Philadelphia Inquirer: Pennsylvania Has Put Billions in Medicaid Business Out for Bid
Medicaid
RCPA Advocacy Efforts and Telehealth Update
In response to the recent developments on the delivery of telehealth services and its intersection with Federal Medicaid payment standards outlined in the “4 walls” requirements, RCPA has widened its efforts in addressing the barriers currently in place. It has been determined that the most effective route to address this would be through legislation. The necessary changes cannot be achieved through a revised Tele-Behavioral Health Bulletin.
RCPA has been working with a bipartisan team of legislators on an updated version of Act 76 to address our limited access to psychiatric services through utilization of our advanced practice professionals. We are working with the Office of Mental Health and Substance Abuse Services (OMHSAS), our stakeholders, and the legislative committees to introduce a bill that would address both the psychiatric office time and the “4 walls” service delivery barriers.
Our members’ feedback over the last few days and during the OMHSAS telehealth forum on Monday has provided an invaluable backdrop to our efforts. RCPA is focused on working with our legislators and stakeholders to introduce this bill, and we will look to our members for support with these efforts. Additionally, we continue our daily efforts with our partners at OMHSAS, who are jointly committed to creating this viable and sustainable effort to preserve Medicaid service access to those most vulnerable in our Commonwealth.
If you have any questions, please contact RCPA Policy Director Jim Sharp.
CMS Issues FAQ on Extended Postpartum Coverage in Medicaid and CHIP
The Centers for Medicare & Medicaid Services (CMS) has released a set of frequently asked questions (FAQ) supplementing the 2021 State Health Official (SHO) letter about extending postpartum coverage in Medicaid and the Children’s Health Insurance Program (CHIP). The FAQ offer guidance to state Medicaid programs on the new option allowing states to provide 12 months of extended postpartum coverage to pregnant individuals in Medicaid and CHIP. They clarify what constitutes full benefits during this extended eligibility period and address whether states need to submit a state plan amendment (SPA) for coverage modifications. For more details, view the FAQ here.
OMHSAS Provides Telehealth and Medicaid Update
RCPA attended the Office of Mental Health and Substance Abuse Services (OMHSAS) telehealth webinar on Monday, January 29, alongside many provider members, regarding the Federal payment conditions related to the delivery of telehealth services and the requirement that the physicians or clinicians must present in the office, or that the client must be in the office during the telehealth session, to meet the guideline. It was explained that despite the standards outlined in the current OMHSAS Telebehavioral Health Bulletin, under the Federal “4 walls” statute, this is a required Federal Medicaid payment condition. These requirements cannot be waived.
The purpose of today’s call was twofold: explaining the “4 walls” requirements, and for providers to give vital feedback to OMHSAS on the impacts, challenges, and barriers to accessing services that this may create for consumers and families. This Medicaid standard remains in effect, and RCPA recommends provider members review their operating practices to ensure compliance.
During this time, RCPA will continue its efforts and work with OMHSAS, the HealthChoices partners, and stakeholders to ensure access to services via telehealth. You can review today’s OMHSAS telehealth webinar slide deck. We are also looking to obtain a recording of the webinar to share with our members.
If you have questions, please contact RCPA Policy Director Jim Sharp. The next RCPA Telehealth Operations Committee meeting is scheduled for Tuesday, February 27; however, we will be reviewing if we need to meet sooner based on current information.
Please share this information with your stakeholder networks.
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