies on aging and the Department of Aging.
The state House and Senate will convene for voting session next Monday (10/24), Tuesday (10/25), and Wednesday (10/26).

Department of Human Services

The Department of Human Services (DHS) has extended its calendar for issuing Medical Assistance remittance advice notifications, mailing checks, and making electronic transfers into early December. Find the updated calendar here.
DHS has published a Medical Assistance Bulletin to inform Medical Assistance providers that it has added CPT code 0094A to the Medical Assistance program fee schedule for the administration of a booster dose of the Moderna COVID-19 vaccine. Find that bulletin here.
DHS has announced the addition of new procedure codes to the Medical Assistance fee schedule for the administration of a pediatric booster dose or a pediatric dose of Pfizer and Moderna COVID-19 vaccines. Find the codes, the payment rates, and the effective dates of the new codes in this Pennsylvania Bulletin notice.
DHS has published a final notice of its funding allocation for FY 2021-2022 to establish a new class of supplemental payments to promote the continuation of quality medical services to individuals enrolled in the Pennsylvania Medical Assistance program and provide financial relief to hospitals during the COVID-19 pandemic. DHS is not otherwise changing the qualifying criteria or payment methodology for these payments. The FY 2021-2022 impact of these payments is $70 million in total funds. Learn more from this Pennsylvania Bulletin notice.
DHS has published a final notice of its funding allocation for FY 2021-2022 to establish a new class of supplemental payments to qualifying acute-care general hospitals that provide a high volume of services to Medical Assistance-eligible and low-income populations in non-rural medically underserved areas. The FY 2021-2022 budget impact of these payments is $5.283 million in total funds. Learn more from this Pennsylvania Bulletin notice.
DHS has announced that the Pennsylvania Patient and Provider Network (P3N), the statewide federated health information exchange, has successfully transitioned to a new, cloud-based system that it believes will improve health care delivery across the state. The P3N is a centralized platform that connects independent health information organizations (HIOs) and facilitates information-sharing, connecting health care providers that participate with the goal of improving care coordination and outcomes for patients. Providers connected to a P3N-certified HIO can find patient medical records anywhere on the P3N network and receive notifications when their patients obtain services from other providers in the state, such as an emergency room visit. Learn more about the new system and its capabilities from this DHS news release.
Kristen Houser has resigned as deputy secretary of DHS’s Office of Mental Health and Substance Abuse Services (OMHSAS). Dr. Dale Adair will serve as acting deputy secretary.

COVID-19: By the Numbers

According to the CDC, the number of new COVID-19 cases reported in Pennsylvania over the past week rose slightly after several weeks of declines; the number of deaths was unchanged.
According to the Department of Health, the number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus remains relatively steady while the CDC reports a nine percent increase in the seven-day rolling average of new daily COVID-19 hospital admissions after a comparable decrease the previous week.
Sixty-two of Pennsylvania’s 67 counties continue to experience a high rate of community transmission of reported COVID-19 cases. The remaining five counties – Adams, Centre, Philadelphia, Snyder, and Sullivan – are experiencing moderate rates of community transmission.

Stakeholder Events

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – October 25

The Department of Health’s Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board will hold its next meeting on Tuesday, October 25 at 9:30. The meeting location will depend on COVID-19 mitigation efforts at that time. If the meeting can be held in person it will be in Room 129 in the Pennsylvania Health and Welfare Building at 625 Forster Street in Harrisburg. If the meeting is held virtually it will be held at bit.ly/ABC_MAP. To dial in, call 267-332-8737, conference ID 440 338 696#. Learn more from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – October 26

The Medical Assistance Advisory Committee’s Consumer Subcommittee will meet virtually on Wednesday, October 26 at 1:00. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – October 27

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, October 27 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program – Advisory Council – October 27

The Department of Health’s Special Pharmaceutical Benefits Program Advisory Council will meet in Harrisburg on Thursday, October 27 at 10:00. Interested individuals may attend in person or participate virtually. For information on the location of the meeting and how to join the meeting virtually, see this Department of Health notice.

DHS – Trauma-Informed Management – October 27

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on trauma-informed management for skilled nursing facilities. The webinar will be held on Thursday, October 27 at 2:00. Learn more about the webinar, the skilled nursing professionals to whom it is directed, and how to participate from this notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Support Subcommittee – November 2

The Managed Long-Term Services and Support Subcommittee of DHS’s Medical Assistance Advisory Committee will meet publicly on Wednesday, November 2 at 10:00 in Harrisburg. Interested parties may attend in person or via webinar; those participating through the webinar must register in advance. For information about the location of the meeting, how to join it virtually, how to register, and how to offer comments or submit questions, see this DHS notice.

Department of Health – Human Immunodeficiency Virus Community Prevention Planning Committee – November 2

The Department of Health’s Human Immunodeficiency Virus Community Prevention Planning Committee will hold a public meeting in Harrisburg on Wednesday, November 2 at 9:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Organ Donation Advisory Committee Meeting – November 3

The Department of Health’s Organ Donation Advisory Committee will hold a public meeting in Harrisburg on Thursday, November 3 at 10:00. Interested parties can participate in person or virtually. For further information about the committee, the meeting, and how to participate, see this Pennsylvania Bulletin notice.

Department of Health – Traumatic Brain Injury Advisory Board Meeting – November 4

The Department of Health’s Traumatic Brain Injury Advisory Board will hold a public meeting in Camp Hill, PA on Friday, November 4 at 10:00. For information about the role of the board, the purpose of the meeting, and the location of the meeting, see this Pennsylvania Bulletin notice.

jsteinbock2022-10-21T20:30:06+00:00October 21st, 2022|COVID-19, Medicaid supplemental payments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for Friday, September 30

The following is an update of selected state health policy developments in Pennsylvania for the week of September 26-30, 2022. (Some of the language used below is taken directly from state documents.)

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to inform providers that it has added CPT codes for administering COVID-19 pediatric boosters. The new codes can be used immediately. Find that bulletin here.
DHS has issued a Medical Assistance Bulletin to advise providers of the addition of procedure codes to the Medical Assistance fee schedule for the provision of private duty nursing services, which are provided through home health agencies to beneficiaries under 21 years of age. The additions take effect on October 1. Find that bulletin here.
DHS’s Office of Long-Term Living has launched its American Rescue Plan Act of 2021 funding reporting portal. The online portal will be available beginning on September 30, 2022 for Office of Long-Term Living providers to submit costs associated with American Rescue Plan funding distributed in 2021, as required by the state. Learn more from this announcement of the portal’s launch and from DHS’s guide on to how to use the portal.
DHS has updated its data on physical health HealthChoices enrollment and participation in the Medical Assistance Transportation Program. Find the update here.

Department of Health

The Department of Health (DOH) has issued new guidance for health care providers and their employees who have been exposed to or contracted COVID-19. The first addresses the return to work for health care workers with confirmed or suspected cases of COVID-19 and the second describes work restrictions for health care workers who have been exposed to COVID-19. Both are introduced to align state standards with recently revised guidance from the federal Centers for Disease Control and Prevention.
DOH has updated its definition of how it defines whether individuals are up to date on their COVID-19 vaccinations. Go here to see the updated definition and learn about the department’s rationale for this change.
DOH has issued a health alert to notify providers, laboratories, infection control specialists, and local health departments about an unvaccinated adult with poliovirus infection and acute flaccid paralysis. Wastewater testing in treatment facilities in Rockland County, New York, which is adjacent to Pennsylvania, and surrounding counties also identified related poliovirus, indicating that the virus is circulating in the community and others may become ill. DOH urges providers to consider polio as a possible cause of sudden onset of limb, facial, oropharyngeal, or respiratory muscle weakness; to contact their local or state health department to discuss such cases; and to encourage any unvaccinated patients to receive polio vaccines. Learn more from this health alert.

COVID-19: By the Numbers

The weekly average of newly reported COVID-19 cases in Pennsylvania and COVID-related deaths continues to hold relatively steady: roughly 2500 new daily cases and 20 new deaths with weekly variances of 10-20 percent.
The number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus also remains relatively unchanged.
According to the CDC, the seven-day moving average of new hospital admissions for COVID-19 in Pennsylvania was 191 admissions a day over the past week, a slight reduction from the previous week.
Sixty-six of Pennsylvania’s 67 counties continue to have a high rate of community transmission of COVID-19. Snyder County is currently experiencing “only” a substantial rate.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs has issued Licensing Alert 02-22 to inform drug treatment programs about the process for establishing mobile narcotic treatment programs. Find the alert here.

Insurance Department

The state Insurance Department has released Pennsylvania’s 2023 individual and small group Affordable Care Act health insurance rates. The release also shares changes in the number of insurers offering coverage to Pennsylvanians and offers information about federal rate subsidies. Learn about the newly released information and find a link to the rates and insurers themselves in this Insurance Department news release.

Monkeypox

The CDC has posted an updated map showing the distribution of 25,613 confirmed cases of monkeypox in the U.S. as of September 29, up only slightly from 23,364 cases on September 21. 713 of those cases were in Pennsylvania, up from 684 a week ago.
As of September 25, 475 of those Pennsylvania monkeypox cases were in Philadelphia, up from 446 on September 18. Learn more about monkeypox in Philadelphia from the city Department of Public Health’s monkeypox web page.

Stakeholder Events

Department of Health – Health Research Advisory Committee Meeting – October 3

The Department of Health’s Health Research Advisory Committee will meet virtually on Monday, October 3 at 10:00 to hold a formal vote on upcoming priorities. Learn more about the meeting and how to participate from this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee Meeting – October 4

The Medical Assistance Advisory Committee’s managed long-term services and supports subcommittee will meet in Harrisburg on Tuesday, October 4 at 10:00; interested parties also may participate virtually. For information about the location of the meeting or to register to participate virtually, see this DHS notice.

Department of Human Services Preventing Workplace Injuries – October 6

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on “Protecting and Preserving our Workforce by Preventing Common Injuries” among health care workers on Thursday, October 6 at 2:00. Learn more about the webinar and how to register to participate from this notice.

DHS – Long-Term Care Workforce Motivation – October 13

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on how to express appreciation for long-term-care workers. The webinar will be held on Thursday, October 13 at 2:00. Learn more, including how to participate, from this notice.

DHS – Office of Mental Health and Substance Abuse Services and Office of Developmental Programs – Suicide Prevention – October 21

The Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs will host a quarterly “Statewide Positive Approaches & Practices” meeting that will share the most recent research and resources to help people with mental health and behavioral challenges, intellectual disabilities, autism, and other developmental disabilities live everyday lives. The specific subject of the meeting, to be held on Friday, October 21 at 9:00, will be suicide prevention and intervention. Find the meeting agenda and information about how to register to participate from this DHS notice.

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – October 25

Department of Health – Special Pharmaceutical Benefits Program – Advisory Council – October 27

jsteinbock2022-09-30T21:16:03+00:00September 30th, 2022|COVID-19, HealthChoices, long-term care, Medical Assistance Bulletin, Meetings and notices|Comments Off

PA Health Policy Update for Friday, September 16

The following is an update of selected state health policy developments in Pennsylvania for the week of September 12-16, 2022. (Some of the language used below is taken directly from state documents.)

General Assembly

The state House convened for voting session this week. The following is an overview of selected health-related legislative activity.

The House unanimously passed House Bill 1630, which grants the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers in Medicaid. The bill was received in the Senate and referred to the Health & Human Services Committee.
The House unanimously passed 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 bill will now be sent to the Senate.
The House Insurance Committee favorably reported Senate Bill 1201, which ensures coverage for early refills of prescription eye drops at 70 percent of the original prescription price, and House Bill 2499, which adopts the National Association of Insurance Commissioners’ model law requiring insurers, with exceptions for small insurers, to conduct an annual risk assessment.
The House Professional Licensure Committee favorably reported House Bill 2800, which amends the Medical Practice Act to address an issue related to the licensure of prosthetists, orthotists, pedorthists, and orthotic fitters in Pennsylvania.
The House Republican Policy Committee held an informational meeting on Monday to examine the Supreme Court’s recent decision to eliminate the existing requirement that a medical professional liability action may only be filed in the county in which the cause of action occurred. A recording of the meeting and testimony submitted to the committee may be viewed here.
The House Human Services Committee favorably reported House Bill 2686, as amended, which establishes a grant program to support the start-up costs of a behavioral health collaborative care model in medical practices.
The House Children & Youth Committee held an informational meeting this week to examine “Child & Adolescent Fatality Trends & Community Responses.” A video recording of the hearing may be viewed here.

The state House and Senate will be in session next Monday (9/19), Tuesday (9/20), and Wednesday (9/21). The following is an overview of selected health-related committee meetings next week.

The House Insurance Committee will convene on Tuesday, September 20 at 10:00 a.m. to consider Senate Bill 225, which seeks to streamline and standardize the process for prior authorization of medical services.
The Senate Health & Human Services Committee will hold an informational hearing on Tuesday, September 20 at 11:00 a.m. on the tick crisis in Pennsylvania.
The House and Senate Democratic Policy Committees will hold a joint hearing on Friday, September 23 to discuss Senate Bill 860 and House Bill 1848 and the need for Pennsylvania to establish a statewide rape-kit tracking system.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin notifying providers of updates to the Medical Assistance program fee schedule for adult vaccines. Find the bulletin here.
DHS has extended its calendar for remittance advice (RA) electronic transfer and mailing dates into November. Find the updated calendar here.
DHS has published information about improvements in how providers can update their enrollment summary in the state’s PROMISe provider internet portal. Find the notice here.
DHS has revised its list of drug companies participating in the state’s Medicaid drug rebate program. Find the updated list here.
In July, DHS proposed new regulations governing the delivery of psychiatric rehabilitation services, and in particular, on the use of telehealth in the delivery of those services. Now, Pennsylvania’s Independent Regulatory Review Commission has published its analysis of the proposed regulation and shared comments submitted by stakeholders in response to the proposed changes. Find the commission’s analysis and stakeholder comments in this Pennsylvania Bulletin notice.
DHS has issued a Medical Assistance Bulletin to announce that it has issued an updated School-Based ACCESS Program provider handbook. Find that bulletin and the updated handbook here.
DHS has posted a notice announcing to stakeholders that it has not yet calculated Medicaid hospice rates for FY 2023 and explaining its process for completing those calculations and notifying affected parties. Find that notice here.

Behavioral Health Commission for Adult Mental Health

The Behavioral Health Commission for Adult Mental Health created to develop recommendations for how to allocate $100 million appropriated for adult mental health purposes in the state’s FY 2023 budget held its fourth public meeting this week. The first part of the meeting focused on workforce development issues, with participants identifying the biggest challenges in workforce development as recruitment, retention, licensing, lack of funding for loan repayment and salary increases, lack of career pathways and pipelines, and burnout.

After additional discussion, commission members decided they should organize their spending recommendations into four categories: workforce ($37 million of the $100 million available), expanding services ($36.7 million), criminal justice ($23.3 million), and other ($3 million); they also discussed priorities within each category. The commission’s final report and recommendations should be presented to the legislature next week but no money will be spent until the General Assembly, which will only meet a few more days this year, specifically authorizes it. Learn more about the Behavioral Health Commission for Adult Mental Health from its section of the DHS web site.

Department of Health

The Department of Health has notified licensed providers that although the CDC now considers individuals up to date with their COVID-19 vaccinations only if they have had a dose of the new bivalent booster shot, providers should continue to consider individuals up to date if they have received either a monovalent or bivalent booster shot on the recommended schedule. Learn more from the Department of Health’s letter to providers.

COVID-19: By the Numbers

The weekly average of newly reported COVID-19 cases in Pennsylvania and COVID-related deaths continues to hold relatively steady.
The number of people hospitalized with COVID-19 and in hospital ICUs and on ventilators because of the virus also remains relatively unchanged.
According to the CDC, 74.5 percent of Pennsylvanians five years of age and older are now vaccinated.
Sixty-five of Pennsylvania’s 67 counties continue to have a high rate of community transmission of COVID-19. Delaware and Philadelphia counties are currently experiencing “only” substantial rates.

Monkeypox

The CDC has posted an updated map showing the distribution of 23,117 confirmed cases of monkeypox in the U.S. as of September 15, up from 21,504 cases on September 1. 684 of those cases were in Pennsylvania, up from 624 a week ago.

Department of Drug and Alcohol Programs

The Department of Drug and Alcohol Programs is offering online training on substance use disorder confidentiality. This updated training incorporates changes based on passage of Pennsylvania Act 33, the Pennsylvania Drug and Alcohol Abuse Control Act, in July. Learn how to receive the training from this Department of Drug and Alcohol Programs notice. Participants can earn PCB continuing education credits.

Stakeholder Events

DHS – Medical Assistance Advisory Committee Consumer Subcommittee – September 21

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, September 21 at 1:00. Go here to register to participate.

DHS – Medical Assistance Advisory Committee – September 22

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, September 22 at 10:00. Go here to register to participate.

Department of Health – Infant Hearing Screening Advisory Committee – September 22

The Department of Health’s Infant Hearing Screening Advisory Committee will hold a virtual public meeting on Thursday, September 22 at 1:00. For information about how to participate, see this Pennsylvania Bulletin notice.

Pennsylvania Rare Disease Advisory Council Stakeholder Summit – September 22

The Rare Disease Advisory Council will hold a stakeholder summit on Thursday, September 22. The summit will feature panels on gene therapy, newborn screening, and the results of the council’s Patient Needs Assessment Survey. Learn more about the stakeholder summit here.

Department of Human Services – Special Populations/Dementia Issues September 22

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on how facilities can help community members understand what dementia is, how it affects people, and how individuals can make a difference in the lives of those touched by dementia. The webinar, to be held on Thursday, September 22 at 2:00, is especially recommended for community liaisons, non-clinical teams, nurse educators, service coordinators, and volunteers. Learn more from this webinar notice.

DHS – Medical Assistance Advisory Committee – Managed Long-Term Services and Supports Subcommittee Meeting – October 4

DHS – Office of Mental Health and Substance Abuse Services and Office of Developmental Programs – Suicide Prevention – October 21

Department of Health – Pennsylvania Achieving Better Care by Monitoring All Prescriptions Board – October 25

jsteinbock2022-09-16T21:36:30+00:00September 16th, 2022|COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for Friday, July 15

The following is an update of selected state health policy developments in Pennsylvania for the week of July 11-15, 2022. (Some of the language used below is taken directly from state documents.)

Final FY 2023 Budget

Governor Wolf signed the Fiscal Code (House Bill 1421) into law on Monday, July 11. With the Fiscal Code’s signing, all the relevant budget-related bills for FY 2023 are enacted, including the budget bill (Senate Bill 1100) and the Tax Code (House Bill 1342).

Governor Wolf

Governor Wolf has signed several bills addressing health care issues.

House Bill 1421 increases Medicaid rates for skilled nursing facilities to help them meet upcoming Department of Health regulation updates that in part will increase staffing requirements. The rate increase of nearly 20 percent increases Medicaid funding for skilled nursing care by almost $300 million a year.
House Bill 2097 amends Title 35 (Health and Safety), in emergency medical services system, further providing for basic life support ambulances.
House Bill 2419 amends the Outpatient Psychiatric Oversight Act by adding a definition of “telebehavioral health technology” and provisions regarding the use of the technology.
House Bill 2604 amends the employee photo identification provisions of the Health Care Facilities Act.
House Bill 2679 amends the Pharmacy Act to preserve three regulatory suspensions authorized under the COVID-19 disaster emergency declaration, including the ability of pharmacists to provide influenza and COVID-19 vaccines to children ages five and older.
Senate Bill 818 amends the Health Care Facilities Act for the purpose of allowing ambulatory surgical facilities to seek an exception or waiver from the Department of Health for certain surgical procedures and permits cardiac catheterization to be performed in ambulatory surgical facilities.
Senate Bill 1235 amends the Insurance Company Law, further providing for contracts and coverage packages in comprehensive health care for uninsured children.
House Bill 2032 amends the Sexual Assault Testing and Evidence Collection Act, providing that the failure to report injuries by firearm or criminal act does not constitute an offense if the submission of sexual assault evidence is an anonymous submission.

General Assembly

The state House and Senate are currently in recess. The House is scheduled to return to session on Monday, September 12 and the Senate is scheduled to return on Monday, September 19.

Department of Human Services

The Department of Human Services (DHS) has published a series of Medical Assistance Bulletins to issue updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of certain prescriptions. These bulletins apply to all licensed pharmacies and prescribers enrolled in the Medical Assistance program. The types of prescriptions covered by these bulletins are:

DHS’s Office of Medical Assistance Programs, Office of Developmental Programs, Office of Child Development and Early Learning, Office of Children, Youth and Families, and Office of Mental Health and Substance Abuse Services have issued a joint bulletin providing guidance to county and private children and youth social service agencies, county mental health/behavioral programs, early intervention programs, and managed care organizations on the process for referring children to county intellectual disability and autism programs when a child has a diagnosis of an intellectual disability, developmental disability, and/or autism. Find that joint bulletin here and see attachments on diagnostic and eligibility information for services through county intellectual disability and autism programs, an overview of the programs offered by the offices issuing the joint bulletin, and the importance of registering with county intellectual disability/autism programs.
The federal Centers for Medicare & Medicaid Services (CMS) has informed states and stakeholders that as a result of the 2022 Additional Ukraine Supplemental Appropriations Act and the Uniting for Ukraine program, many displaced Ukrainian nationals arriving in the U.S. are eligible for health insurance through Medicaid, CHIP, the health insurance marketplace, or the Refugee Medical Assistance program. Learn more from this CMS fact sheet.

COVID-19: By the Numbers

The daily average of newly reported COVID-19 cases rose 17 percent over the past week, to 2850 new cases a day.
COVID-19-related deaths in the past week remained comparable to their level of recent weeks.
The number of Pennsylvanians hospitalized with COVID-19 and on ventilators because of the virus remained generally steady over the past week but the number in hospital ICUs rose 30 percent.
Fifty-two of Pennsylvania’s 67 counties are currently experiencing high rates of community transmission of COVID-19, down from 62 counties last week. Four counties experienced a moderate rate of community transmission and 11 a substantial rate.

Monkeypox

The Department of Health has issued a health alert advising providers about the current state of availability of testing for monkeypox and when providers should consider pursuing such testing for their patients. Find that alert here.

The CDC has posted an updated map showing the distribution of 1053 confirmed cases of monkeypox in the U.S. as of July 13, 32 of them in Pennsylvania and more than half of those cases in Philadelphia.

Stakeholder Events

Department of Human Services – Medical Assistance Advisory Committee – Consumer Subcommittee – July 27

The Medical Assistance Advisory Committee’s consumer subcommittee will meet virtually on Wednesday, July 27 at 1:00. Go here to register to participate.

Department of Human Services – Medical Assistance Advisory Committee – July 28

The Medical Assistance Advisory Committee will meet virtually on Thursday, July 28 at 10:00. Go here to register to participate.

Department of Health – Special Pharmaceutical Benefits Program Advisory Council – July 28

The Department of Health’s Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a public teleconference meeting on Thursday, July 28, 2022, from 10 a.m. to 12 p.m. The SPBP Advisory Council will provide program guidance and recommendations to the Department’s SPBP in regard to the following: drug formulary; covered lab services; drug utilization review; clinical programs; eligibility; and program management. Learn more about the meeting and how to register to participate in this notice.

jsteinbock2022-07-18T17:02:52+00:00July 18th, 2022|COVID-19, Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2023 budget|Comments Off

PA Health Policy Update for Friday, July 8

The following is an update of selected state health policy developments in Pennsylvania for the week of July 5-8, 2022. (Some of the language used below is taken directly from state documents.)

FY 2023 Budget Update

Governor Wolf and the General Assembly reached a final budget agreement for FY 2022-2023 this week. In total the budget spends $45.3 billion, which is $1.3 billion more than the prior fiscal year’s budget. The budget makes significant investments in education, housing, child tax credits, health care, and property tax and rent rebate programs. It also allocates $2.1 billion to the state’s rainy day fund. The following is an overview of budget-related bills and their status as of 2:00 p.m. on Friday, July 8.

Senate Bill 1100 is the General Appropriations bill. The House passed the bill by a vote of 180-20 and the Senate subsequently concurred with House amendments by a vote of 47-3. The bill has been presented to the governor for his signature.
The Fiscal Code bill is House Bill 1421, which is scheduled to be considered off the floor by the Senate Rules & Executive Nominations Committee Friday afternoon.
The Human Services Code bill is House Bill 1420. It passed the House and Senate on Thursday but Governor Wolf vetoed the bill early Friday. The Senate is expected to amend Human Services Code language, with the exception of the “Agency with Choice” delay, into the Fiscal Code later today and send it to the House for concurrence.
House Bill 1342 is the Tax Code bill. The Senate and House both passed this yesterday. It was presented to the governor and is currently awaiting his signature.

Governor Wolf

Governor Wolf signed House Bill 1561 and House Bill 1563 into law this week. These bills, which are now Act 32 and 33 of 2022, amend the Mental Health Procedures Act and the Drug and Alcohol Abuse Control Act, respectively, to align them with HIPAA and give providers, facilities, and insurers the ability to share more easily patient mental health and substance use disorder treatment information. Both pieces of legislation were presented to Governor Wolf for his signature.
Governor Wolf signed Senate Bill 861, which enters Pennsylvania into the EMS compact, on third and final consideration. The bill has been presented to Governor Wolf for his signature.

General Assembly

The state House and Senate remain in session while they work to finalize the FY 2023 budget and pass legislation before they recess and are not scheduled to return to Harrisburg until mid-September. The following is an overview of action taken by the General Assembly as of Friday, July 8 at 2:00 p.m.

The Senate voted to concur with House amendments to Senate Bill 818, which aligns the procedures permitted in ambulatory surgery centers with those permitted by the Centers for Medicare & Medicaid Services (CMS), and sent it to Governor Wolf for his signature.
The Senate passed House Bill 2679 on third and final consideration. The bill, which is now on the governor’s desk, authorizes pharmacists and pharmacy interns to administer influenza and COVID-19 vaccines to individuals five and older.
The Senate passed House Bill 2604, which amends the requirement for health care facility ID badges to permit the use of health system names rather than specific licensed facility names. The bill is now on the governor’s desk.
The Senate passed House Bill 2032, which states that a health care professional’s failure to report a victim’s injuries to law enforcement as required by the Crimes Code does not constitute a criminal offense when a sexual assault victim wishes to remain anonymous. The bill is now on the governor’s desk for his signature.
The Senate passed Senate Bill 106 and sent it to the House for concurrence. Senate Bill 106 includes a number of constitutional amendments, including one establishing that the state constitution does not grant the right to taxpayer-funded abortion or any other rights relating to abortion.
The Senate passed House Bill 2419, which expands access to outpatient psychiatric care via telemedicine, and sent it to Governor Wolf for his signature.
The House passed Senate Bill 1235, which prohibits the Department of Human Services from developing or using bidding or service zones that limit a health service corporation or hospital plan corporation contractor from submitting bids. The bill is now on the governor’s desk.

Department of Human Services

The Department of Human Services (DHS) has proposed amending the state’s Human Services Code to enable individuals who are 14 years of age or older but under 18 years of age who meet the admission requirements to gain access to psychiatric rehabilitation services; to amend the diagnoses that enable an individual to obtain those services without use of the exception process; and to revise outdated language and add definitions of ”serious mental illness” and ”serious emotional disturbance” that align with definitions currently used by the Federal Substance Abuse and Mental Health Services Administration. Learn more about what DHS has proposed and why it has proposed it in this Pennsylvania Bulletin notice.
DHS has published a Medical Assistance Bulletin announcing the addition of procedure code A4928 to the Medical Assistance fee schedule for disposable surgical masks dispensed to Medical Assistance beneficiaries effective with dates of service on and after July 1, 2022. This bulletin applies to Medical Assistance-enrolled certified registered nurse practitioners, physician assistants, physicians, podiatrists, and medical suppliers that prescribe or dispense disposable surgical masks to Medical Assistance beneficiaries in the fee-for-service and managed care delivery systems. Find the bulletin here.
DHS has published a series of Medical Assistance Bulletins to issue updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of certain prescriptions. These bulletins apply to all licensed pharmacies and prescribers enrolled in the Medical Assistance program. The types of prescriptions covered by these bulletins are:
DHS has posted the minutes of the June 23 meeting of its Medical Assistance Advisory Committee meeting. Find those minutes here.
DHS also has posted the minutes of the June 22 meeting of the Medical Assistance Advisory Committee’s consumer subcommittee. Find those minutes here.

Department of Health

The Department of Health (DOH) has updated its guidance to hospitals in response to Act 30 of 2022, recently passed by the state legislature, which extends COVID-19-related waivers through October 31, 2022. Among other things, this guidance addresses mandatory data reporting, suspension of services, alternative uses of hospital space, hospital-based laboratory analysis of COVID-19 tests, mandatory patient COVID-19 testing, and more. For a complete review of the implications of Act 30 for hospitals, see this updated DOH guidance.
DOH has announced that its COVID-19 community-based testing sites will now offer three forms of free testing: point-of-care tests where tests are performed and results are analyzed on-site; the distribution of at-home COVID-19 antigen tests; and continued administration of mid-nasal passage swab PCR testing. The department currently operates testing locations in Berks, Blair, Centre, Clarion, Clinton, Erie, and Washington counties. Learn more from this DOH announcement.
“COVID Alert PA,” DOH’s COVID-19 app that advises users of potential exposure to individuals diagnosed with COVID-19 and provides updated data on the state of the pandemic in Pennsylvania, has a new message informing users that “The current app will be discontinued on July 27, 2022.”

COVID-19: By the Numbers

The daily average of newly reported COVID-19 cases fell 10 percent over the past week, to 2440 cases a day.
COVID-19-related deaths in the past week were the same as they were the week before.
The number of Pennsylvanians hospitalized with COVID-19 remained generally steady over the past week, as did the number of COVID-19 patients in hospital intensive care units and on ventilators.
Sixty-two of Pennsylvania’s 67 counties are currently experiencing high rates of community transmission of COVID-19, up from 35 counties last week. The remaining five counties (Clarion, Forest, Potter, Sullivan, and Tioga) experienced a substantial rate of community transmission.

State Board of Pharmacy

The State Board of Pharmacy has published a final rule in the Pennsylvania Bulletin related to the administration of injectable medications, biologicals, and immunizations. The rule allows pharmacists to administer influenza immunizations by injectable or needle-free delivery methods to children nine years of age and older. Additionally, qualified and authorized pharmacy interns are permitted to administer injectable medications, biologicals, and immunizations to persons 18 years of age or older and administer influenza immunizations by injectable or needle-free delivery methods to children ages nine years and older under certain conditions. Find the bulletin here.

Stakeholder Events

Department of Health – COVID-19 Therapeutics – July 12

The Department of Health, Department of Human Services, and Pennsylvania Emergency Management Agency will hold a webinar on COVID-19 therapeutics on Tuesday, July 12 at 4:00. The webinar is intended for providers and facility administrators and will cover why, when, and
how to prescribe and obtain outpatient COVID-19 treatment and preventive therapies. Learn more about the webinar and how to register to participate in this notice.

Department of Health – Newborn Screening and Follow-Up Technical Advisory Board – July 14

The Department of Health’s Newborn Screening and Follow-Up Technical Advisory Board will meet virtually on Thursday, July 14 from 10 a.m. until 1 p.m. The agenda will include discussions about board member terms; updates from the Bureau of Family Health; payment options for additional conditions; research on dried blood spot specimens; a discussion on metachromatic leukodystrophy; and updates from the ethics, lysosomal storage disorders/X-ALD, cystic fibrosis, hemoglobinopathy, and critical congenital heart defects subcommittees. For information about how to join the meeting, see this Pennsylvania Bulletin notice.

Department of Human Services – Long-Term Care Learning Network/Nursing Facilities – July 14

DHS’s Long-Term Care Learning Network, part of its quality strategy for nursing facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a special populations webinar on “Filling the Day With Meaning: Thinking Outside the Box.” The webinar, to be held on Thursday, July 14 at 2:00, will seek to share with participants the benefits of meaningful engagement for residents living with dementia and is especially directed toward special population workers involved in recreational therapy, restorative team members, CNAs, and volunteers. Learn about registration and how to join the webinar from this notice.

Department of Human Services – Medical Assistance Advisory Committee – Consumer Subcommittee – July 27

The Medical Assistance Advisory Committee’s consumer subcommittee will meet virtually on Wednesday, July 27 at 1:00. Go here to register to participate.

Department of Human Services – Medical Assistance Advisory Committee – July 28

The Medical Assistance Advisory Committee will meet virtually on Thursday, July 28 at 10:00. Go here to register to participate.

jsteinbock2022-07-08T20:28:06+00:00July 8th, 2022|COVID-19, Medical Assistance Bulletin, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania proposed FY 2023 budget|Comments Off

PA Health Policy Update for the Week of May 9-13

The following is an update of selected state health policy developments in Pennsylvania for the week of May 9-13, 2022. (Some of the language used below is taken directly from state documents.)

Primary Election

Pennsylvania’s 2022 primary election will be held on Tuesday, May 17. Registered Republicans and Democrats will have an opportunity to select which candidates will represent their parties in the general election for local and statewide races, including governor, lieutenant governor, U.S. senator, U.S. representative, state senator, and state House representative.

General Assembly

The Joint State Government Commission issued a report this week regarding nurse licensure in the commonwealth. House Resolution 142 directed the Joint State Government Commission to conduct a review of the State Board of Nursing, specifically the “authorization to test” process and how it might be improved. Among other recommendations, the report highlights the need for additional staff at the state Board of Nursing, improved processing of licensure applications, and revision of the criminal background check process.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to inform providers of the addition of CPT codes M0222 and M0223 to the program’s fee schedule for the administration of the monoclonal antibody bebtelovimab for treatment of COVID-19 effective February 11, 2022. Find that bulletin here.
DHS has published a Medical Assistance Bulletin to issue its 2022 immunization schedule for Medical Assistance beneficiaries ages 18 years or younger. Find the bulletin here.
DHS has published a final notice of its funding allocation for FY 2022 for several classes of inpatient disproportionate share hospital (Medicaid DSH) and supplemental payments to Medical Assistance-enrolled and qualifying inpatient acute-care general hospitals. The funding allocation is for DSH and supplemental payments for inpatient care, critical access hospitals, burn centers, obstetric and neonatal services, academic medical centers, physician practice plans, autism intervention, and trauma centers. DHS is not changing the qualifying criteria or payment methodology for these payments and the notice does not list allocations to individual recipients. Learn more from this Pennsylvania Bulletin notice.
DHS has issued a flyer explaining how individuals and organizations can obtain doses of Naloxone, the life-saving medication used in the event of a suspected opioid overdose.
DHS has posted the minutes of the April 28 meeting of its Medical Assistance Advisory Committee.
The federal Centers for Medicare & Medicaid Services (CMS) has released a “State Health Official Letter” to provide guidance to states on coverage and payment for stand-alone vaccine counseling in Medicaid and CHIP. In the letter, CMS explains that it is interpreting the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit to require the provision of stand-alone vaccine counseling to eligible beneficiaries. This guidance links the mandatory COVID-19 vaccine and vaccine administration coverage and reimbursement under the American Rescue Plan with the health education requirement under Medicaid’s EPSDT benefit. Learn more from the CMS letter to state health officials.
CMS has published its reassignment of Medicaid provider claims final rule. This rule reinterprets the scope of the general requirement that state payments for Medicaid services must generally be made directly to the individual practitioner or institution providing services or to the beneficiary in the case of a class of practitioners for which the Medicaid program is the primary source of revenue. Specifically, this final rule explicitly authorizes states to make payments to third parties on behalf of individual practitioners for practitioners’ health insurance and welfare benefits, skills training, and other benefits customary for employees if the individual practitioner consents to such payments on their behalf. This rule is generally viewed as an effort to aid home health care workers. See the final rule here.

COVID-19: By the Numbers

Daily COVID-19 case counts climbed for the seventh consecutive week – this week, significantly. The state’s seven-day average of new cases rose 65 percent, from 1874 on May 5 to 3101 on May 12.
The seven-day average of COVID-19-related deaths rose from ten on May 6 to 12 on May 12.
The growing number of COVID-19 cases in the state has led to a large but not proportional increase in COVID-19-related hospitalizations: after consecutive weeks of 22 percent increases in hospitalizations, COVID-19-related hospitalizations rose 24 percent in the past week.
The number of these patients on ventilators remained unchanged over the past week while the number in hospital intensive care units rose 14 percent.
The significant increase in the number of new COVID-19 cases in Pennsylvania has resulted in significant changes in the status of community transmission of the virus in the state’s 67 counties. Currently, no counties are experiencing a low rate of community transmission and only four counties (Mifflin, Perry, Snyder, and Somerset) are experiencing a moderate rate; nine counties (Blair, Fayette, Franklin, Fulton, Greene, Huntingdon, Jefferson, Juniata, and Philadelphia) experienced a substantial rate of community transmission; and the remaining 54 counties are currently experiencing a high rate of community transmission of COVID-19.

Stakeholder Events

Department of Health – Health Research Advisory Committee – May 18

The Department of Health’s Health Research Advisory Committee will meet virtually on Wednesday, May 18 to hold a formal vote on upcoming priorities. For information about how to participate in the meeting see this Pennsylvania Bulletin notice.

Department of Human Services – Learning Network/Nursing Facilities – May 19

DHS’s Learning Network, part of its Quality Strategy for Nursing Facilities, is offering in collaboration with the Community HealthChoices managed care organizations and the Jewish Healthcare Foundation a webinar on the role that vaccinations, including influenza, pneumonia, COVID-19, and others, can play in avoiding hospitalizations from nursing homes. The webinar will be held on Thursday, May 19 at 2:00. For further information about the webinar and to register to participate, go here.

DHS, Department of Health, Department of Veterans Affairs – PA Cares Training Summit – May 24

Pennsylvania’s departments of Human Services, Health, and Veterans Affairs, in cooperation with the five branches of the U.S. armed forces, will hold a “PA Cares Training Summit 2022” on Tuesday, May 24 at 8:00 a.m. The event will focus on considerations that are needed to promote wellness in the lives of service members, veterans, and their families. The target audience is professionals in the field and includes but is not limited to community mental health and substance abuse agencies, social workers, professional counselors, nurses, psychiatrists, psychologists, clergy/pastoral or spiritual practitioners, and the staff of Pennsylvania veterans centers. Learn more about the event, its agenda, the presenters, and how to participate from this program announcement. Participation is limited to the first 300 people who register.

DHS – Medical Assistance Advisory Committee – Consumer Subcommittee – May 25

The consumer subcommittee of DHS’s Medical Assistance Advisory Committee will meet virtually on Wednesday, May 25 at 1:00. Go here to register to participate.

Department of Health – Statewide HIV Planning Group – May 25 and 26

The Department of Health’s Statewide HIV Planning Group will hold a public meeting in Harrisburg, on Wednesday, May 25 and Thursday, May 26 from 9:00 to 4:30 on both days. The purpose of these meetings is to conduct an integrated prevention and care HIV planning process in which the Department of Health works in partnership with the community and stakeholders to enhance access to HIV prevention, care and treatment services. Interested parties also may participate virtually. For additional information, including the location of the meeting and how to join virtually, see this Pennsylvania Bulletin notice.

DHS – Medical Assistance Advisory Committee – May 26

DHS’s Medical Assistance Advisory Committee will meet virtually on Thursday, May 26 at 10:00. Go here to register to participate.

DHS – Medical Advisory Committee – Managed Long-Term Services and Supports Subcommittee – June 1

The Medical Assistance Advisory Committee’s managed long-term services and supports subcommittee will be held virtually on Wednesday, June 1 at 10:00. There will be an opportunity to submit questions and offer comments. Go here to register to participate or dial in at 415-655-0052, access code 498030891#.

DHS – Office of Long-Term Living – Financial Management Services Stakeholder Meeting – June 3

DHS’s Office of Long-Term Living will hold a financial management services stakeholder meeting on Friday, June 3 at 1:00. The purpose of this virtual meeting is to discuss upcoming changes for the administration of financial management services under the Community HealthChoices, OBRA Waiver, and Act 150 programs. Representatives from the Office of Long-Term Living and Community HealthChoices managed care organizations will discuss upcoming changes. Go here to register to participate.

jsteinbock2022-05-13T20:36:26+00:00May 13th, 2022|COVID-19, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Uncategorized|Comments Off

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