Emergency department visits for pneumonia have been increasing, particularly among children and young adults. Some hospitals and college student health centers have reported clusters of cases of pneumonia due to Mycoplasma pneumoniae. National laboratory surveillance for respiratory viruses is also noting an increase in percent positivity for rhinovirus/enterovirus in PA. Testing for respiratory pathogens should be performed to guide appropriate management and treatment. PCR-based molecular tests are preferred for rapid and accurate diagnosis of both M. pneumoniae and rhinovirus/enterovirus. Antibiotics should not be used to treat viral infections. Macrolides are the first line of treatment for M. pneumoniae infections. Macrolide-resistant strains are emerging, but susceptibility testing is not generally available. Consider using tetracyclines or fluoroquinolones if a macrolide does not appear to be effective. Use transmission-based precautions (droplet and contact) to reduce spread in health care and community settings. Promote respiratory hygiene and encourage symptomatic individuals to stay at home. Encourage vaccination for influenza and other respiratory viruses to reduce the risk of co-infections. Report unusual clusters or outbreaks of respiratory illnesses to the Pennsylvania Department of Health by calling 1-877-PA-HEALTH (1-877-724-3258) or your local public health department. Individual cases of M. pneumoniae and rhinovirus infection are not reportable to the Department. The full HAN is available.

The purpose of this bulletin is to advise Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that the Pennsylvania Department of Human Services is continuing the alternative payment methodology to pay the Medical Assistance Program Fee Schedule rate for the administration of the novel coronavirus (SARS-CoV-2) vaccine during a SARS-CoV-2 vaccine-only visit. In addition, this bulletin contains an updated The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook (FQHC/RHC Handbook) to clarify the payment methodology for vaccine-only visits.

The managed care delivery system has grown to be the primary model for delivering healthcare services to approximately 75% of the Medicaid population. The newest Issue Brief, created in collaboration with Population Health Alliance (PHA), summarizes key provisions from CMS’ 2024 final Medicaid managed care rule. Sellers Dorsey Managing Director Leesa Allen and Director Brian Dees, alongside PHA contributors, assess potential impacts and opportunities for states, MCOs, providers, and solution partners to improve access to and quality of care for Medicaid enrollees. Click here to download the Issue Brief.

Pennsylvania Auditor General Tim DeFoor recently visited Erie to speak with pharmacists locally on the struggles they face and talk about the reform needed. DeFoor released a performance audit in August that outlines how Pennsylvania taxpayers paid $7 million more for Medicaid prescription drug benefits than they should have in 2022. Read more.

On September 12, Pennsylvania Governor Shapiro’s office announced Executive Order (EO) 2024-03, which outlines a statewide housing action plan on affordable housing aimed at addressing homelessness. The Housing Action Plan will be a data-driven statewide plan with recommendations to the governor for increasing housing supply and supporting the preservation of existing housing.

Legislation intended to help recognize and respond to perinatal and postpartum depression (PPD) is on Pennsylvania Governor Shapiro’s desk. House Bill 2127 directs the Department of Health to centralize information on symptoms and treatment for PPD online and on fact sheets available in doctors’ offices, including an up-to-date list of organizations that provide counseling. The Senate on Tuesday unanimously approved the legislation. The House on Wednesday voted to concur to amendments made by the Senate. Maternal mental health conditions are the leading cause of pregnancy-associated death in the commonwealth, according to the Pennsylvania Maternal Mortality Review Committee. Nearly 75% of mothers affected receive no treatment.

From Law 360

The U.S. Department of Labor (DOL) and two other agencies unveiled proposed regulations that for the first time would require private health insurers to cover the full cost of over-the-counter contraception, including male condoms and the morning-after pill, without a prescription.

The DOL, the U.S. Department of Health and Human Services, and the Treasury Department jointly unveiled the proposed rules, which would also require insurers to eliminate cost sharing on more FDA-approved prescription birth control and force new disclosures to people enrolled in private health plans to let them know they can get no cost-sharing coverage.

The White House said in a facesheet describing the proposal that if finalized, the policy would expand free birth control coverage for 52 million American women of reproductive age who are covered by private health insurance.

The Commonwealth of Pennsylvania is taking action against the state’s high maternal mortality rate through the development of a statewide Maternal Health Strategic Plan.

In partnership with the office of Pennsylvania Governor Shapiro, the health agencies involved in plan development include the departments of Health, Human Services, Drug and Alcohol Programs, and Insurance.

The vision for Pennsylvania’s Maternal Health Strategic Plan is a Pennsylvania where every pregnant and birthing person has easy access to high-quality perinatal, birth and postpartum care that is person-centered, comprehensive, equitable, and affordable and that results in healthy outcomes and long-term good health and well being.

Your voice matters in decisions that affect maternal health. You are invited to share your voice on the Commonwealth of Pennsylvania’s Maternal Health Strategic Plan survey.

The survey is available through November 4, 2024.

Important Notice for Physicians Renewing Licenses in Pennsylvania

Help Us Maintain Accurate Provider Data

Your Role in Addressing Workforce Shortages

 

Why Accurate Data Matter:

Maintaining accurate and current information on providers is essential for effectively analyzing, designing, and designating areas with health care workforce shortages across Pennsylvania. The Pennsylvania Department of Health’s Primary Care Office (PCO) relies on these data to ensure that health care resources are allocated where they are needed most.

How Your Participation Makes a Difference:

• Support Workforce Analysis: Accurate provider data help identify regions with health care provider shortages, ensuring targeted interventions and support.
• Improve Health Care Access: By updating your information, you contribute to a more efficient allocation of health care resources, improving access to care for underserved populations.
• Enhance Statewide Planning: Your data help the PCO and other stakeholders design effective strategies for addressing health care needs in various regions.

How We Collect and Update Provider Information:

The PCO uses several methods to ensure that provider data remains accurate and up to date:

• Self-Reported Survey Responses: When you renew your license, please provide detailed and accurate information about your practice, including address, office hours, specialty, and patient care details. The information from licensure surveys is the most critical of all data sources.
• Annual Medicaid Claims File: We obtain practitioner information from Medicaid claims, which helps verify and update provider data.
• Statewide Organization Input: We receive periodic updates from various organizations, which contribute to our data accuracy.
• Direct Outreach: Occasionally, PCO staff may contact you directly to collect and verify practice-related information.

While the PCO can update existing provider information, we cannot add new providers to the computer system used for shortage designation. Your updates are crucial for maintaining the quality of data used in health care planning.

How You Can Help:

1. Respond to Surveys: Provide thorough and accurate responses to surveys at the time of your license renewal.
2. Keep Information Current: Go to the Center for Medicare and Medicaid Services website to update your practice details in the National Provider Identifier system regularly to reflect any changes in address and specialty.
3. Participate in Outreach Efforts: Engage with PCO staff during direct contact initiatives to verify and update your practice information.

Pennsylvania Department of Health
Primary Care Office
RA-DHSHRTDESIGNATION@pa.gov