The Pennsylvania Department of Human Services (DHS) released a Medical Assistance (MA) Bulletin that addresses Behavioral Health Group Therapy provided in FQHCs and Rural Health Clinic (RHC) settings. MA Bulletin 08-20-03 applies to FQHCS and RHCs who are MA enrolled and provide services to MA beneficiaries in a fee-for-service (FFS) or through managed care delivery systems. DHS has added the HQ modifier to procedure code T1015 to identify behavioral health group therapy encounters provided by FQHCS and RHCs. This is effective beginning Sept. 15, 2020 and the T1015 code is to be billed when a behavioral health group therapy session is led by a psychiatrist, licensed clinical psychologist, licensed clinical social worker (LCSW), licensed professional counselor (LPC) or licensed marriage and family therapist (LMFT).

The Pennsylvania Department of Human Services (DHS) released a Medical Assistance Bulletin implementing a separate PPS encounter rate for vision services provided by FQHCs and RHCs. The separate vision PPS rate can be billed by an ophthalmologist or optometrist and is effective with dates of service on and after Oct. 1, 2020. DHS indicates:

• FQHCs and RHCs may bill for a vision encounter in addition to a physical health, behavioral health and dental encounter on the same day
• To receive a separate vision PPS encounter rate and be eligible to bill for vision encounters, FQHCs and RHCs must submit a Medicaid FQHC Cost Report to DHS
• For billing, the U3 pricing modifier with the T1015 code must be on the claim

For more details, access the Bulletin here.

HRSA has drafted an Interim Final Rule (IFR) that would implement the President’s Executive Order on insulin and EpiPens. This IFR is currently being reviewed by OMB, which is the last step before it is published. (No draft has yet been released to the public.) Once published, it will go into effect almost immediately, before any opportunity for public comment. However, OMB is legally required to hold “listening sessions” with any groups who request one before they finalize their review. Therefore, PACHC and NACHC encourage health centers to reach out to OMB ASAP to request a meeting, as follows:

• Go to https://www.reginfo.gov/public/do/eo/neweomeeting
• When it asks for the RIN, enter “0906-AB25”
• OMB MUST accept your request unless they’ve already approved the rule (although they may try to condense several meetings into one)

Requesting a meeting will allow FQHCs to share their concerns with the proposal and help to slow down the approval process.

Navigators and Certified Application Counselors (Assisters) must be registered with the Pennsylvania Insurance Department to provide enrollment assistance to consumers seeking coverage on Healthcare.gov and on the upcoming Pennsylvania insurance exchange, Pennie.com. Registrations last for two years. To renew your current or expired registration or verify your expiration date, go to PID’s Licensee Verification Page.

The Centers for Medicare and Medicaid Services (CMS) released the 2021 Assister Certification training for those operating on the federally facilitated marketplace. Pennsylvania assisters (Navigators and Certified Application Counselors) SHOULD NOT take this training. Pennsylvania is a state-based marketplace for the 2021 Enrollment period. The Pennsylvania assister training will be available by Oct. 1, 2020 from the Pennsylvania Health Insurance Exchange Authority (Pennie) through Cognosante, PACHC’S partner for assister services. New guidance has also been released regarding Pennsylvania Insurance Department (PID)registration for new enrollment assisters. For those who have not previously taken assister training and have never registered with PID, you may now register prior to completing your training. This is a change from previous years. For more information, please contact Tia Whitaker, Statewide Director for Outreach and Enrollment.