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.
Bookshelf with law booksThe 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.

2015-03-05T06:00:02+00:00March 5th, 2015|Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Revises Guidelines for Medicaid Presumptive Eligibility

Healthy Pennsylvania Medicaid Benefits Posted

Bookshelf with law booksThe 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.

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

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.

2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off on PA Issues Bulletin Detailing Healthy PA Benefits

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.

2014-11-05T06:00:17+00:00November 5th, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy|Comments Off on PA Makes Healthy PA Implementation Official
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