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PA Puts New HealthChoices Contracts Up for Bid

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program. The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January. The contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years.  Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes. With a projected value of about … Read More

Posted in HealthChoices PA, Meetings and notices

DHS Issues RFI for Vendors to Help Monitor Payments

Pennsylvania’s Department of Human Services (DHS), which administers the state’s Medicaid program, is seeking information from vendors that offer data mining and predictive analytics that might help the state monitor Medicaid and other payments. DHS seeks to use such services to “…detect patterns of waste, fraud, and abuse in its programs on a prospective or retrospective basis.” Among the challenges such vendors might address in their responses, as stated in the RFI, are: Identifying claim review strategies that efficiently and proactively prevent or address potential errors (e.g., prepayment edit specifications or parameters). Providing mechanisms to investigate patterns that may indicate abuse of services by clients. Producing innovative views of utilization or billing patterns that illuminate potential errors. Maximizing recoveries by … Read More

Posted in Meetings and notices

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.

Posted in Healthy PA, Meetings and notices, Pennsylvania Medicaid laws and regulations

MAAC Meets

The Medical Assistance Advisory Committee that works with the Pennsylvania’s Department of Public Welfare met recently in Harrisburg. Among the subjects discussed during the meeting were the state’s recently passed budget, the Medical Assistance program, the prospects for Medicaid expansion, and more. Read the official state file note summarizing the meeting here.

Posted in Meetings and notices, Pennsylvania Medicaid policy, Pennsylvania state budget issues

Health Law PA News

The Pennsylvania Health Law Project has published its January 2013 newsletter, which includes articles on the state’s budget process (including a schedule of upcoming budget hearings), the continued expansion of HealthChoices, changes in Medicaid-covered behavioral health and substance abuse services, limits on Medical Assistance benefits, the overall benefits of Medicaid expansion for Pennsylvania, and more. Go here to download the Pennsylvania Health Law Project’s Health Law PA News.

Posted in Meetings and notices, Pennsylvania Medicaid policy, Pennsylvania state budget issues

DPW Announces Fee Schedule Changes

The Pennsylvania Department of Public Welfare has issued a Medical Assistance Bulletin detailing changes in the fee-for-service fee schedule.  The changes take effect immediately.   Read the bulletin with the changes here.

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

DPW Issues DSH Notice

The Pennsylvania Department of Public Welfare (DPW) has published a notice “announcing its intent to allocate funding for several classes of disproportionate share hospital (DSH) payments made to qualifying Medical Assistance (MA) enrolled acute care general hospitals.”  These allocations include funding for FY 2013 critical access, OB/NICU, trauma, burn center, academic medical center, and other supplemental DSH payments. Find the complete Pennsylvania Bulletin notice here.

Posted in Medicaid supplemental payments, Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

DPW Issues Bulletin on Peritoneal Dialysis

The Pennsylvania Department of Public Welfare (DPW) has issued a new Medical Assistance Bulletin titled “Information Regarding Peritoneal Dialysis Treatment.”  The stated purpose of the bulletin is “to provide information to providers regarding the use of peritoneal dialysis (PD) in treating beneficiaries with kidney failure, the potential benefits of PD over hemodialysis, and the screening of beneficiaries for PD suitability.” The new bulletin is available here.

Posted in Meetings and notices, Pennsylvania Medicaid laws and regulations

DPW Issues Medical Assistance Bulletins

The Department of Public Welfare (DPW) has issued a number of new bulletins governing Pennsylvania’s Medical Assistance program. These new regulations include an amendment to the state’s Medicaid plan for children with disabilities; the process for prior authorization of pituitary suppressive drugs; the process for prior authorization of erythropoiesis stimulating protein; the process for prior authorization of benign prostatic hyperplasia treatments; the process for prior authorization of antibiotics (GI); and the process for the prior authorization of platelet aggregation inhibitors. In addition, DPW formally announced the expansion of HealthChoices to 13 counties in western Pennsylvania and the termination of ACCESS Plus in those counties effective October 1 and its intention to publish in the near future a new bulletin adding … Read More

Posted in Meetings and notices, Pennsylvania Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

DPW Updates Dependence Treatment Procedures

The Pennsylvania Department of Public Welfare (DPW) has issued a new Medical Assistance Bulletin updating its procedures for seeking prior authorization for opiate dependence treatment. The new bulletin, which can be found here, applies to all licensed pharmacies and prescribers enrolled in the state’s Medical Assistance program that provide services through the Medical Assistance fee-for-service program. An update of the Medical Assistance handbook for prior authorization of these services can be found here. The new policy takes effect on September 10.

Posted in Meetings and notices, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Uncategorized
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