The Centers for Medicare and Medicaid Services (CMS) has released an informational bulletin, as well as a slide presentation, that are related to continuity of coverage for individuals receiving home and community-based services (HCBS). The purpose of the bulletin is to highlight the federal renewal requirements and available flexibilities to promote continuity of coverage.
The Pennsylvania Department of Human Services released Medical Assistance Bulletin 99-24-03 on May 28, 2024, detailing updates to the Medical Assistance (MA) Program Fee Schedule based on the 2024 Healthcare Common Procedure Coding System (HCPCS) changes. These updates include new codes such as 90867, 90868, and 90869 for transcranial magnetic stimulation (TMS) treatment billing, along with additional modifications to other procedure codes, setting of limitations, fee adjustments, and new prior authorization requirements effective from the same date. This bulletin applies to all providers serving MA beneficiaries under the Fee-for-Service system and those in the MA Managed Care system should contact their respective organizations for specific billing guidance.
For more detailed information, read the full bulletin here.
If you have any other questions, please contact RCPA COO and Policy Director Jim Sharp.
The Office of Developmental Programs (ODP) has shared ODPANN 24-051. The purpose of this communication is to announce the release of the ISP Manual that includes information from the Consolidated, Community Living, and Person/Family Directed Support waiver amendments that were effective on November 1, 2023. View the announcement and documents below for instructions and details:
A new bulletin addressing revisions to the Older Adults Protective Services Act (OAPSA) has been released by the Commonwealth Court. This bulletin specifically focuses on clarifying the legal standing of certain provisions, notably the “lifetime employment ban” for individuals with criminal convictions. Enacted in 1987, OAPSA aimed to protect Pennsylvania’s older population from exploitation, neglect, and abuse, establishing a program for their safeguarding, including those in mental health inpatient and residential facilities. However, subsequent amendments in 1996 introduced a permanent employment ban for individuals convicted of certain crimes. Despite this, a 2015 ruling by the Commonwealth Court found this provision unconstitutional, citing violations of due process guarantees under the PA constitution.
The full bulletin, titled “Bulletin OMHSAS-24-03 Employment Bans in OAPSA,” can be accessed here. Further inquiries regarding OMHSAS-24-03 can be directed to OMHSAS via email. You can also contact RCPA Policy Director and COO, Jim Sharp, with any additional questions.
The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the OMHSAS-24-01 Restraint Seclusion and Exclusion Bulletin, updating policies on restraint, seclusion, and exclusion in state mental hospitals to reduce these practices. This bulletin supersedes OMHSAS-09-06, necessitating adjustments in local hospital policies. Changes include shifting from “manual hold” to “physical restraint” terminology and clarifications in definitions. It strictly prohibits mechanical and chemical restraints, allowing physical restraint only as a last-resort emergency measure with detailed guidelines on application, documentation, and debriefing protocols. The emphasis is on individualized care, de-escalation techniques, and personnel training to ensure the humane and judicious use of physical restraint.
If you have any questions, please contact RCPA COO and Policy Director Jim Sharp.
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.
The Office of Developmental Programs (ODP) has shared the bulletin Home and Community-Based Waiver Services Provided to Individuals in an Acute Care Hospital along with its accompanying attachment. The purpose of this bulletin is to provide guidance on the delivery of home and community-based waiver services to individuals who are hospitalized in an acute care hospital. Please review the bulletin and attachment for information and details relevant to this topic.
The Department of Drug and Alcohol Programs (DDAP) issued Policy Bulletin 23-02, which describes modifications to the DDAP Gambling Treatment Manual. Changes outlined in the bulletin include updated qualifications for providers, extended certification timelines, revised billing rates, and streamlined processes for client sessions, record-keeping, and grievance handling. The revised manual can also be accessed on the DDAP website.
The Department of Human Services (DHS) Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) issued a Medical Assistance (MA) bulletin today detailing MA payment for street medicine.
This bulletin informs MA providers that DHS will cover certain services for MA beneficiaries experiencing unsheltered homelessness in their lived environment, known as street medicine. Covered services include physical and behavioral health services, such as primary care, vaccinations, wound care, counseling, and diagnostics in the lived environment. The bulletin applies to enrolled physicians, nurse midwives, nurse practitioners, physician assistants, psychologists, mobile mental health treatment providers, and outpatient practitioners in mental health. Managed care providers should contact their managed care organization(s) for billing questions.
The complete bulletin can be viewed here as well as on the DHS website.
