On October 15, 2019,the Pennsylvaia Department of Human Services (DHS) released the Pennsylvania HealthChoices Physical Health Medicaid Managed Care request for applications (RFA). Reflecting the current framework, Medicaid managed care organizations (MCOs) will serve the five HealthChoices zones covering all 67 counties: Southeast, Southwest, LehighCapital, Northwest, and Northeast. Contracts are worth nearly $13 billion. Pennsylvania failed to implement new contracts and negated awards from 2016 as well as the awards from the 2017 rebid. As a result, the HealthChoices program is currently operating under extensions of contracts originally awarded in 2012. The most recent awards in early 2017, which would have been for a three-year, $12 billion contract, were protested by Aetna, UnitedHealthcare, and AmeriHealth Caritas, leading the state to cancel the RFA and reissue the procurement. Applications are due December 17, 2019, and contracts are expected to begin January 2021, running for five years, with an option to extend for an additional period of three years. An award date was not announced.

Pennsylvania Insurance Commissioner Jessica Altman announced Pennsylvania’s approved 2020 individual and small group ACA health insurance rates, highlighted increased marketplace competition within several counties and noted a decrease in counties with only one carrier. Click here to see the press release. Pennsylvania will have seven insurers in the health insurance market offering individual plans for 2020.

• Ambetter
• Capital Blue Cross
• Geisinger Health Plan
• Highmark
• Independence Blue Cross
• Oscar
• UPMC

On October 11, 2019, two District Courts issued nationwide preliminary injunctions to stop the Trump Administration’s public charge rule, which would have taken effect Oct. 15, 2019.  This proposal was opposed by NACHC, PACHC and many other organizations that expressed concern about the proposal’s impact on immigrant families and refugees. An article further explaining the ruling can be found here. A Kaiser Family Foundation study showed Community Health Centers   reported that immigrant patients have declined to enroll in or renew Medicaid coverage out of fear of becoming a public charge, even those patients who are not covered by this rule.

The Pennsylvania Department of State this announced a brand new public facing Licensure Processing Guide. The guide breaks down the licensing process into three phases and provides the average length of time each phase will take as of the previous quarter. It also offers recommendations for how to shorten processing times. Additionally, new to the department’s website are two short videos, “How to Apply for a Professional License” and “What Happens to My Application.” The first boards featured in the Licensure Processing Guide are the Cosmetology, Nursing and Osteopathic Medicine Boards. More licensing boards will be built and additional licenses will be added to existing boards on a rolling basis, with the Medical, Real Estate and Engineering Boards in process now.

The Drug Enforcement Administration has announced that it will collect unwanted vaping devices during its National Prescription Drug Take Back Day, which is scheduled to take place from 10 a.m. to 2 p.m. tomorrow at collections sites throughout the United States. The announcement comes as updated CDC data shows the number of cases of a lung illness officials believe is linked to e-cigarette use and vaping has reached 1,604. (Sources: NPR’s “Shots,” 10/25; CNN, 10/24)

Cleveland Clinic this week released its annual list of the top 10 medical innovations the health system predicts will “transform health care” in 2020. The list includes a dual-acting osteoporosis drug, an oral immunotherapy to reduce the effect of peanut allergies, and more. (Source: Becker’s Health IT & CIO Report, 10/24)

This annual report from the Center for Connected Health Policy (CCHP) is the most current guide of Medicaid provider manuals, state laws, and regulations for telehealth in all 50 states and the District of Columbia.  Key findings this year include reimbursement for some form of live video in all states and DC, and 22 states with reimbursement for remote patient monitoring.  The report includes an interactive map of policies as well as an at-a-glance infographic.  Click here to access the guide.

Harrisburg, PA – On October 18, 2019, Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller joined the Center of Excellence (COE) Regional Learning Network to meet with COEs in Central Pennsylvania and hear directly from their employees about the successes and challenges of fighting the opioid epidemic. Since 2017, Pennsylvania’s 45 COEs have expanded access to and improved engagement in treatment to more than 20,500 Medicaid recipients around Pennsylvania.

“It goes without saying that our goal is to save lives and help people get the treatment they need to live healthy lives,” said Secretary Miller. “We want to be sure we are doing everything we can to fight the opioid epidemic and give people the resources they need to be successful in recovery, and the COE model is making that possible for more Pennsylvanians.  We know, though, that there is still more work to be done. The Regional Learning Network gives us the opportunity to learn from COE employees since they are hearing directly from the people we are helping and can help inform our response to the opioid crisis moving forward.”

Prior to the COEs, as few as 48 percent of Medicaid beneficiaries diagnosed with opioid use disorder were receiving treatment. Of those, only 33 percent remained engaged in treatment for more than 30 days. Today, more than 70 percent receive treatment after being diagnosed with an opioid use disorder, and 62 percent remain in treatment for more than 30 days.

The Regional Learning Network is made up of representatives from each COE in a region. The networks meet regularly to determine best practices for addressing the opioid epidemic. Each year, all of the Regional Learning Networks come together for a Statewide Learning Network to share and explore best practices.

COEs provide treatment that is team-based and whole-person focused, with a goal of integrating substance use disorder treatment, behavioral health, and primary care. The centers’ care managers work to keep people with OUD engaged in treatment by coordinating follow-up care and community supports. Their work confronts the most common barriers to treatment and provides vital support to maintain recovery.

COEs work as a hub-and-spoke network, with the designated center serving as the hub. The spokes can include primary care practices, the criminal justice system, emergency departments, social services providers, and other treatment providers and referral sources. With a commitment to educating the community, the COE team works to ensure health care, education, and law enforcement organizations can identify those who need treatment and refer them to the center.

For more information on the state’s efforts to battle the opioid epidemic, visit www.pa.gov/opioids.