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Tags Posts tagged with "Medicaid"

Medicaid

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Photo by Markus Winkler on Unsplash

The Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Secretary Jen Smith recently provided an update on the federal four walls rule. The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule, or Notice of Public Rulemaking, that could create exceptions to the existing four walls requirement for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.

The official language posted to the federal register can be found on page 15 of the Federal Register, which is scheduled to be published on July 22, and is copied below.

“This proposed rule includes a proposal to create exceptions to the Medicaid clinic services benefit four walls requirement, to authorize Medicaid payment for services provided outside the four walls of the clinic for IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas. Our current regulation at 42 CFR § 440.90(b) includes an exception to the four walls requirement under the Medicaid clinic services benefit only for certain clinic services furnished to individuals who are unhoused. We believe these proposed exceptions would help maintain and improve access for the populations served by IHS/Tribal clinics, behavioral health clinics, and clinics located in rural areas.”

As a reminder, this is a proposed rule intended to announce and explain CMS’s plan to address the problem. As such, all proposed rules must be published in the Federal Register to notify the public and give them an opportunity to submit comments. The proposed rule and the public comments received on it form the basis of a final rule. More information on the final rulemaking process is available here. Interested parties should provide public comments on this proposed rule to the addresses listed in the federal register by September 9, 2024.

While CMS works through this process, OMHSAS, RCPA, and the PA General Assembly continue efforts to address this through the recently released HCO 3450 legislation that will address the psychiatric outpatient in-office requirements and the Medicaid “4 walls” standards. RCPA will work with our members and the National Council for Mental Wellbeing on developing public comments for submission regarding this proposed rule. If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

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RCPA recently signed two letters, one to Governor Shapiro and one to the PA Department of Human Services (DHS), alongside dozens of other organizations and the Pennsylvania Community Health Worker Collaborative (PACHW) regarding the state’s plan for an amendment to authorize payments for Community Health Worker services under Pennsylvania State Medicaid. The letters outlined several key features PACHW wished to highlight regarding these payments, including:

  • Requesting DHS set “an equitable and adequate” reimbursement rate;
  • The creation of a Community Health Worker provider type; and
  • Recognizing Social Determinants of Health (SDoH) as a primary diagnosis code.

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Hole torn in a dollar bill with medicaid text

On April 25, 2024, at 12:00 pm, a virtual statewide briefing will be conducted on Medicaid unwinding and expanded enrollment options. This event will feature Health and Human Services (HHS) Regional Director Melissa Herd, Pennsylvania Department of Human Services Secretary Val Arkoosh, and Pennie Executive Director Devon Trolley.

The agenda will include a briefing on what’s happening at the federal level when it comes to Medicaid, an update on the Medicaid “unwinding” process currently wrapping up in Pennsylvania, and the expanded eligibility requirements for enrolling in Pennie coverage even when it’s not open enrollment.

To register, please visit here.

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Photo by Michael Schofield on Unsplash

The While House issued a press release announcing that the Access Final Rule will be released later today. These regulations include:

  • The Nursing Home Minimum Staffing Rule, which will require all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day of total staffing, including a defined number from both registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day);
  • Introducing the requirements of the rule in phases to make sure nursing homes have the time they need to hire staff, with longer timeframes for rural communities;
  • Ensuring adequate compensation for home care workers for HCBS operations of in-home care (both Personal Assistance Services and Community Habilitation) by “requiring that at least 80 percent of Medicaid payments for home care services go to workers’ wages. This policy would also allow states to take into account the unique experiences that small home care providers and providers in rural areas face while ensuring their employees receive their fair share of Medicaid payments and continued training as well as the delivery of quality care;”
  • The state requirement to be more transparent in how much they pay for home care services and how they set those rates, increasing the accountability for home care providers; and
  • The creation of a state home care rate-setting advisory group made up of beneficiaries, home care workers, and other key stakeholders to advise and consult on provider payment rates and direct compensation for direct care workers.

We will continue to monitor the details of these regulations and Pennsylvania’s plans to comply. If you have any questions, please contact Fady Sahhar.

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