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medical assistance

The PA Provider Advocacy Coalition, an organization that constitutes a variety of PA providers and advocates across all fields, recently sent a letter to the Shapiro Administration regarding the FY 2024/25 budget. RCPA signed onto the letter, which calls for rate adjustments and investments in Medicaid services in order to address the current workforce crisis. The Coalition states in the letter:

We recognize that addressing these workforce challenges will require a sustained, coordinated, multi-faceted public and private sector response. Earlier this year, our coalition met with representatives of your administration to recommend the creation of a Health Care Workforce Council to help lead this multiyear effort. However, there is one aspect of this overall problem that is relatively straightforward—chronic underpayment by the Medical Assistance program.

RCPA will continue to keep our members informed of updates. If you have any questions, please contact your RCPA Policy Director.

RCPA recently joined over a dozen PA associations in delivering a joint letter to the Shapiro Administration requesting investments be made in behavioral health services for the Fiscal Year (FY) 2024/25 budget. As noted in the letter, which was compiled by the PA Provider Advocacy Coalition:

The mental health system all too often is unable to deliver the right care, at the right time and in the right setting. We recognize that there is no simple fix and that a sustained, multiyear effort by all stakeholders—the commonwealth, counties, providers, insurers, and advocates—is necessary to rebuild and create a mental health system for the 21st century.

RCPA will continue to keep our members informed of updates. If you have any questions, please contact your RCPA Policy Director.

The Department of Human Services (DHS) has made the Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) Managed Care Quality Strategy (MCQS) for the Commonwealth available for public review and comment. The MCQS is an updated version of the previous strategy submitted to the Centers for Medicare and Medicaid Services (CMS) in December 2020 and accounts for the ongoing post-pandemic delivery system pressures that have affected how managed care organizations (MCOs) deliver care. The MCQS may be viewed online. Comments may be submitted via email, and those received within 30 days will be reviewed and considered. Additional information is available on the Pennsylvania Bulletin.

If you have any questions, please contact Fady Sahhar.

The Department of Human Services (DHS) Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) issued a Medical Assistance (MA) bulletin today detailing MA payment for street medicine.

This bulletin informs MA providers that DHS will cover certain services for MA beneficiaries experiencing unsheltered homelessness in their lived environment, known as street medicine. Covered services include physical and behavioral health services, such as primary care, vaccinations, wound care, counseling, and diagnostics in the lived environment. The bulletin applies to enrolled physicians, nurse midwives, nurse practitioners, physician assistants, psychologists, mobile mental health treatment providers, and outpatient practitioners in mental health. Managed care providers should contact their managed care organization(s) for billing questions.

The complete bulletin can be viewed here as well as on the DHS website.

As the Federal Public Health Emergency unwinds, more than a million Pennsylvanians on the Medicaid rolls will have their eligibility determinations reviewed. RCPA has been a part of the MA/CHIP Watch Group, an advocacy partnership focused on this process for children and families to ensure coverage for services. The partnership is a group of Pennsylvania health, law, and policy advocates who work directly with and on behalf of Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) enrollees. For approximately one year, the group has been meeting regularly with DHS staff to discuss DHS’ plans to resume regular operations when the federal provision for continuous coverage, put into place in March 2020 at the onset of the COVID-19 pandemic by the Families First Coronavirus Response Act (FFCRA), ends.

DHS has an unprecedented task ahead: conducting MA eligibility checks for an estimated 1.1 million MA enrollees, who either no longer appear to be eligible or have overdue renewals. The group remains very concerned about the enormous administrative workload the County Assistance Offices (CAOs) will face when redetermining eligibility for this large volume of cases while resuming regular operations after three years, and how that is likely to translate into individuals losing coverage, though remaining eligible.

Recently, the group presented a letter of recommendations to DHS Secretary Dr. Val Arkoosh outlining these concerns and pathways to ensure transitional care and coverage for children. Additionally, RCPA in their meetings with DHS continues its advocacy and support for the recommendations outlined in the letter to Secretary Arkoosh.

Message from the Department of Human Services (DHS)**

Pennsylvania’s Department of Human Services (DHS) is changing which Physical Health Managed Care Organizations (PH Plans) are available for Medical Assistance (MA) consumers. This is an opportunity for DHS to be sure that the program and our partners are continuing to strive towards improved access to care and superior quality of care and support provided by the PH Plans to MA consumers.

The PH plans available in your county may change. In some counties, your current MCO will no longer be available, and in others, you may have new options to pick from. If you have to select a new plan, DHS is committed to helping you find a plan that meets your individual needs, while also allowing you to keep your current health care providers. It’s important for you to consider what doctors, hospitals, or other health care providers are in a PH plan’s network.

This enrollment period is your opportunity to compare the health plan options in your region and choose the best plan for you.

Please note that the above information means that your agency needs to alert your consumers to the change so they can make an informed decision. Otherwise, they will be auto-assigned. Visit here for more details regarding which plans are available by county.

**Does NOT affect current Behavioral HealthChoices or
Community HealthChoices participants.**

ODP Announcement 22-087 issues an important reminder that major changes are being made to the HealthChoices Physical Health Managed Care Organizations (MCOs) offering Medical Assistance benefits on September 1, 2022. A large number of Medical Assistance consumers must select a new MCO by August 16, 2022. If they do not make a selection, a new MCO will be automatically chosen for them.

If Medical Assistance consumers are unsure if they need to select a new MCO, or haven’t received selection materials, they should contact Pennsylvania Enrollment Services at the following:

TTY: 800-618-4225 | Monday – Friday | 8:00 am – 6:00 pm
Home | PA Enrollment Services

ODP Announcement 22-073 announces that the Department of Human Services (DHS) is preparing for the eventual end of the Public Health Emergency. Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has continued Medical Assistance (MA) coverage for most people unless they moved out-of-state, passed away, or asked to end their MA.

When the federal PHE ends, the Department of Human Services must determine if people are still eligible for MA. MA recipients will have to complete a renewal to maintain their MA coverage.

DHS is seeking trusted partners to assist in this PHE unwinding process through means of connection to individuals that will need to renew MA benefits. Today, an email newsletter called the DHS Helper Portal is being launched.

Sign up to become a helper today!

  1. Fill out the simple online form.
  2. The form will generate an email to the email address given.
  3. Confirm the address by walking through the prompts in the email.
  4. Congratulations! You are a helper!