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Authors Posts by Jim Sharp

Jim Sharp

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This week, the Centers for Medicare & Medicaid Services (CMS) announced the Calendar Year 2023 Physician Fee Schedule (PFS) final rule. The final rule includes several National Council and RCPA recommended priorities. These are wins for mental health and substance use care organizations that will help expand access to care by strengthening the workforce.

RCPA recommends members review this 2023 Physicians Fee Schedule Final Rule Summary for impacts on your agencies practice and/or policies.

Key Highlights:

  • Telehealth Flexibility Extensions: CMS is extending telehealth flexibilities implemented under the Public Health Emergency (PHE) for a 151-day period after the expiration of the PHE.
  • CMS is allowing behavioral health clinicians to offer services incident to a Medicare practitioner under general (rather than direct) supervision.
  • Licensed professional counselors and marriage and family therapists are now able to bill incident to Medicare practitioner for their services.
  • Medicare will allow opioid treatment programs to use telehealth to initiate treatment with buprenorphine for patients with opioid use disorder, continuing the flexibilities under the Ryan Haight Act of 2008.
  • CMS is also clarifying that opioid treatment programs can bill for opioid use disorder treatment services provided through mobile units, such as vans, in accordance with Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) guidance.

The Final Rule, in alignment with the Consolidated Appropriations Act (CAA) of 2022, implements an extension of a number of flexibilities for a 151-day period after the expiration of the Public Health Emergency (PHE), which is set to expire on January 11, 2023.

In the event of further extensions of the federal PHE, we will communicate this info to members. Under the current timeframe for PHE continuation, states must be notified by November 11, 2022.

We thank our members and Steering Committees for their guidance, recommendations, and support through the review process. If you have any questions, please contact your respective RCPA Policy Director.

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In partnership with the Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Children, Youth, and Families (OCYF) is funding trauma training opportunities for all child welfare professionals in PA via Lakeside Global. From September 30, 2022, through September 30, 2023, PA child welfare professionals serving children in PA are able to take advantage of FREE trainings facilitated by the team at Lakeside Global to become trauma-aware, trauma-sensitive, trauma-informed, or healing-centered. This also includes “Train the Trainer” sessions to support trauma-informed sustainability within a child welfare organization.

To learn more about how you can take advantage of this professional development, please view the Trauma Training Announcement.

If you have questions relating to any of these trainings, please email PA Care Partnership or RCPA Policy Director Jim Sharp.

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On October 28, 2022, House Bill 1630 was signed into law by Governor Tom Wolf as P.L. Act 98 of 2022 and is effective immediately. This law repealed three sections of the Office of Mental Health and Substance Abuse Services (OMHSAS) regulations at 55 Pa. Code § 1153.14(1); § 1223.14(2); and § 5230.55(c) that were previously suspended by the Public Health Emergency (PHE). Behavioral Health (BH) providers may now deliver and bill for BH services through audio-only telehealth for both Outpatient Psychiatric Services and Outpatient Drug and Alcohol Services that is consistent with OMHSAS bulletin OMHSAS-22-02, titled “Revised Guidelines for the Delivery of Behavioral Health Services Through Telehealth” that was issued on July 1, 2022. Additionally, BH providers delivering Psychiatric Rehabilitation Services now have the ability to provide supervision through a video or audio platform.

The purpose of this email is to inform you that the following sections have officially been repealed:

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The Public Health Emergency (PHE) is a federal declaration made by the secretary of the US Department of Health and Human Services that was put in place in response to the COVID-19 pandemic. If it is not renewed every 90 days, it ends.

While the PHE is in place, Pennsylvania is allowed to keep Medical Assistance (MA) open for most people, even if they stopped meeting eligibility criteria or did not return a renewal for their MA. This is known as the continuous eligibility option, and people covered by MA could only have their benefits closed during the PHE if they passed away, moved out of state, or asked DHS to close their coverage.

So, what does this mean for MA recipients in Pennsylvania? Here are five important things to know as we approach a possible end to the federal PHE:

  1. When will the PHE end?

On October 13, 2022, the US Department of Health and Human Services announced that it was once again extending the PHE due to COVID-19.

This means that the earliest that the PHE will expire is January 11, 2023. DHS is continuing to monitor the status of the PHE and will let MA recipients know once an expiration date has been announced or if the PHE will be extended past January.

  1. MA recipients will need to complete a renewal to make sure they are still eligible for benefits

When the PHE ends, states will have to complete renewals for everyone covered by MA to determine eligibility. Coverage will not automatically end, but when a renewal is received it must be completed. If a renewal is not submitted to DHS or the individual is no longer eligible when they complete their renewal, they will be disenrolled and referred to Pennie or the Children’s Health Insurance Program (CHIP) for additional coverage options.

Renewal Packets

Not all renewals will be mailed to MA recipients at the same time when the PHE ends. DHS will be mailing renewal packets to individuals currently covered by MA the month before their renewal is due. If an individual is signed up to receive text messages from DHS, they will receive a text notification when their renewal packet is mailed. ​A due date will be listed on the renewal packet. If help is needed with completing the renewal or getting the needed verification documents by the due date, MA recipients can contact their local county assistance office or call the Statewide Customer Service Center at 877-395-8930 or 215-560-7226 in Philadelphia.

Completing Your Renewal

Renewals can be submitted using one of these three methods:

    • Online: Use the COMPASS website at dhs.pa.gov/COMPASS. Verification documents can be submitted electronically using this method or by using the myCOMPASS PA mobile app.
    • Phone: Call 866-550-4355, Monday–Friday, 8 am–5 pm; a representative will help you through the process and submit your renewal for review.
    • In Person: Complete the forms received in the renewal packet and drop them off at any local county assistance office.

If you have questions regarding completing your renewal, please view the PHE FAQ.

Keep your contact information up-to-date

One of the most important things you can do before the end of the PHE is make sure your phone number, email, and mailing address are up to date with DHS.

You can easily update your information anytime by using your My COMPASS account or the myCOMPASS PA mobile app (available from Apple or Google) . If you do not have a myCOMPASS account or the mobile app, you can call the Statewide Customer Service Center to update your contact information at 877-395-8930 or 215-560-7226 in Philadelphia, which are available Monday–Friday, 8 am–4:30 pm.

  1. If found ineligible, you still have options

If a renewal shows that a recipient is no longer eligible for MA, options are available to stay covered.

    • Age 19 or older — DHS will send the individual’s information to Pennie, Pennsylvania’s state-based health and dental insurance marketplace. Pennie can help review the individual’s coverage options and help learn about financial assistance that may be available to help pay for coverage.
    • Children under age 19 — Individuals will be directly connected to the Children’s Health Insurance Program (CHIP) and parents will learn more about coverage.
    • Reconsiderations — If an individual’s benefits closed because they didn’t send in the renewal or needed proof to go along with it, they can submit the renewal or any associated paperwork up to 90 days after they are closed for the renewal to be reevaluated without the need to submit a new application.
    • Appeals — If an individual believes a mistake was made when conducting their renewal, they can appeal that decision. Directions for how to appeal are on the notice you get from DHS.
  1. Resources are available to help in the PHE transition
  1. Help get the word out about the PHE

You and/or your organization can help DHS spread information about the end of the PHE by using your existing communications channels, such as social media and newsletters, to get trusted messages to your neighbors and community members. Simply sign up to be a Helper and you will receive information — key dates, print materials, toolkits, and more — via email that will support you in this effort.

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Governor Tom Wolf signed into law House Bill 1630, which makes permanent certain COVID-related regulatory suspensions under the Department of Human Services. While the bill primarily addresses pharmacy benefits, it contained language repealing several Department of Human Services (DHS) regulatory standards, making permanent several critical telehealth flexibilities listed below.

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