COVID-19 Vaccine Payment Bulletin

Posted on by klb520

The PA Department of Human Services (DHS) has finally released the long-awaited Medical Assistance Bulletin outlining payment for administration of COVID-19 vaccine during a vaccine-only visit in which no other services are provided on the same date. The bulletin announces DHS is implementing an alternative payment methodology (APM):

  1. To pay the MA Program Fee Schedule rate for the administration of the vaccine on or after Dec. 1, 2020
  2. To pay the enhanced MA Program Fee Schedule rate for the administration of the vaccine to homebound MA beneficiaries during a vaccine-only visit for dates of service on or after April 1, 2021

It is important to note that the bulletin applies to fee-for-service only; providers rendering services to MA beneficiaries in the managed care delivery system (HealthChoices) must utilize the COVID-19 vaccine administration codes for DHS tracking purposes but must contact the managed care organization (MCO) with billing questions. The bulletin outlines the procedure codes for administration of the vaccine, which are distinct to each COVID vaccine and the specific dose in the required schedule. In order to bill under this new APM, a request to opt in to the APM as of Dec. 1, 2020, must be submitted by the FQHC/RHC chief financial officer (CFO) via email to DHS at financialgatekeeper@pa.gov within 30 days of issuance of the bulletin (by March 26, 2022) and must include both the FQHC/RHC nine-digit service location number for which the opt-in is to be applied. The email should indicate the FQHC/RHC is accepting the APM. Claims submitted within 60 days of the issuance of the bulletin (April 25, 2022) will not be subject to the time frames for submission of claims in 55 Pa. Code §1101.63(b). Read the full bulletin.

HRSA Makes Changes to Health Center COVID-19 Survey

Posted on by klb520

Beginning with the Health Center COVID-19 Survey issued on Feb. 24, HRSA will add new options for questions 7b and 8b. These questions ask where health centers distributed N95 masks and test kits received through HRSA’s COVID-19 Response Programs. Here are the new options:

  • Provided to migratory/seasonal agricultural workers directly or through partnerships with community organizations serving these individuals
  • Provided to individuals with limited English proficiency directly or through partnerships with community organizations serving these individuals
  • Provided to older adults and/or individuals with disabilities directly or through partnerships with community organizations serving these individuals
  • Provided to school-age children and/or their families directly or through partnerships with schools

Provided to individuals living in HUD-assisted housing and/or individuals experiencing homelessness directly or through partnerships with local housing authorities

 

Public Charge Proposed Rule Published

Posted on by klb520

The Department of Homeland Security (DHS) announced that it is publishing a Notice of Proposed Rulemaking (NPRM, or proposed rule) around Public Charge. “Public charge” refers to the factors that immigration officials consider when determining if a legal immigrant should be approved for a Green Card; use of certain public benefits is one of these factors. In general, the NPRM proposes to establish in regulation the Public Charge standards that were in place from 1999 through 2018. Under these standards, the only public benefits that may be considered in a public charge determination are cash assistance and institutional long-term care. In 2018, the Trump Administration expanded the list of public benefits to include use of Medicaid, SNAP, and certain housing supports. The Biden Administration withdrew the Trump regulation in 2021, and now is seeking to enshrine the previous standards in regulations as, to date, these standards exist only in sub-regulatory guidance, and therefore can be easily withdrawn without public input.

Barriers to Medicaid and CHIP Enrollment

Posted on by klb520

The Biden Administration has announced a Request for Information (RFI) related to healthcare access through Medicaid and the Children’s Health Insurance Program (CHIP). The RFI’s aim is to better understand barriers to enrollment. A list of questions to inform responses is available and responses are due by April 18, 2022.

Pennie Assisters

Posted on by klb520

Pennie has helpful quick reference guides and tools available at www.agency.pennie.com/assisters. Bookmark this page for tips and easy access to assister-specific materials. The latest addition is the Special Enrollment Period Quick Reference Guide. The guide provides detailed information on all special enrollment period effective dates, needed documentation and self-attestation rules. This guide and other Qualifying Life Event instructions are available on the Feb. 18 Pennie Lunch and Lunch.

 

 

2022 Outreach and Enrollment Peer Networking

Posted on by klb520

PACHC’s February 2022 Outreach and Enrollment Peer Networking call was recorded and is available on our Outreach and Enrollment Slack page.  Topics of discussion included Final Open Enrollment 2022 Pennie numbers, assister reporting, upcoming trainings and Medicaid enrollment. Be sure to review the recording for observations, trends and news. Questions, contact Tia Whitaker, Statewide Director, Outreach and Enrollment.

Supreme Court Won’t Hear Challenge to State Mask Mandate

Posted on by klb520

The Supreme Court again rejected an opportunity to hear arguments in a lawsuit that sought to challenge Maine’s COVID-19 vaccine mandate for healthcare workers. The Supreme Court had already rejected the Maine challengers in October, when, over three dissents, the justices refused to intervene on an emergency basis. Maine is one of three states, along with New York and Rhode Island, that require vaccination of healthcare workers and allow exemptions only for medical reasons. Although the Supreme Court has limited the federal government’s power to require COVID-19 shots or tests, the justices have allowed state and local mandates, even without religious exemptions. The court left in force New York’s requirement in December.

Do Your Part to Protect 340B Program

Posted on by klb520

Please keep up your efforts to expand the list of PROTECT 340B cosponsors. We’re told that the current list of 71 cosponsors “is definitely getting the Senate’s attention.” With the possibility of Congress addressing other 340B issues, it becomes even more important to show support for the protections for covered entities in this bill. Here are resources to support your advocacy:

There are currently five Pennsylvania co-sponsors: Reps. Matt Cartwright, Glenn Thompson, Dwight Evans, Susan Wild and Fred Keller.

State Supreme Court Chooses New Congressional Map

Posted on by klb520

On Wednesday, Feb. 23, Pennsylvania’s highest court chose a new congressional districting map. By a 4-3 vote, the commonwealth’s new 17-district map—one less district than the 2010 map due to the 2020 census results—largely sticks to current lines and is expected to provide for eight Republican-leaning districts, six Democratic-leaning districts and three districts that could be considered toss-ups. The map also pits two incumbents—U.S. Reps. Fred Keller and Glenn Thompson—against each other in central Pennsylvania. With the prolonged finalization process, the court decided to extend the petition-gathering schedule but keep the May 17 primary date.

Pennsylvania Association of Community Health Centers Events

Posted on by klb520

It’s Time to Register!

We hope that you are planning to join us for one or more of these upcoming March events that will be held in-person at the Best Western Central Hotel in Harrisburg:

  • C-Suite Forum, March 23 – health center executive teams will gather for a day focused on addressing pandemic fatigue from the executive management perspective
  • Emergency Preparedness Summit, March 24-25 – representatives from health centers across the state will meet to ensure compliance with CMS requirements and strengthen emergency planning

Visit the Events page of PACHC’s website for more information on the events and to register. Questions? Contact Amanda Tekely, Events and Communications Manager