DHS issued MA Bulletin 99-24-08 Pennsylvania’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule and Coding Matrix, effective Oct. 29, 2024. This bulletin applies to all providers enrolled in the Medical Assistance (MA) Program who provide EPSDT screens for MA beneficiaries in the fee-for-service and managed care delivery systems. Providers rendering services in the managed care delivery system should address any payment related questions to the appropriate MA managed care organization. This is in response to CMS published highly anticipated guidance on early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Under the EPSDT requirements at Section 1905(a)(4)(B) and (r) of the Social Security Act, children under age 21 are entitled to Medicaid coverage of Section 1905(a) services that are medically necessary to correct or ameliorate physical or mental conditions, even if these services are not covered under the state plan.

CMS updated the Medicare Benefit Policy Manual, Chapter 13 (PDF) with CY 2024 requirements and payment policies for Rural Health Clinics and Federally Qualified Health Centers.

The updated booklets can be found using these links:

·       Information for Rural Health Clinics (PDF) booklet

·       Federally Qualified Health Center (PDF) booklet

·       Instruction to your Medicare Administrative Contractor (PDF)

Under Section 5121 of the Consolidated Appropriations Act of 2023, states will be required to provide screening, diagnostic, and targeted case management services to young people who are reentering from incarceration. CMS recently posted a slide deck on the requirements, which outlines relevant State Plan Amendment processes. CMS also recently issued a Notice of Funding Opportunity (NOFO) for planning grants to promote continuity of care during reentry. Grant funds can be used to support Medicaid and reentry efforts, including establishing claims processing systems at correctional facilities, investing in IT to establish bidirectional data exchange between Medicaid and corrections, and setting up processes to screen for Medicaid and CHIP eligibility in correctional facilities. There are two application deadlines for this funding: November 26 for Cohort 1, and March 17 for Cohort 2.

Pennsylvania Governor Josh Shapiro signed legislation that would extend Medicaid coverage to doula services in the state. Under the new law, introduced as HB 1608, Medicaid will reimburse certified doulas for providing childbirth education and support services, including physical and emotional support, during pregnancy, labor and delivery and up to one year postpartum. The law also establishes a Doula Advisory Board to set standards and requirements for doulas practicing in Pennsylvania. The board would include a diverse membership, including practicing providers and representatives from various state agencies. In January 2024, DHS released MA Bulletin 13-24-01 on how Doula’s can enroll in the Medicaid Program. DHS expects to issue an MA Bulletin in the coming months with billing instructions for doulas enrolled in Medicaid. DHS anticipates doulas will be able to bill Medicaid beginning January 1, 2025.

 As part of it’s comprehensive topic guide, the Rural Health Information Hub recently added a map of Rural Emergency Hospitals as of July 2024.

– Respond by December 9. The federal Occupational Safety and Health Administration (OSHA) seeks comments on their request to extend requirements for collecting information specified in OSHA’s COVID-19 Recordkeeping and Reporting in Healthcare Standard, which applies to settings where any employee provides healthcare services. The requirements include establishing and maintaining a log of each instance identified by the employer that an employee is COVID-19 positive; making the individual log entry available upon request for examination and copying; and reporting to OSHA each work-related COVID-19 fatality and each work-related COVID-19 in-patient hospitalization within specific timeframes of the employer learning of them. OSHA would like to hear from the public:

• whether the information collection requirements are necessary for the proper performance of the agency’s function to protect workers;
• if OSHA’s estimate of the burden (time and costs) of collecting the information is accurate; and
• what are some ways to minimize the burden on employers who must comply.

OSHA will summarize responses when they submit their request to the Office of Management and Budget to extend the requirements.

Among key findings in this brief from the North Carolina Rural Health Research and Policy Analysis Center:

• Various hospital types converted to REHs in 2023: seven were Sole Community Hospitals, six were Critical Access Hospitals, four were Prospective Payment System hospitals, and two were Medicare Dependent Hospitals.
• Counties with REH conversions were relatively challenged, showing highest median rates of poverty, uninsured individuals, and people in poor or fair health.
• Counties with a REH conversion also faced health care access challenges, with fewer primary care and mental health providers and higher emergency department visit rates among Medicare beneficiaries.

In response to a court order, the Centers for Medicare & Medicaid Services (CMS) has finalized appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpatients but are subsequently reclassified as outpatients receiving observation services during their hospital stay, along with other eligibility criteria.  This final rule establishes processes for standardized appeals, expedited appeals, and retrospective appeals for beneficiaries, and it extends the timeframe for providers to submit a claim following a favorable decision and to submit records as requested by a contractor. While CMS estimates a relatively low number of appeals that meet these criteria, they acknowledge that there will be administrative costs for hospitals to accommodate the new appeals process. This final rule is effective October 11, 2024.

– Respond by December 9. In response to an Executive Order to lower prescription drug costs, the Centers for Medicare & Medicaid Services (CMS) developed a model to test whether a simpler approach to offering low-cost, clinically important generic drugs can improve medication adherence, lead to better health outcomes, and improve satisfaction with the Part D prescription drug benefit for people with Medicare and for prescribers.  This RFI aims to obtain input from a broad range of interested parties to support continued development of the model.

A survey by Gallup and West Health showed that accessing health care may be easier for residents in some states due to low costs, high rates of health insurance coverage and an abundance of health care providers. The survey found that Pennsylvania has the sixth highest number of primary care physicians per 10,000 residents (19.78) and the sixth highest number of specialist physicians per 10,000 residents (22.01). Read more.