Pennsylvania Medical Assistance Bulletin Archives - Page 5 of 5

PA Health Policy Update for the Week of January 3-7

The following is an update of selected state health policy developments in Pennsylvania for the week of January 3-7, 2022. (Some of the language used below is taken directly from state documents.)

Governor Wolf

Governor Wolf announced that the state is organizing regional support sites for both hospitals and long-term-care facilities and strike teams to support hospitals facing staffing shortages. The effort, to be coordinated by the Department of Health and the Pennsylvania Emergency Management Agency, will include the following major components:

Critical capacity support through the launch of regional support sites for Pennsylvania hospitals suffering from a lack of beds or staffing to meet inpatient needs. Hospitals struggling to meet inpatient demands will have the opportunity to transfer patients to hospitals within these regional sites for care. Each regional site will have increased capacity for approximately 60 days beginning in February, supported by medical support staff including physicians, respiratory therapists, and registered nurses.
Staffing support that will be sent directly to hospitals from the Department of Health based on identified need. Staffing resources may include physicians, respiratory therapists, and registered nurses for short-term deployments over the next three months.
Expanded long-term-care capacity through the launch of regional sites to allow for more rapid discharge of patients by hospitals. Each site will increase the state’s capacity to support long-term-care residents with additional medical staff, including registered nurses and aides.

Go here to see the announcement from the governor’s office.

General Assembly

The House of Representatives will hold voting session during the week of January 10 on Monday (1/10), Tuesday (1/11), and Wednesday (1/12).
House Bill 1280, which amends the Patient Test Result Information Act, is scheduled for second consideration on Monday and third consideration on Tuesday. This bill would eliminate the definition of “significant abnormality” and revise the written notice requirement for health care providers in an effort to provide clarity and eliminate conflicting interpretations of the act.
The House Health Committee is scheduled to convene on Tuesday, January 11 at 9:30 a.m. to consider, among other bills, House Bill 1630, which would grant the Pennsylvania Auditor General the authority to audit managed care contracts and subcontracts with pharmacy benefit managers (PBMs) in Medicaid. The committee also will consider Senate Bill 780, which would create public awareness of cytomegalovirus (CMV) and provide for CMV screening for certain newborns.

State Revenue Collection

The Revenue Department announced that Pennsylvania collected $3.8 billion in General Fund revenue in the month of December – $464.3 million, or 13.7 percent, more than projected. Year-to-date General Fund revenue collections total $22.6 billion, which is $1.5 billion, or 7.0 percent, above estimate.

Department of Human Services

The Department of Human Services has issued a Medical Assistance Bulletin explaining that Medicaid will pay pharmacies for the administration of vaccines to Medicaid beneficiaries by licensed pharmacists effective November 1, 2021. The bulletin also provides instructions for pharmacies to submit claims for the administration of vaccines by pharmacists to Medicaid fee-for-service beneficiaries. Find the bulletin here.

Department of Health

The Department of Health (DOH) has issued revised guidance, applicable to the general population in a community setting, about who needs isolation or quarantine because of a diagnosis of COVID-19 or contact with someone who has been diagnosed with or is suspected of having COVID-19 and how long that isolation or quarantine must last. Find that guidance here.
DOH has updated its recommended work restrictions for health care workers based on vaccination status and type of exposure.
DOH has recirculated a series of long-term care-specific vaccine materials that long-term-care facilities can use in their efforts to comply with federal requirements for staff vaccination. Find the vaccine outreach toolkit here and an accompanying fact sheet here.
DOH has updated its long-term-care facilities COVID-19 visitation guidance FAQ. Find it here. (Note: this link opens to a downloadable file.)
DOH has issued an alert about an outbreak of hepatitis A in southeastern Pennsylvania. The alert includes instructions for providers about diagnosing the condition, preserving laboratory samples, and reporting diagnosed cases to the state.
DOH has introduced changes in Lyme disease surveillance requirements and testing practices and has shared these changes with providers in this health alert.

COVID-19: By the Numbers

Daily COVID-19 case counts are higher than they have been at any time since the pandemic began. The state’s total of 29,026 new cases on Thursday, January 6 was the highest single-day total since the pandemic began, breaking a new record set the previous day.
The number of new COVID-19-related deaths remains high.
To date, Pennsylvania has had 1.8 million confirmed cases of COVID-19, nearly 400,000 cases that have been classified as “probably” COVID-19, and 37,500 deaths attributed to the disease.
All 67 Pennsylvania counties continue to experience a high rate of COVID-19 transmission.
From December 1 through December 31, the number of Pennsylvanians hospitalized because of COVID-19 rose 33 percent; the number in hospital ICUs because of COVID-19 rose 12 percent; and the number on ventilators because of the virus rose 23 percent.
This situation is reflected in the high rate of occupancy in the state’s hospitals. There currently are only 477 unoccupied adult ICU beds – 13.4 percent of the total of such beds in the state; 2026 unoccupied medical/surgical beds – 10 percent of such beds; 41 unoccupied pediatric ICU beds (11 percent); 239 unoccupied pediatric beds (21.9 percent); and 912 unoccupied airborne isolation beds (28.4).
On January 4 the Department of Health elaborated on some of these figures, reporting that approximately 28 percent of all staffed adult ICU beds are occupied by COVID-19 patients and that 32 percent of all ventilators state-wide are in use.
Media reports confirm the challenges some communities and hospitals are facing, including limited numbers of hospital beds, staffing challenges, and difficulty getting enough COVID-19 testing materials. For examples, see these reports about conditions in the Philadelphia area (here, here, and here), the Pittsburgh area (here and here), and central Pennsylvania.
According to the CDC, as of Thursday, December 30, 74.1 percent of Pennsylvanians age 18 and older are fully vaccinated.

Stakeholder Events

Health Research Advisory Committee – January 10

The Department of Health’s Health Research Advisory Committee will hold a virtual public meeting on Monday, January 10, 2022 at 2:30 pm via Microsoft Teams at (267) 332-8737 with Conference ID: 994 021 882#. Learn more from this Pennsylvania Bulletin notice.

Medical Marijuana Advisory Board – January 27

The Medical Marijuana Advisory Board will hold virtual meetings on the following days at 10:00 am: Thursday, January 27, 2022; Tuesday, March 22, 2022; Thursday, May 26, 2022; Thursday, July 28, 2022; Tuesday, September 27, 2022; and Tuesday, November 22, 2022. These virtual meetings will be broadcasted live for the public through Commonwealth Media Services. Check www.medicalmarijuana.pa.gov and click on the Medical Marijuana Advisory Board tab for live streaming information the day of the virtual meeting. Learn more from this Pennsylvania Bulletin notice.

Special Pharmaceutical Benefits Program Advisory Council – January 27

The Statewide Special Pharmaceutical Benefits Program Advisory Council will hold a public teleconference meeting on Thursday, January 27, 2022 at 10 am. To participate dial in by location at (412) 648-8888 or (866) 588-4789. The meeting ID is 487 872 318#. Learn more from this Pennsylvania Bulletin notice.

jsteinbock2022-01-07T21:14:24+00:00January 7th, 2022|Coronavirus, COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid COVID-19|Comments Off

PA Health Policy Update for the Week of August 16-20

The following is an update of selected state health policy developments in Pennsylvania for the week of August 16-20, 2021. (Some of the language used below is taken directly from state documents.)

The Wolf Administration

The Wolf administration has directed vaccine providers to support COVID-19 vaccination clinics and has introduced a free COVID-19 testing program for schools across the state. Learn more from this news release and from a Department of Health order in support of the governor’s directive.

General Assembly

The Senate Aging & Youth Committee held a hearing this week to examine proposed revisions of the state’s Child Protective Services Law. Testimony presented to the committee and a video transcript may be found here.

Next week the Senate Health & Human Services and Aging & Youth committees will hold a joint hearing with the House Aging & Older Adult Services and Human Services committees to “discuss the Department of Human Services’ intent to contract with Maximus as its independent enrollment broker (IEB) and the impact this will have on seniors and adults with disabilities.” The hearing will take place on Monday, August 23 at 12:30 p.m. Livestream the hearing here.

Department of Health

Effective August 18, the Department of Health’s order regarding daily hospital data reporting through the Corvena system is amended to add new data fields related to the vaccination status of hospital patients. View details in the amended order here.
The Department of Health has issued an advisory to health care facilities and providers caring for people whose immune systems are moderately to severely compromised about the CDC’s recommendation that such individuals may benefit from an additional dose of mRNA COVID-19 vaccine to ensure they have enough protection against COVID-19. Find the advisory here.
The Department of Health has informed health care facilities and providers of the CDC’s recommendation that pregnant people should be vaccinated against COVID-19. Learn more from a department health advisory.
In July the Department of Health’s nursing home surveyors conducted 466 inspections, including 289 complaint investigations, of 329 separate nursing homes. Of these inspections, 30 were COVID-19-specific investigations. There were five new sanctions finalized against nursing care facilities in the past month resulting in a total of $40,150 in fines. Learn more from this department news release.

Department of Human Services

DHS has added September dates to its calendar of MA remittance advice delivery dates. Find the updated list here.
DHS has published a Medical Assistance Bulletin announcing changes in the Medical Assistance program fee schedule, including changes resulting from the implementation of the 2021 Healthcare Common Procedure Coding System procedure codes updates. In addition, DHS also is adding other procedure codes and making changes to procedure codes currently in the MA program fee schedule, including fee adjustments, as well as setting limitations and prior authorization requirements. These changes are effective for dates of service on and after August 23, 2021. Find this Medical Assistance Bulletin here.
Officials from DHS and the Department of Health have introduced the PA Health Equity Analysis Tool (HEAT), an interactive map that synthesizes Medical Assistance and population health data to show opportunities for intervention to promote better health and promote health equity. PA HEAT provides state, county, zip code, and census track-level data on a number of population health measures and social determinants of health and how they affect local communities and Pennsylvania as a whole. Results can also be displayed according to environmental justice areas, which are calculated based on concentrations of people living at or below the federal poverty line, based on resident demographics. Learn more about PA HEAT from this DHS announcement and from the PA HEAT web site.
DHS has released quarterly licensing and enforcement activity data for its five licensing offices that oversee providers of long-term care, child care, behavioral health care, day activity programs, and residential care for individuals with intellectual disabilities and autism. Find a summary of the report in this DHS announcement.
A notice in the Pennsylvania Bulletin announces that documents are now available on DHS’s web site about proposed annual case-mix per diem rates for state fiscal year 2021-2022 for non-public and county nursing facilities and the budget adjustment factor that will be applied to non-public and county nursing facilities. Find the Pennsylvania Bulletin notice here and the DHS web site with the nursing facility rates here.

COVID-19: By the Number

The daily number of new COVID-19 cases continued to rise during the past week. The 3451 new cases reported on Thursday was the highest single-day total since April 30.
The number of deaths, while slightly higher during the past week, remains far lower than when comparable numbers of new cases were being reported in the spring.
For the week of August 6-12 the state’s overall COVID-19 test positivity rate was 6.0 percent, up from 5.4 percent last week and the fifth consecutive week with an increase.
In Pennsylvania, only Sullivan County is classified as having a low rate of COVID-19 transmission this week; three counties – Forest, Tioga, and Warren – have a moderate rate of transmission; 25 counties are currently experiencing a substantial rate of transmission; and 38 currently show a high rate of transmission, including nine of the ten most populous counties in the state: Philadelphia, Allegheny, Delaware, Bucks, Montgomery, York, Lehigh, Berks, and Lancaster.
The number of Pennsylvanians hospitalized because of COVID-19 has more than doubled since the beginning of the month; the number on ventilators because of the virus is two-and-half times greater than it was at the beginning of the month; and the number in hospital intensive care units has more than tripled since the beginning of the month.
According to the state’s COVID-19 Dashboard, only 57 pediatric ICU beds in the state are not currently occupied. That figure represents 14.7 percent of the total of such beds in Pennsylvania.
According to the state’s revised figures, 64.7 percent of Pennsylvanians 18 years of age and older are now fully vaccinated – 5.86 million people – up from 62.8 percent last week. Only 54,000 Pennsylvanians completed a vaccine regimen in the past week and only 134,000 have done so since the beginning of August.

Around the State

Governor Wolf is “…reinstating a mask mandate for all state employees and contracted staff working under his jurisdiction regardless of their vaccination status, starting on Monday,” PennLive reports.
A shortage of nurses in the Philadelphia area has led hospitals to offer signing and retention bonuses of as much as $20,000 to experienced nurses. The Philadelphia Inquirer offers the details.
“Overburdened health care systems from Texas to Florida are pleading with Western Pennsylvania hospitals to take on transfer patients at record-high rates as beds and ventilators reach capacity in covid-19 hot spots across the country,” the Pittsburgh Tribune-Review reports.
“While nearly a third of deer tested in Pennsylvania carried antibodies indicating they were exposed to COVID-19, the Pennsylvania Game Commission noted there is no evidence that deer can transmit the virus to humans and advised hunters to ‘take usual precautions when handling their harvests.’” The Bradford Era explains what this means.
WTAE TV in Pittsburgh has published on its web site an interactive map showing the COVID-19 transmission rate for every county in the state. Find the map here (scroll down to see it).
The Wolf administration plans to engage at least 100 people to perform COVID-19 contact tracing, Spotlight PA reports.

Stakeholder Event

The Department of Health’s Health Research Advisory Committee will hold a public meeting on Monday, August 23, from 10:00 a.m. to 11:30 a.m. The meeting will be held virtually via Microsoft Teams at +1 267-332-8737 with Conference ID: 545 844 262#. The purpose of the meeting is to review the work of the committee and plan future health research priorities. Find the meeting agenda here.

jsteinbock2021-08-20T21:33:37+00:00August 20th, 2021|Coronavirus, COVID-19, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Department of Health and COVID-19, Pennsylvania Department of Health coronavirus, Pennsylvania Medicaid, Pennsylvania Medicaid coronavirus, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, social determinants of health|Comments Off

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law books The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Safety Net Admin2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

New Medical Assistance Bulletin Addresses Hospital Uncompensated Care

The Pennsylvania Department of Human Services has issued a new Medical Assistance Bulletin titled “Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans.”
According to the document,

The purpose of this Medical Assistance (MA) Bulletin is to remind hospitals of the requirements for the Hospital Uncompensated Care Program (Program) and reinforce the responsibility of hospitals to actively engage patients when determining eligibility for the Program.

See the entire Bulletin here.

PA Safety Net Admin2018-01-08T06:00:47+00:00January 8th, 2018|Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Issues Bulletin on Medicaid Expansion

The Pennsylvania Department of Human Services (DHS) has issued a new Medical Assistance Bulletin on the state’s expansion of its Medicaid program via the HealthChoices managed care program.
The bulletin notifies providers of the introduction of a new adult benefit package that applies to all adult Medicaid recipients in the state, highlighting some of the major changes in benefits from past packages. It also provides information about the state’s plan for a phased transition from the current private care option (PCO) insurance plans to HealthChoices plans over the coming months.
See DHS Medical Assistance Bulletin 99-15-05 here.

PA Safety Net Admin2015-04-30T06:00:10+00:00April 30th, 2015|HealthChoices PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

PA Revises Guidelines for Medicaid Presumptive Eligibility

The Pennsylvania Department of Human Services has revised its guidelines for hospitals qualified to make presumptive eligibility determinations for potentially Medicaid-eligible patients who seek services but are uninsured.
The revisions are described in Medical Assistance Bulletin 01-15-08, “Revised Presumptive eligibility as Determined by Hospitals,” which was issued on February 24 but is retroactive to January 1.
In support of that new guidance the state also has issued an addendum for providers outlining their responsibilities and a worksheet for hospitals to use in determining eligibility.

PA Safety Net Admin2015-03-05T06:00:02+00:00March 5th, 2015|Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

Healthy Pennsylvania Medicaid Benefits Posted

The Pennsylvania Department of Human Services has published materials describing Medicaid benefits under the state’s Healthy Pennsylvania Medicaid expansion.
A Medical Assistance Bulletin (#99-15-02) describing the “Interim Healthy Benefit Plan” can be found here and tables comparing the benefits packages under the “Healthy” (low risk), “Healthy Plus” (high risk), and Private Coverage Option plans (PCO) can be found here.

PA Safety Net Admin2015-01-22T06:00:53+00:00January 22nd, 2015|Healthy PA, Meetings and notices, Pennsylvania Medicaid laws and regulations|Comments Off

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments: a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

PA Safety Net Admin2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Makes Healthy PA Implementation Official

The Pennsylvania Department of Public Welfare (DPW) has published an official notice in the state’s Medical Assistance Bulletin announcing the implementation of the Healthy Pennsylvania Medicaid expansion program on January 1, 2015.
The notice provides background information about the plan, how it will work, and how it will differ from the state’s current Medicaid program. It also presents the final word on how the state will define “medically frail” for determining which benefits package participants will receive, outlines how the program’s health screening of applicants will work, and explains enrollees’ cost-sharing responsibilities.
The Bulletin notes that the state will issue a separate announcement to providers with more information about the scope of benefits to be provided, how the program will employ private insurers to serve the state’s Medicaid population, and when training will be offered to familiarize providers on how to work with the new program.
Find the Bulletin here.

PA Safety Net Admin2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off

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