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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.

Posted in HealthChoices PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy

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.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid policy

PA Officially Ends Enhanced Medicaid Payments

The Affordable Care Act-mandated increase in Medicaid payments for primary care services ends on December 31. While some states believe this increase improved access to care for their Medicaid population and will continue the increase using their own money, Pennsylvania will not, and a new Medical Assistance Bulletin informs primary care providers in the state that the fee-for-service rates they are paid will return to their previous level on January 1. See the Medical Assistance Bulletin notice here.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

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.

Posted in Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

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 … Read More

Posted in Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid policy

Providers Must Re-enroll to Serve PA Medicaid Population

All health care providers that serve Pennsylvania’s Medicaid population must re-enroll with the state if they wish to continue doing so. The requirement, established under the Affordable Care Act, applies to providers that participate in both the state’s Medicaid managed care and fee-for-service programs. Additional information can be found about the requirement and how to re-enroll in this Medical Assistance Bulletin notice.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

DPW Announces Revisions of Medicaid Fee Schedule

The Pennsylvania Department of Public Welfare (DPW) has published a notice of its intention to implement changes in the Medicaid fee schedule and to update selected prior authorization requirements. Those notices are published here, in the June 22 edition of the Pennsylvania Bulletin, and the changes took effect on June 24. DPW also published a Medical Assistance Bulletin on the procedure code updates and a table showing the updates.  Find the bulletin here and the table here.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

DPW Establishes Exceptions to Monthly Prescription Limit

Since January of last year, Pennsylvania’s Medical Assistance program has limited categorically needy adult recipients over the age of 21 to six prescriptions a month. While Medical Assistance has established a process for seeking exceptions to this limit, the Department of Public Welfare has now published a new MA Bulletin that lists exceptions that will automatically be granted. Find that list in this MA Bulletin.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

Path to FY 2013 EHR Payments Set

The Pennsylvania Department of Public Welfare has published Medical Assistance Bulletins that explain to providers how to pursue their Medicaid electronic health record (EHR) incentive payments for FY 2013. The bulletin for eligible hospitals can be found here and the bulletin for eligible physicians and other providers can be found here.

Posted in Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

PA Prepares to Boost Medicaid Primary Care Rates

Pennsylvania will soon begin paying primary care providers more for the services they deliver to their Medical Assistance patients. Under the Affordable Care Act, state Medicaid programs are required to pay primary care providers Medicare-level fees for calendar years 2013 and 2014.  This policy was adopted as part of a broader effort to recruit more physicians to serve Medicaid patients at a time when Medicaid enrollment will increase significantly in most states. Now, the Pennsylvania Department of Public Welfare (DPW) is presenting its plan for how it will go about implementing this federal requirement. DPW has issued a new Medical Assistance Bulletin titled “Medical Assistance Program Fee for Select Primary Care Services and Physician Attestation Form” that identifies eligible providers … Read More

Posted in Health care reform, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy
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