The federal Substance Abuse and Mental Health Services Administration (SAMHSA) released a proposed rule that would permanently allow providers to prescribe buprenorphine using telehealth for opioid use disorder treatment without requiring an in-person physical evaluation. With comments due on or before Feb. 14, 2023, the proposed rule also includes a change to the consent process required for telehealth visits, among other proposed changes.

The Childhood Blood Lead Test Act was signed into law in November. 3, 2022, took effect January 2, 2023. The Act provides for blood lead assessment and testing of specific children and pregnant women by healthcare providers; imposes duties on the Department of Health; and requires particular health insurance policies to cover blood lead tests. The purposes of the Act are to substantially reduce and eventually eliminate the incidence of childhood lead poisoning in the Commonwealth, to improve public awareness of lead safety issues in housing, to educate property owners and tenants about practices that can reduce the incidences of lead poisoning and encourage testing of all children in Pennsylvania by two years of age so that prompt diagnosis and treatment, as well as prevention of harm, are possible. The state Health Department gave notice in the Pennsylvania Bulletin regarding how Act 150 of 2022 is to be implemented by healthcare providers.

On Dec. 22, the Pennsylvania Department of Human Services (DHS),Office of Medical Assistance Programs issued MA Bulletin 01-22-78: 340B Drug Pricing Program – Dispensing 340B Purchased Drugs. According to DHS, “This bulletin does not reflect any change to the Department’s policy. As per the 2013 MA Bulletin (link added), and as reflected in the current bulletin, authorized 340B entities are still able to dispense and bill 340B eligible drugs in both FFS and Managed Care.” The Bulletin notes that “contract pharmacies must dispense non-340B-purchased drugs to beneficiaries in the FFS and managed care delivery systems.”

The federal COVID-related Public Health Emergency (PHE), currently set to expire on Jan. 11, 2023, is expected to be extended once more, to April 2023. During the PHE, Pennsylvania has allowed continued Medicaid (Medical Assistance (MA)) coverage for most individuals enrolled in MA as required by the federal Families First Coronavirus Response Act (FFCRA) in exchange for increased federal Medicaid funding. However, the previous continuous coverage requirement tie to the PHE was severed with passage of the omnibus spending bill by Congress last week sets March 31, 2023, as the last day of the requirement, regardless of the status of the PHE. The bill allows states to continue to receive enhanced federal funding, in gradually decreasing amounts, throughout 2023. When the continuous Medicaid coverage requirement ends, the PA Department of Human Services (DHS) will review Medicaid eligibility for everyone on MA. While DHS originally planned to conduct the “unwinding” of continuous Medicaid coverage over a six-month time period, DHS in November shared its intention to take a full 12 months to review eligibility for all Pennsylvanians on Medicaid. For most, this means Medicaid will be reviewed when their Medicaid renewal would normally occur. Please remind your patients who are currently covered by MA that it is critical to ensure their contact information with the County Assistance Office (CAO) is up to date so they can receive Medicaid-related correspondence, including the renewal packet. Contact information can be updated on the COMPASS website, on the myCOMPASS PA mobile app, or by calling the Statewide Customer Service Center at 1-877-395-8930 (in Philadelphia, call 215-560-7226). MA-insured individuals also have the option to sign up for text alerts related to their benefits renewal.

When mapmakers reimagined the boundaries of Pennsylvania’s 253 legislative districts, they did it with an eye on the state’s growing racial and ethnic minorities, and officials say that has helped yield the most diverse incoming class of lawmakers yet, the Associated Press reported. The number of state lawmakers who are Black, Latino or of South Asian descent will rise as part of what House Democrats call the “most diverse class of freshmen legislators” in Pennsylvania history after candidates ran in this year’s election in the newly drawn map of districts. The proportion of Black lawmakers is now slightly outpacing that of Black residents in Pennsylvania, with both around 11%, even after the departure for higher offices of two Black lawmakers, Summer Lee (elected to Congress) and Austin Davis (elected lieutenant governor). The election, however, was mixed for Latinos: Their rapid population growth over the past decade in Pennsylvania and several new districts designed to boost their electoral strength did not translate into significant electoral gains in the Legislature. There, the number of Latinos will rise from four to five, or just 2% in a state where Latinos make up 8% of Pennsylvania’s 13 million residents. Proportional representation would be more like 20 seats.

CMS released a State Health Official (SHO) letter that provides guidance to states on policy for Medicaid and the Children’s Health Insurance Program (CHIP) to allow one provider to discuss a Medicaid or CHIP beneficiary’s case with a specialist, with or without the beneficiary present, and to pay the specialist for their services directly. The current policy only allows payment in this circumstance if the provider who is seeking the consultation is paid for the consulted provider’s services and then pays the consulted provider directly. This change more directly “links” routine care with specialty care, allowing more people to benefit from practitioners with specialized knowledge.

For more, read the full letter https://www.medicaid.gov/federal-policy-guidance/downloads/sho23001.pdf

CMS issued an informational bulletin on the provisions included in the Consolidated Appropriations Act, 2023 (CAA, 2023) related to the Medicaid continuous enrollment condition.

The CAA, 2023 updates various Medicaid and CHIP provisions, including significant changes to the continuous enrollment condition of the Families First Coronavirus Response Act. Under the CAA, 2023, expiration of the continuous enrollment condition will no longer be linked to the public health emergency (PHE) and instead the condition will end on March 31, 2023. Following the end of the condition, states will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, the Children’s Health Insurance Program, and the Basic Health Program. As of January 2023, the PHE is still in effect.

Read the Informational Bulletin for more detail.