The following is an update of selected state health policy developments in Pennsylvania for the week of December 5-9, 2022.  (Some of the language used below is taken directly from state documents.)

Shapiro-Davis Transition

Governor-elect Shapiro announced that he will appoint Uri Monson, the chief financial officer of the School District of Philadelphia, as Budget Secretary.  He also announced Jennifer Selber will be appointed General Counsel and Larry Hailsham, Jr. will be Executive Deputy Chief of Staff.  Selber currently serves as the Executive Deputy Attorney General of Pennsylvania in charge of the criminal division and Hailsham most recently served as the Shapiro campaign’s political director.

General Assembly

• Democrats and Republicans continue to struggle over control of the state House. On Wednesday Representative Joanna McClinton (D-Philadelphia) was sworn in during an unannounced ceremony as majority leader.  Republicans swiftly denounced the swearing-in as an “illegitimate power grab.”  In addition, Representative Summer Lee (D-Allegheny County) and Representative Austin Davis (D-Allegheny County) formally submitted their resignations on Wednesday.  At the same time they won re-election to those seats Ms. Summer was elected to Congress and Mr. Davis was elected Lieutenant Governor.  Their resignations, along with the passing of Representative Tony DeLuca (D-Allegheny County), make the current breakdown in the state House 101 Republicans and 99 Democrats.
• The state Senate released its 2023 session calendar through June.  The calendar can be viewed here.

Department of Human Services

• The Department of Human Services (DHS) has announced its intent to allocate $18.034 million in state and federal funds for FY 2023 Medicaid disproportionate share hospital payments (Medicaid DSH) to acute-care general hospitals that qualify as a trauma center.  DHS also is amending the qualifying criteria and payment methodology for these payments for newly accredited trauma centers and hospitals seeking trauma center accreditation.  See the announcement and learn more about the changes in the qualifying criteria and payment methodology in this Pennsylvania Bulletin notice.  Public comments are due within 30 days.
• DHS has issued a Medical Assistance Bulletin to inform providers about updates to the statewide Preferred Drug List (PDL) that take effect on January 9.  Find the bulletin here.
• DHS has issued Medical Assistance Bulletins addressing requirements for prior authorization and the type of information that will be needed, as of January 9, to evaluate the medical necessity of prescriptions for:
  • lipotropics
  • stimulants and related agents
  • platelet aggregation inhibitors
  • pituitary suppressive agents, LHRH
  • hypoglycemics, SGLT2 inhibitors
  • ophthalmic anti-inflammatories
  • monoclonal antibodies – Anti-IL, Anti-IgE, Anti-TSLP (formerly monoclonal
    antibodies – Anti-IL, Anti-IgE)
  • obesity treatment agents
• DHS has posted guidance for providers on procedure code/modifier combinations to be used when requesting home accessibility durable medical equipment and durable medical equipment repairs in the Medicaid fee-for-service program.  Find the instructions here.
• DHS is updating the Medical Assistance fee schedule for disposable breast milk collection and storage bags and breast pump replacement supplies.  Learn about the new fees and new procedure codes to accompany them from this Pennsylvania Bulletin notice.
• Beginning on December 16, providers will find a new question on the electronic provider enrollment application:  “Will your provider agency be rendering Personal Care Services or Home Health Care Services that are subject to EVV [electronic visit verification]?”  DHS has posted information for providers about what this question means and how they should approach answering it.

COVID-19:  By the Numbers                          

• The number of new COVID-19 cases reported daily in Pennsylvania rose nearly 30 percent in the past week, an increase possibly attributable to social gatherings over the Thanksgiving holiday.  The number of new deaths remains within the usual range for recent months.
• According to the Department of Health, the number of Pennsylvanians hospitalized with COVID-19, on ventilators because of the virus, and in hospital ICUs remains relatively unchanged.
• The CDC reports a 22 percent increase over the past week in the seven-day rolling average of new daily COVID-19 hospital admissions.
• As of December 7, 39 Pennsylvania counties are experiencing high rates of community transmission of COVID-19; 25 are experiencing substantial rates of community transmission; and three counties are experiencing moderate rates of community transmission.  This is almost identical to the previous week.

Department of Drug and Alcohol Programs

• The Department of Drug and Alcohol Programs has issued an information bulletin explaining that as a result of a new Pennsylvania law passed last month, private and public treatment and rehabilitation facilities may not deny addiction treatment to individuals based solely on a negative result on a drug test.  This policy takes effect on January 1.  Learn more from this information bulletin.
• The Department of Drug and Alcohol Programs has announced that it has awarded nearly $19 million in grant funding through its substance use disorder loan repayment program to help substance use disorder treatment professionals repay their outstanding qualifying educational loans.  More than 280 practitioners, including case managers, counselors, licensed social workers, physician assistants, and registered nurses, shared in the funding.  Learn more from this department news release.

State Board of Nursing

The State Board of Nursing proposes amending its process for reactivating nursing licenses.  Learn more from this Pennsylvania Bulletin notice.  Public comments on the proposed changes are due within 30 days.