PHC4 Archives - Safety-Net Association of Pennsylvania

PA Health Policy Update for September 5

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

Fiscal Year 2025-26 Budget Update

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

The House stands adjourned until September 22.

Department of Health

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

Department of State

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

Department of Human Services

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

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

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

Pennsylvania Health Care Cost Containment Council (PHC4)

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

Around the State

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

Stakeholder Meetings

DHS Statewide Positive Approaches & Practices Conference – September 17

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

Dual Diagnosis Professional Conference Series – September 18

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

PA Safety Net Admin2025-09-05T19:11:23+00:00September 5th, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for August 22

The following is an update of selected state health policy developments in Pennsylvania from August 18 – 22. (Some of the language used below is taken directly from state documents).

Fiscal Year 2025-26 Budget Update

There was no legislative activity surrounding the state budget this week, with both houses in recess, but officials continue their informal negotiations. The budget impasse is expected to extend into mid-September.

The House stands adjourned until September 22 and the Senate until September 8.

Department of Human Services

The Department of Human Services (DHS) added a new PROMISe Banner page with information on a New Batch EDI Translator effective September 2025. For additional information see the EDI as a Service FAQ here.

Department of Health

The Department of Health alerted providers and public health officials about a late-summer surge in COVID-19 cases that is expected to peak in September. Find information on how to handle this sharp increase in cases in this health alert.

The Department of Health alerted Pennsylvanians that an individual from another state who was contagious with measles visited multiple locations across the state, creating a potential for exposure to others in this health alert.

Pennsylvania Healthcare Cost Containment Council (PHC4)

PHC4 publicly released new County-Level Condition-Specific and County-Level Utilization reports today, giving insight into ambulatory/outpatient usage and hospitalization rates of high interest conditions, using the most recent data available.

Around the State

The Altoona Mirror reported on the efforts of PA legislators to introduce the state’s own Medicaid work requirements in response to the federal requirements passed as part of the One Big Beautiful Bill Act.

Counties and providers of human services explain how they are bracing for the protracted state budget standoff in this article from the Pennsylvania Capital Star.

City + State profiled State Treasurer Stacy Garrity in this article after she announced her candidacy for governor in 2026.

Attorney General Dave Sunday announced that an agreement has been finalized that ensures free access to personal medical records for thousands of patients — including Medicaid patients — formerly treated at Crozer Health hospitals.

Stakeholder Meetings

HIV Community Prevention Planning Committee – September 10

The Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee will hold a public meeting (in-person and virtually) on Wednesday, September 10, 2025, from 9 a.m. to 12 p.m. For registration information click here.

PHC4 Committee Meetings – August – September

The PA Health Care Cost Containment Council (PHC4) announced the following meetings

Education Committee meeting (August 28, 2025, at 10 a.m.)
Council meeting (September 4, 2025, at 10 a.m.)
Payment Data Advisory Group meeting (September 11, 2025, at 10 a.m.)

Individuals who wish to participate may contact rgreenawalt@phc4.org at least 24 hours in advance.

MAAC – July Meeting Materials

The Department of Human Services (DHS) published the meeting materials from the July meeting of the Medical Assistance Advisory Committee (MAAC):

Meeting Minutes
Office of Long-Term Living presentation
Office of Mental Health and Substance Abuse Services presentation

PA Safety Net Admin2025-08-23T01:22:42+00:00August 22nd, 2025|Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for July 25

The following is an update of selected state health policy developments in Pennsylvania from July 21 – July 25. (Some of the language used below is taken directly from state documents).

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders continue to negotiate a final Fiscal Year (FY) 2025-26 budget agreement. The state House of Representatives and Senate are currently in recess pending a final budget agreement.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) has informed states, including Pennsylvania, that it “does not anticipate approving new state proposals of section 1115 demonstration expenditure authority that allow for expanded continuous eligibility or extending existing section 1115 demonstration authority for expanded continuous eligibility, beyond what is required or available under the Medicaid or CHIP statutes.” This will likely prevent Pennsylvania from implementing continuous eligibility for children on Medicaid until the age of six and 12 months of Medicaid coverage to individuals leaving state correctional facilities.

Department of Human Services

The Department of Human Services (DHS) has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of June 2025.

DHS has announced that the Human Services Provider Directory has moved to a new web address. The new address is https://www.humanservices.dhs.pa.gov/human_service_provider_directory/.

Department of Health

The Department of Health (DOH) has announced the launch of seven new training opportunities to assist health care providers reduce overdose risk and improve patient outcomes. Training is available online and in-person at no cost and includes continuing education credits for health care providers. Find additional information in this press release.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of its Cardiac Procedures Report, which includes results for six cardiac procedures performed in Pennsylvania acute care hospitals from January 1, 2022 through December 31, 2023. This report displays hospital-specific ratings for in-hospital mortality, readmissions, extended postoperative length of stay, volume of cases, and average hospital charges.

Board of Dentistry

The State Board of Dentistry has published final form rulemaking to implement licensure by endorsement for dentists. The rulemaking is effective upon its publication in the Pennsylvania Bulletin. Find the final rulemaking here.

Board of Examiners in Speech-Language Pathology and Audiology

The State Board of Examiners in Speech-Language Pathology and Audiology has published final form rulemaking to implement licensure by endorsement. The rulemaking is effective upon its publication in the Pennsylvania Bulletin. Find the final rulemaking here.

Around the State

Spotlight PA has published a piece on the closure of pharmacies across Pennsylvania and the broken payment system that’s being blamed for their closure.

Pennsylvania’s ongoing budget impasse and the impact it will potentially have on schools, county governments, and mass transit was the focus of an article published by The Philadelphia Inquirer.

PennLive has written an article about the potential for additional rural hospital closures due to the federal changes in H.R. 1 that will impact Medicaid funding for hospitals.

Stakeholder Meetings

DHS – Long-Term Services & Supports Subcommittee – August 6

The Long-Term Services and Supports (LTSS) Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold its next public meeting on August 6 at 10:00 a.m. The meeting will be held virtually. Register to participate here.

DOH – Organ Donation Advisory Committee – August 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, August 7 from 10:00 a.m. to 1:30 p.m. The meeting will be held in person and virtually. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Infant Hearing Screening Advisory Committee – August 7

The Infant Hearing Screening Advisory Committee will hold a public meeting on Thursday, August 7 from 12:00 p.m. until 3:00 p.m. at 6340 Flank Drive, Harrisburg, PA 17112. The meeting will be conducted in person only. Find information on how to RSVP in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-07-25T19:33:08+00:00July 25th, 2025|Federal Medicaid issues, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Health Policy Update for July 18

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

Fiscal Year 2025-26 Budget Update

Governor Shapiro and legislative leaders continue to negotiate a final Fiscal Year (FY) 2025-26 budget agreement. The state House of Representatives and Senate briefly convened in Harrisburg this week to position House Bill 1330, which provides for appropriations from the General Fund, to enable the budget to be swiftly enacted when an agreement is reached. Both chambers are currently recessed pending a final agreement.

General Assembly

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

The House of Representatives unanimously passed House Bill 564, which requires the Department of Human Services (DHS) to implement a campaign to increase public understanding and engagement with the 988 suicide and crisis lifeline. The bill will now be sent to the Senate for consideration.

The Senate passed Senate Bill 604, which authorizes the state to join the National Counseling Compact. The bill was subsequently sent to the House of Representatives and referred to the Professional Licensure Committee.

The Senate Health & Human Services Committee met on Thursday, July 17 and favorably reported House Bill 1429, which requires a study on the feasibility of implementing chip-enabled electronic benefit cards (EBT) for the Supplemental Nutrition Assistance Program (SNAP), and House Bill 1527, which extends the Rare Disease Advisory Council’s sunset date to 2028.

The Center for Rural Pennsylvania held an informational hearing on Wednesday, July 16 regarding health care provider policies that have been implemented in other jurisdictions to address the shortage of health care workers in rural areas. A recording of the hearing is viewable here.

Department of Human Services

The Department of Human Services (DHS) has issued a Remittance Advice (RA) related to its previous announcement that it will begin to mass adjust claims submitted for discharge dates October 1, 2024 through June 6, 2025 due to a delay in implementing Version 42 of the APR DRG classification system for Medical Assistance (MA) enrolled acute care general hospitals.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through the month of August. Find the updated calendar here.

Department of Health

The Department of Health (DOH) has issued final notice to temporarily schedule any material, compound, mixture or preparation which contains any quantity of the following Nitazene substances, their salts, isomers and salts of isomers: Butonitazene, Etodesnitazene, Flunitazene, Isotonitazene, Metodesnitazene, Metonitazene and Protonitazene. This final order to temporarily schedule will temporarily categorize this class of compounds as Schedule I controlled substances. Find more information in this press release.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) along with the Department of Human Services has announced that licensing staff from both agencies will begin conducting coordinated annual inspections of substance use disorder (SUD) and mental health treatment facilities that are licensed by both agencies for outpatient, partial hospitalization and residential services.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of a report that includes state-wide data and facility-specific information about the financial health of Pennsylvania’s general acute care hospitals for fiscal year 2023. Financial Analysis, Volume One, is the first in a three-part series of financial reports produced annually by PHC4.

Around the State

The Pennsylvania Capital-Star has written an article about the potential impact of the recently enacted federal reconciliation package on Medicaid coverage in the Pittsburgh area.

Spotlight PA has published a piece about the board that oversees how Pennsylvania counties spend opioid settlement money and how it operates outside of the state’s transparency laws.

WESA has published an article about Pennsylvania’s FY 2025-26 budget, which is more than two weeks late, and the state of negotiations.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – July 23

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

DHS – Medical Assistance Advisory Committee – July 24

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

DOH – Organ Donation Advisory Committee – August 7

DOH – Infant Hearing Screening Advisory Committee – August 7

PA Safety Net Admin2025-07-18T20:47:25+00:00July 18th, 2025|Medical Assistance Advisory Committee, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for June 27

The following is an update of selected state health policy developments in Pennsylvania from June 23 – 27. (Some of the language used below is taken directly from state documents).

General Assembly

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

The Senate unanimously voted to concur with the House’s amendments to Senate Bill 411, which provides the ability for the Pennsylvania Department of Health to create and utilize a stroke registry. The bill will now be sent to Governor Shapiro’s desk for his signature.

The Senate unanimously passed House Bill 640, which updates annual reporting requirements for the Department of Drug & Alcohol Programs (DDAP). The amended bill will now be sent back to the House for concurrence.

The Senate unanimously passed House Bill 309, which amends the Osteopathic Medical Practice Act to allow team physicians traveling internationally with their club or national team to treat their own players on site during games without needing a Pennsylvania medical license. The amended bill will now be sent back to the House for concurrence.

The Senate passed Senate Bill 715, which extends the Rare Disease Advisory Council’s sunset date to 2028. The bill was subsequently sent to the House and referred to the Health Committee.

The Senate passed Senate Bill 88, which provides coverage for supplemental screenings and diagnostic examinations without cost-sharing if a patient is at average risk or higher for breast cancer. The bill was subsequently sent to the House and favorably reported out of the Insurance Committee.

The House of Representatives passed House Bill 1100, which creates a grant program to provide eligible public-school entities with funding to acquire and distribute menstrual hygiene products. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 1445, which prohibits an insurer from denying what would otherwise be a service covered by the policy simply because the health care service was received in a school setting. The bill was subsequently sent to the Senate and referred to the Banking & Insurance Committee.

The House of Representatives passed House Bill 1590, which supports Pennsylvania’s implementation of a new federal Medicaid flexibility that waives the longstanding “four walls” requirement for outpatient behavioral health clinics. The bill will now be sent to the Senate for consideration.

The House of Representatives passed House Bill 583, which requires the Department of Human Services to establish a benefit package for dental services for Medicaid. The bill was subsequently sent to the Senate and referred to the Health & Human Services Committee.

The House of Representatives passed House Bill 1442, which places requirements on coroners to report Sudden Unexpected Death in Epilepsy (SUDEP). The bill was subsequently sent to the Senate and referred to the Local Government Committee.

The House and Senate will reconvene on Monday, June 30 for voting session.

Department of Human Services

The Department of Human Services (DHS) has issued a Medical Assistance Bulletin to notify providers that it will begin using Milliman Clinical Guidelines (MCG) as the screening guidelines to determine medical necessity for services, items, procedures, or level of care provided to Medical Assistance (MA) beneficiaries, effective July 18, 2025.

DHS has also issued a Medical Assistance Bulletin to advise providers of changes to the MA program fee schedule. The department is adding and end-dating codes as a result of the 2025 updates published by the Centers for Medicare & Medicaid Services to the Healthcare Common Procedure Coding System (HCPCS). The changes are effective for dates of service on and after June 16, 2025.

DHS has announced the proposed assessment amount, the proposed assessment methodology, and the estimated aggregate impact on nursing facilities that will be subject to the assessment under the Nursing Facility Assessment Program beginning in Fiscal Year (FY) 2025-2026. Find additional information in this Pennsylvania Bulletin notice.

The Office of Long-Term Living (OLTL) has shared an alert from the Centers for Medicare & Medicaid Services (CMS) about a fraud scheme that uses phishing fax requests, which falsely claim to be from CMS staff, to obtain medical records and documentation for auditing purposes.

DHS has issued a revised MA 549 form to use for dental benefit limit exception (BLE) requests. Find additional information in this Medical Assistance Bulletin.

Department of Health

The Department of Health (DOH), in partnership with the Pennsylvania Insurance Department and the Department of Human Services has launched a public survey looking for feedback on and suggestions for improving women’s health care across the commonwealth. The 10-minute survey is open through July 7 and focuses on women’s preventive health care, like health screenings, birth control, pregnancy care, and mental health services.

Independent Fiscal Office

The Independent Fiscal Office (IFO) has published a revised document updating its prior impact of the Medicaid provisions included in the federal reconciliation bill package being negotiated by the U.S. Congress.

Department of State

The Department of State has announced that Pennsylvania will become a full participant in three health care compacts – physician, nursing, and physical therapy – beginning July 7. Click the respective compact link for more information regarding its implementation.

Department of Aging

The Department of Aging has announced that it is conducting an evaluation of the PA Link to inform the design of a strategic plan to refresh and improve the program to better serve older adults, people with disabilities, and caregivers. Find additional information in this Pennsylvania Bulletin notice.

State Board of Nursing

The State Board of Nursing has released proposed regulations implementing Act 60 of 2021, which establishes title protection for certified registered nurse anesthetists (CRNA). Find the proposed rulemaking in this Pennsylvania Bulletin notice.

State Board of Pharmacy

The State Board of Pharmacy has issued final-form rulemaking to effectuate Act 140 of 2020, which establishes criteria for pharmacy technician training programs as well as the standards of practice and registration fees for both pharmacy technicians and pharmacy technician trainees. Find the final rulemaking in this Pennsylvania Bulletin notice.

Around the State

The Philadelphia Inquirer has published an article about the Pennsylvania Medicaid program’s cost growth and its role in current state budget talks.

Stakeholder Meetings

PHC4 – Council Meeting – July 3

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced it will hold a council meet on July 3 at 10:00 a.m. PHC4 will also hold an Education Committee meeting on June 25. Find additional information in this Pennsylvania Bulletin notice.

DOH – HIV Planning Committee – July 16-17

The Human Immunodeficiency Virus (HIV) Community Prevention Planning Committee has announced it will hold a virtual public meeting on Wednesday, July 16 and Thursday, July 17. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Renal Disease Advisory Committee – July 18

The Renal Disease Advisory Committee will hold its quarterly public meeting on Friday, July 18. The purpose of the meeting is to discuss new and ongoing issues relating to treatment of chronic renal disease and the Department of Health’s programs related to care and treatment. Find information on how to participate in this Pennsylvania Bulletin notice.

DOH – Special Pharmaceutical Benefits Program Advisory Council – July 31

The Special Pharmaceutical Benefits Program Advisory Council will hold a public meeting on Thursday, July 31. 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. Find details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-06-27T21:30:45+00:00June 27th, 2025|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for June 20

The following is an update of selected state health policy developments in Pennsylvania from June 16 – 20. (Some of the language used below is taken directly from state documents).

Governor Shapiro

The Shapiro administration has shared a document with stakeholders outlining the potential impact of H.R. 1, the reconciliation package currently being considered by the U.S. Congress. The assessment primarily addresses the impact on Medicaid coverage. It does not include a detailed overview of the provisions in the reconciliation package related to provider taxes or state directed payments, from which Pennsylvania receives significant funding.

General Assembly

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

The House Health Committee met on Monday, June 16 and favorably reported, among other bills, House Bill 1234, which expands the Medical Assistance program to cover blood pressure monitors for home use as a pregnancy-related service on a per pregnancy basis.

The House Professional Licensure Committee met on Tuesday, June 17 and favorably reported House Bills 80 and 482, which enable Pennsylvania to join the Audiology and Speech-Language Pathology Interstate Compact and the National Occupational Therapy Licensure Compact respectively, and Senate Bill 115, which requires the Department of Human Services to offer a skills competency exam in lieu of high school diploma or GED requirements for individuals seeking employment as direct care staff in personal care homes or assisted living residences.

The House Insurance Committee met on Tuesday, June 17 and favorably reported House Bill 1445, which prohibits an insurer from denying what would otherwise be a service covered by the policy simply because the health care service was received in a school setting.

The state House of Representatives and Senate will reconvene in Harrisburg for voting on Monday, June 23.

Department of Human Services

The Department of Human Services (DHS) has announced the proposed annual case-mix per diem payment rates for state Fiscal Year (FY) 2025-26 for non-public and county nursing facilities that participate in the Medical Assistance (MA) program. Find additional information in this Pennsylvania Bulletin notice.

DHS has issued Provider Quick Tip #263 regarding the electronic submission process for Office of Medical Assistance Programs’ (OMAP) fee-for-service (FFS) and the Office of Long-Term Living’s (OLTL) and LTC 180-day exception requests and other claims requiring documentation in the Promise Portal.

Department of Health

The Department of Health (DOH) has announced the Newborn Screening and Follow-up Technical Advisory Board is adding Metachromatic Leukodystrophy (MLD) screening, effective January 1, 2026, to the supplemental conditions mandated for screening and follow-up by commonwealth submitters and follow-up by the commonwealth newborn screening program. Find additional information in this Pennsylvania Bulletin notice.

DOH has published notice of the clinical laboratories approved for the following services.

Independent Fiscal Office

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

Insurance Department

The Pennsylvania Insurance Department (PID) has announced that most health insurers are requesting significant premiums increases for plan year 2026. On average, insurers are asking for a 19 percent increase to premiums in the individual market, and a 13 percent increase to premiums in the small group market.

Around the State

State Senate Majority Leader Joe Pittman (R-Indiana) has stated he, “sees no practical way that a budget will be completed on June 30.” His comments and the significant increase in funding for the Medicaid program were the subject of an article by the Pennsylvania Capital-Star.

The Pew Charitable Trusts has published an article about the share of state budgets spent on Medicaid and which states have increased their own resources on Medicaid.

A CBS3 report has highlighted insurance denials and called attention to the Pennsylvania Insurance Department’s external review process for claim denials.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – June 25

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 25 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – June 26

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on June 26 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

PHC4 – Council Meeting – July 3

DOH – Newborn Screening Advisory Board – July 24

The Newborn Screening and Follow-Up Technical Advisory Board will hold a public meeting on Thursday, July 24 from 10:00 a.m. until 12:00 p.m. The meeting will be conducted in person only. Find additional details and information on how to participate in this Pennsylvania Bulletin notice.

DOH – Health Research Advisory Committee – July 30

The Health Research Advisory Committee will hold a public meeting on Wednesday, July 30 from 10:00 a.m. to 11:00 a.m. The meeting will be held at the Nesquehoning Recreational Center. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Brain Injury Advisory Board – August 1

The Brain Injury Advisory Board will hold a public meeting on Friday, August 1 from 10:00 a.m. to 3:00 p.m. The meeting will be held in person at the Pennsylvania Training and Technical Assistance Network. Find additional details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-06-23T19:51:18+00:00June 20th, 2025|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for March 28

The following is an update of selected state health policy developments in Pennsylvania from March 24 – 28. (Some of the language used below is taken directly from state documents).

Special Election Update

Two special elections occurred this week on Tuesday, March 25 to fill vacancies in the state House of Representatives and Senate. Democrat Dan Goughnour won the special election to represent House District 35, which was vacated after the passing of Representative Matt Gergely. His election sustains the Democratic one-vote majority in the House. In a surprising outcome, Democrat Jim Malone narrowly defeated Republican Josh Parsons to replace the Senate seat formerly held by Ryan Aument who resigned to work for U.S. Senator Dave McCormick. Malone’s election will narrow the Republican majority in the Senate to 27-23.

General Assembly

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

The House of Representatives passed a package of bills that seek to codify federal Affordable Care Act (ACA) patient protections in state statute.

- House Bill 404, which enables an adult child to receive insurance coverage until age 26.
- House Bill 535, which prohibits annual and lifetime coverage limits.
- House Bill 618, which prohibits the denial of health insurance coverage due to pre-existing conditions.
- House Bill 755, which maintains access to preventative health care services.

The House Aging & Older Adult Services Committee met on Monday, March 24 and favorably reported, in addition to other legislation, House Bill 372, which requires the Department of Aging to publicly release a compliance report on the Area Agencies on Aging (AAAs).

The House Labor & Industry Committee met on Tuesday, March 25 and favorably reported, among other bills, House Bill 926, which seeks to prevent health care workplace violence by placing several requirements on health care facilities.

The Senate Judiciary Committee met on Tuesday, March 25 and favorably reported, among other bills, Senate Bill 347, which prohibits the implementation of safe injection sites throughout the commonwealth, and Senate Bill 326, which amends the Controlled Substance, Drug Device, and Cosmetic Act to automatically schedule a controlled substance when one is added by the federal government and removes the Secretary of Health’s ability to reschedule a controlled substance.

The Senate will reconvene on Monday, March 31 through Wednesday, April 2. The House of Representatives is now recessed until Monday, April 7.

Department of Human Services

The Department of Human Services (DHS) has issued an updated Pennsylvania Medicaid Managed Care Directory.

DHS has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of February.

Independent Regulatory Review Commission

The Independent Regulatory Review Commission (IRRC) has issued comments to the State Board of Nursing regarding its proposed rule on nursing education programs issued January 25, 2025. Find IRRC’s comments here.

IRRC has announced it received the following final form rulemaking which will be considered at its May 15 meeting.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of a report on Cancer Surgery Volume, giving stakeholders insight into cancer surgeries performed at hospitals and ambulatory/outpatient settings.

Around the State

The New York Times has written an article about Democrat Jim Malone’s surprising victory in a district that strongly supported President Trump in the 2024 election. Spotlight PA also published an article about this story.

The Pennsylvania Capital-Star has written an article about a package of bills that passed the state House of Representatives this week codifying federal Affordable Care Act (ACA) protections in state statute.

Fox43 has published a piece about unions representing Pennsylvania nurses and their efforts to pass legislation addressing workplace violence.

Stakeholder Meetings

DOH – Special Pharmaceutical Benefits Program Advisory Committee – April 24

The Statewide Special Pharmaceutical Benefits Program (SPBP) Advisory Council will hold a public teleconference meeting on Thursday, April 24 from 10:00 a.m. to 12:00 p.m. Find additional information and details on how to participate in this Pennsylvania Bulletin notice.

DOH – Medical Marijuana Advisory Board – 2025 Meeting Schedule

The Medical Marijuana Advisory Board has provided notice in the Pennsylvania Bulletin of its upcoming meeting dates. Meetings will be held from 10:30 a.m. to 12:30 p.m. on each day listed in the Capitol Media Center, Room 1, East Wing, Harrisburg, PA 17126, with an option for board members to participate virtually.

PA Safety Net Admin2025-03-28T19:22:00+00:00March 28th, 2025|Governments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for February 21

The following is an update of selected state health policy developments in Pennsylvania from February 17 – 21. (Some of the language used below is taken directly from state documents).

General Assembly

The state House of Representatives and Senate began hearings on Governor Shapiro’s FY 2025-26 budget proposal this week. The following are the health-related agency budget hearings that occurred this week.

The Department of Health appeared before the Senate Appropriations Committee on Wednesday, February 19. A recording of that hearing is viewable here.

The Department of Health and the Department of Drug & Alcohol Programs appeared before the House Appropriations Committee on Friday, February 21. A recording of that hearing is viewable here.

The House of Representatives and Senate will continue budget hearings next week. The only health-related agency scheduled to appear is the Department of Aging, which will be before the Senate Appropriations Committee on Tuesday, February 25 at 1:00 p.m. and the House Appropriations Committee on Thursday, February 27 at 1:00 p.m. The House Appropriations Committee’s full hearing schedule is viewable here and the Senate Appropriations Committee’s full hearing schedule is viewable here.

Department of Human Services

The Department of Human Services (DHS) has released a rate and wage study for its long-term services and supports (LTSS) and home and community-based services (HCBS) programs. The study assessed rates paid to LTSS and HCBS providers in order to inform the commonwealth’s budget and rate setting process. The study is viewable here.

DHS has issued a Medical Assistance Bulletin to advise providers that effective February 18, the Medical Assistance (MA) program will cover Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screening and diagnostic services to eligible juveniles in the 30 days prior to release, and targeted case management services, both physical and behavioral health, in the 30 days prior to and for at least 30 days following release from a carceral setting.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs (DDAP) has announced it will hold a webinar on March 3 at 10:00 a.m. to discuss the changes to 42 CFR Part 8 (Medications for the Treatment of Opioid Use Disorders) and their practical implications in treatment settings. Find additional information and details on how to participate here.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the release of a special report on the finances of rural hospitals in Pennsylvania. Find the full report and data visualizations from the report here.

Around the State

The Philadelphia Inquirer’s Harold Brubaker has written an article about Sharon Regional Medical Center and Crozer Health and the financial support provided by the state to help keep them open and serving patients.

Governor Shapiro’s appointment by President Trump to serve a two-year term on the Council of Governors was covered by The Philadelphia Inquirer. Among other things, the council is tasked with improving state-federal partnerships and coordinating national security and disaster response efforts.

Stakeholder Meetings

DHS – Consumer Sub-MAAC – February 26

The Consumer Subcommittee of the Medical Assistance Advisory Committee (MAAC) will hold a public meeting on February 26 at 1:00 p.m. The meeting will be held virtually. Click here for additional information.

DHS – Medical Assistance Advisory Committee – February 27

The Medical Assistance Advisory Committee (MAAC) will hold a public meeting on February 27 at 10:00 a.m. The meeting will be held virtually. Click here for additional information.

Pennsylvania Health Care Cost Containment Council – Committee Meetings

The Pennsylvania Health Care Cost Containment Council (PHC4) has announced the schedule of various committee meetings for the first quarter of 2025. Find a detailed schedule and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-02-21T21:58:30+00:00February 21st, 2025|Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid, Pennsylvania proposed FY 2026 budget|Comments Off

PA Health Policy Update for January 24

The following is an update of selected state health policy developments in Pennsylvania January 20 – 24. (Some of the language used below is taken directly from state documents).

Pennsylvania Row Offices

Pennsylvania’s three row officers – Attorney General Dave Sunday, Auditory General Tim DeFoor, and Treasurer Stacy Garrity – were sworn into office on Tuesday, January 21. This marks the first time all three row offices are held by Republicans.

General Assembly

Following the unfortunate passing of Rep. Matt Gergely (D-Allegheny), Speaker McClinton has scheduled a special election for the 35^th Legislative District to occur on Tuesday, March 25.

The state House of Representatives and Senate are scheduled to return to session on Monday, January 27, 2025. The following is a selection of health care-related legislative activity currently scheduled for next week.

The Senate Health & Human Services Committee is scheduled to meet “off the floor” on Monday, January 27 to consider Senate Bills 155, 156, and 157, which are part of a package of bills aimed at eliminating waste, fraud, and abuse in public assistance programs.

The House Aging & Older Adult Services Committee will convene on Tuesday, January 28 at 9:30 a.m. for an informational meeting on direct care workers and the homecare industry. The meeting will be held in Room G-50 of the Irvis Office Building.

The House Insurance Committee is scheduled to meet on Tuesday, January 28 “at the call of the chair” to consider, among other bills, House Bill 111, which prohibits insurers from denying coverage to individuals solely because they have an opioid reversal agent in their prescription profile. The meeting will be held in Room B-31 of the Main Capitol.

The House Human Services Committee will convene on Wednesday, January 29 at 9:00 a.m. for an informational hearing on traumatic brain injury care needs and coverage options. The hearing will be held in Room G-50 of the Irvis Office Building.

The House Health Committee will convene on Wednesday, January 29 at 10:00 a.m. in Room G-50 of the Irvis Office Building to consider the following bills.

- House Bill 27, which requires health care facilities to adopt and implement policies to mitigate exposure to surgical smoke through the use of a smoke evacuation system for each procedure that generates surgical smoke.
- House Bill 33, which implements greater oversight of medical marijuana labs and product testing.
- House Bill 79, which establishes a medical debt relief program in the commonwealth.

Department of Human Services

The Department of Human Services (DHS) has issued its report on Medicaid managed care enrollment in Pennsylvania for the month of December.

DHS has updated its calendar of mailing dates for Remittance Advices and corresponding electronic transfers and checks through February. Find the updated calendar here.

Department of Health

The Department of Health (DOH) and the Patient Safety Authority have released draft recommendations to all hospitals and birthing centers to mitigate the risk of harm related to shoulder dystocia. Find the draft recommendations and instructions on how to comment in this Pennsylvania Bulletin notice.

Department of Drug & Alcohol Programs

The Department of Drug & Alcohol Programs’ (DDAP) State Epidemiological Outcomes Workgroup (SEOW), in partnership with Drexel University’s Department of Community Health and Prevention, has released two new reports.

Emerging Drug Trends: Adulterants and Novel Psychoactive Substances in Pennsylvania. This report examines recent trends in adulterants and novel psychoactive substances in the drug supply, drug checking services and programs, and related public policies.
Harm Reduction in Pennsylvania: Policies, Needs, and Services. This report provides an overview of harm reduction services in Pennsylvania, including naloxone availability, syringe service programs, overdose prevention, and drug checking.

State Board of Nursing

The State Board of Nursing has issued proposed rulemaking that would amend regulations related to professional, practical, and certified registered nurse practitioner education programs. The proposed amendments also codify current board practice and update requirements to meet national standards. Find the proposed rulemaking in this Pennsylvania Bulletin notice.

Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council (PHC4) has released new county-level utilization data and condition-specific reports, which provide greater insight into ambulatory/outpatient utilization and hospitalization rates for high interest conditions. Find the full reports here.

Around the State

Pennsylvania anticipates it will receive $212 million over 15 years from a multi-state opioid settlement recently reached with the Sackler family and Purdue Pharma. Read the Pennsylvania Capital-Star’s coverage here.

The Philadelphia Inquirer has published an article about the challenges confronting Governor Shapiro, who is mid-way through his first term, including an anticipated $4.5 billion budget deficit.

The Patriot-News has written an article about Pennsylvania’s continued downward trajectory of vaccination rates among children.

Spotlight PA has published a detailed article about Bucktail Medical Center and its recent receipt of $1 million from the state in an effort to prevent its closure.

Stakeholder Meetings

Council on Aging – 2025 Meeting Dates

The Pennsylvania Council on Aging, an independent advisory board under the Office of the Governor and supported by the Department of Aging, has released its meeting schedule for 2025. Find the full schedule and details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2025-01-24T20:07:55+00:00January 24th, 2025|Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid|Comments Off

PA Health Policy Update for November 1

The following is an update of selected state health policy developments in Pennsylvania October 28 – November 1. (Some of the language used below is taken directly from state documents).

Governor Shapiro

Governor Shapiro signed the following bills into law this week.

House Bill 1608, now known as Act 115 of 2024, which extends Medicaid coverage to doula services and creates a doula advisory board.
House Bill 2185, now known as Act 117 of 2024, which requires the Department of Health to develop type 1 diabetes informational materials for parents and guardians.
House Bill 2381, now known as Act 119 of 2024, which enables the licensing boards or commissions under Department of State to promulgate one-time, temporary regulations necessary for the implementation of each licensure compact enacted by the General Assembly.
Senate Bill 365, now known as Act 121 of 2024, which amends the Workers’ Compensation Act to provide first responders with post-traumatic stress injury (PTSI) coverage.
Senate Bill 920, now known as Act 122 of 2024, which establishes a statewide sexual assault evidence tracking system.
Senate Bill 267, now known as Act 134 of 2024, which adds urgent care centers to the list of safe haven locations for newborn children.
Senate Bill 1080, now known as Act 137 of 2024, which allows licensed practical nurses to make death pronouncements in the hospice setting.

General Assembly

The state House of Representatives and Senate are currently recessed until after the November 5 General Election.

Department of Human Services

The Department of Human Services (DHS) has announced its intent to allocate funds in FY 2024-2025 for several classes of inpatient disproportionate share hospital (DSH) payments and supplemental payments to Medical Assistance enrolled, qualifying inpatient general acute care hospitals. DHS does not intend to change the qualifying criteria or payment methodology for these payments. Find additional information in this Pennsylvania Bulletin notice.

DHS has published its proposed Psychiatric Residential Treatment regulations in the Pennsylvania Bulletin. These proposed regulations codify the minimum licensing standards, Medical Assistance participation requirements, and payment conditions for psychiatric residential treatment facilities which treat certain children, youth, or young adults under 21 years of age.

DHS has published a Medical Assistance Bulletin with updates to the PROMISe™ Provider Handbook 837 for Medical Assistance enrolled federally qualified health centers (FQHCs) and rural health clinics (RHCs).

The Office of Medical Assistance Programs (OMAP) has announced it will be hosting several upcoming community health worker (CHW) listening sessions throughout November and December in order to gather information that will help DHS’ strategic plan for CHWs. Find a schedule of the listening sessions as well as details on how to participate here.

DHS has issued a Medical Assistance Bulletin with Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix. This bulletin applies to all providers enrolled in the Medical Assistance program who provide EPSDT screens for Medical Assistance beneficiaries.

DHS has shared the following presentations used at the Medical Assistance Advisory Committee (MAAC) meeting on October 24.

Insurance Department

The Pennsylvania Insurance Department has published a notice in the Pennsylvania Bulletin that the Medical Care Availability and Reduction of Error (MCARE) assessment for all basic insurance coverage and self-insured participating health care providers for calendar year 2025 will be 29 percent applied to the prevailing primary premium for each participating health care provider.

Board of Medicine

The State Board of Medicine has published its final-form rulemaking related to licensure by endorsement. The regulations are effective upon publication in the Pennsylvania Bulletin. Find the final-form regulations here.

Office of the Attorney General

The Office of the Attorney General (OAG) has filed a civil suit against Prospect Medical Holdings, which owns Crozer Health System, over breach of contract. OAG has alleged Prospect has broken its 2016 court-approved “asset purchase agreement” by closing facilities and diverting funding from the sale of real estate to shareholders and investors. The lawsuit seeks a preliminary injunction to preserve Crozer’s existing services, and the appointment of a receiver to manage the Crozer Health System until another buyer can be identified. Find additional details in this press release.

Revenue Collection Update

The Department of Revenue has announced Pennsylvania collected $4.2 billion in General Fund revenue in September, which was $33.7 million, or 0.8 percent, less than anticipated. Fiscal year-to-date General Fund collections total $10.1 billion, which is $20.2 million, or 0.2 percent, above estimate.

Around the State

Spotlight PA has published an article written by Stephen Caruso about a slate of bills to improve maternal health care in Pennsylvania.

WHYY has written an article about Attorney General Michelle Henry’s decision to sue Prospect Medical Holdings over Crozer Health System.

City & State Pennsylvania has published an article about Pennsylvania’s health insurance marketplace, Pennie, as the open enrollment period nears.

Stakeholder Events

Pennsylvania Health Care Cost Containment Council – November 7

The Pennsylvania Health Care Cost Containment Council (PHC4) will hold a public meeting on Thursday, November 7. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Organ Donation Advisory Committee – November 7

The Organ Donation Advisory Committee will hold a public meeting on Thursday, November 7 from 10:00 a.m. to 1:30 p.m. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – HIV Planning Committee – November 20

The Statewide HIV Planning Committee will hold public meetings at the Hilton Harrisburg (One North 2nd Street, Harrisburg, PA 17101) on Wednesday, November 20 from 9:00 a.m. to 5:00 p.m. and on Thursday, November 21 from 9:00 a.m. to 4:30 p.m. The meeting will also be held virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

DOH – Spinal Cord Research Advisory Committee – November 18

The Spinal Cord Research Advisory Committee will hold a public meeting on Monday, November 18 from 10:30 a.m. to 11:30 a.m. The meeting will be held in person and virtually. Find additional details on how to participate in this Pennsylvania Bulletin notice.

PA Safety Net Admin2024-11-01T20:14:07+00:00November 1st, 2024|Financial, Governments, Medical Assistance Bulletin, Meetings and notices, Pennsylvania Bulletin|Comments Off

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