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Photo by Markus Winkler on Unsplash

The Medical Assistance Bulletin 08-24-04, issued by the Department of Human Services (DHS) Office of Medical Assistance Programs (OMAP), provides updates to the PROMISe (Provider Reimbursement and Operations Management Information System) Provider Handbook 837, Professional/CMS-1500 Claim Form, specifically focusing on Appendix E – FQHC/RHC (Federally Qualified Health Center/Rural Health Center) Handbook. Released on March 1, 2024, the bulletin outlines revisions to Federal and State requirements for FQHCs and RHCs in Pennsylvania participating in the Medical Assistance (MA) Program.

Notable changes include the addition of pharmacists and licensed dietician-nutritionists as eligible practitioners for billable encounters starting March 1, 2024. The revision addresses group therapy encounters and introduces guidelines for telehealth, telemedicine, and teledentistry in FQHC and RHC services. A new section on alternative payment methodologies is included, along with updates to the MA Cost Reporting and Wraparound Reporting sections. The Centers for Medicare & Medicaid Services’ clarification designates “hospital” as an allowable place of service for FQHC and RHC services. Providers are encouraged to review the revised handbook for detailed information on these changes.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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Message from The Centers for Medicare & Medicaid Services (CMS):

The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.

Over the last few days, we have continued to meet with health plans, providers and suppliers to hear about their most pressing concerns. As announced previously, we have directed our Medicare Administrative Contractors (MAC) to expedite actions needed for providers and suppliers to change the clearinghouse they use and to accept paper claims if providers need to use that method. We will continue to respond to provider and supplier inquiries regarding MAC processes.

CMS also recognizes that many Medicaid providers are deeply affected by the impact of the cyberattack. We are continuing to work closely with States and are urging Medicaid managed care plans to make prospective payments to impacted providers, as well.

All MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites as early as today, Saturday, March 9.

CMS looks forward to continuing to support the provider community during this difficult situation. All affected providers should reach out to health plans and other payers for assistance with the disruption. CMS has encouraged Medicare Advantage (MA) organizations to offer advance funding to providers affected by this cyberattack. The rules governing CMS’s payments to MA organizations and Part D sponsors remain unchanged. Please note that nothing in this statement speaks to the arrangements between MA organizations or Part D sponsors and their contracted providers or facilities.

If you have any questions, please contact Fady Sahhar.

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The Pennsylvania Developmental Disabilities Council (PADDC) is working on a project to enhance Pennsylvania’s self-advocate leadership to focus on system and policy change. We invite people with developmental and intellectual disabilities (I/DD) and providers or organizations to connect them to self-advocates who may want to be part of the conversation.

The first step in the plan is to gather contact information so they can listen and learn from you. Please complete their survey through the links below.

The long-term plan includes talking with self-advocates with intellectual and developmental disabilities about:

  1. Connecting self-advocates to network and organize as a powerful, united community;
  2. Creating the foundation for an effective statewide network of skilled advocates who can influence system change; and
  3. Involving people interested in advocacy and system change to plan together for the future.

Please visit one of the links below by March 20 to help them learn about self-advocacy in Pennsylvania!

  1. If you are an individual with intellectual and/or developmental disabilities and are interested in becoming an advocate, please use this survey link.
  2. If you are an organization or provider that engages with people with intellectual/developmental disabilities, please use this survey link.

Please share this opportunity to connect with interested Pennsylvania advocates and I/DD providers or organizations in your network!

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With state and federal laws governing the use and disclosure of confidential substance use disorder (SUD) information having undergone significant changes, including the recently announced final rule modifying 42 CFR Part 2, the Pennsylvania Department of Drug and Alcohol Programs (DDAP) issued Licensing Alert 04-2024 to clarify the identification of recipients of confidential SUD information for treatment, payment, or healthcare operations for compliance with 28 Pa. Code § 709.28(c)(1).

Consent forms must now include names of recipients, with a single form applicable for future disclosures, using a generalized recipient description. Treatment providers are urged to ensure their consent forms comply with these regulations and updated policies. For additional questions treatment providers can contact the Bureau of Program Licensure.

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All sessions are scheduled from 10:00 am – 3:00 pm.

  • Tannersville, PA, Northampton Community College: June 5, 2024
  • Butler, PA, Monarch Institute: June 12, 2024
  • Malvern, PA, PaTTAN East: June 18, 2024
  • Bellefonte, PA, Central Penn Institute of Science and Technology: June 26, 2024

In this second annual ODP Employment Regional Symposium, participants will hear from employers about how, what, and why they hired individuals with developmental disabilities. Individuals who are employed and their teams will describe how having a job made a difference in their lives and the lives of their families. Representatives from the Office of Developmental Programs (ODP), Office of Vocational Rehabilitation (OVR), and the Bureau of Special Education will discuss collaboration across systems and offices with a focus on things that you thought might not be possible.

Who should attend?

Anyone interested in advancing the employment of individuals with developmental disabilities including but not limited to: current and future employers, self-advocates, local education authorities, intermediate units, ODP employment/community participation support/residential providers, supports coordinators, administrative entities transition counselors, regional employment coalitions, and OVR business liaisons.

Boxed lunches will be provided. Morning beverages and snacks are on your own.

Registration information will be sent in a separate ODP Announcement.

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As noted in a previous alert from the Department of Human Services (DHS), the Department of Health and Human Services (HHS) has also been providing updates regarding the recent cybersecurity incident that impacted Change Healthcare (a unit of UnitedHealth Group). HHS has noted that their first priority is to help coordinate efforts to avoid disruptions to care throughout the health care system.

On March 5, 2024, HHS announced immediate steps that the Centers for Medicare and Medicaid Services (CMS) is taking to assist providers to continue to serve patients. CMS will continue to communicate with the health care community and assist, as appropriate. Providers should continue to work with all their payers for the latest updates on how to receive timely payments.

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