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OMAP

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Photo by Markus Winkler on Unsplash

The office of Medical Assistance has issued an update on EVV compliance to advise providers of changes to the manual edit thresholds for Electronic Visit Verification (EVV) records in both personal care services (PCS) and home health care services (HHCS), effective with dates of service on and after January 1, 2025.

This bulletin applies to providers enrolled in the MA Program who render PCS and HHCS to beneficiaries or participants in the MA fee-for-service (FFS) delivery system, including through home and community-based services waivers and the managed care delivery system via Physical HealthChoices or Community HealthChoices. Beneficiaries may receive services in the following programs:

  • Office of Developmental Programs (ODP): Adult Autism Waiver, Community Living Waiver, Consolidated Waiver, Person/Family Directed Support Waiver, and Base Funded Program;
  • Office of Long-Term Living (OLTL): OBRA Waiver, Act 150, and Community HealthChoices; or,
  • Office of Medical Assistance Programs (OMAP): MA FFS and Physical HealthChoices.

Read the full bulletin here. This bulletin will be a key topic at the RCPA PD&A meeting on September 11, for which you can register here.

If you have any questions, please contact Fady Sahhar or Melissa Dehoff.

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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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The Pennsylvania Office of Medical Assistance Programs (OMAP) Pediatric Shift Care Team is conducting a survey to identify individuals interested in participating in the development of education and training content for a new online learning portal. More will be shared about this effort during the upcoming Stakeholder Update Call, which is taking place on August 15 from 10:30 am – 12:00 pm.

If you are interested in participating in the initiative, please take this short 2-minute survey: Pediatric Shift Care Subject Matter Expert Interest Survey. The survey has been extended and will close on August 18, 2023, following the Stakeholder Update Call.

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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.

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Using funds available through the American Rescue Plan Act (ARPA), the Department of Human Services Office of Medical Assistance Programs has developed a plan to create Pediatric Complex Care Resource Centers (PCCRC) across Pennsylvania to support families of children with complex medical needs. This initiative is currently in the planning phase, with the centers slated to launch in early 2023.

For more information, visit here. You can also visit the DHS website for Complex Case Planning information.

If you have any questions, please contact Cindi Hobbes.

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Message from the Department of Human Services (DHS):

FOR IMMEDIATE RELEASE
December 20, 2021 

Department of Human Services Discusses Spending Plan for Home and Community-Based Services Enhanced Federal Funding to Support Mental Health Services, Children 

Harrisburg, PA — Pennsylvania Department of Human Services (DHS) today highlighted Pennsylvania’s spending plan for approximately $1.2 billion in enhanced federal Medicaid funding made available to states through the American Rescue Plan Act (ARPA). This funding will support Medicaid’s home and community-based services (HCBS) system throughout the commonwealth, which helps seniors, people with disabilities, children with complex medical needs, and many other groups safely live in their community among their family and peers. This funding will strengthen Pennsylvania’s home and community-based services system by allowing more Pennsylvanians access to critical services in their communities and supporting service providers that perform this work every day.

“We owe a huge debt of gratitude to the professionals who care for our most vulnerable, including children, seniors, people with disabilities, and those needing mental health services,” said Acting Secretary Meg Snead. “This enhanced funding through the American Rescue Plan Act will allow employers to recruit and retain skilled workers and allows them to plan for the future to provide training, certification, technology access, and much more.”

DHS received conditional approval of its spending plan on December 1 from the Centers for Medicare & Medicaid Services. On today’s call, DHS outlined how funding will be used through the Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Child Development and Early Learning (OCDEL), and the Office of Medical Assistance Programs (OMAP).

  • OMHSAS will prioritize funding for workforce recruitment and retention to qualifying providers, specifically mobile crisis mental health services, intensive behavioral health services (IBHS), psychiatric rehabilitation, and family-based mental health services. While many mental health services are not considered HCBS under ARPA, within the parameters of this funding opportunity, OMHSAS also will invest in training clinicians in trauma-informed treatment modalities, technology and training for telehealth, and updating the state hospital system’s technology infrastructure and providing staff training for use of electronic health records to facilitate more efficient transitions to community-based placements and services.
  • OCDEL supported a 3 percent rate increase for Infant/Toddler Early Intervention services, which allows all providers of Early Intervention services, including Service Coordination, to receive a 3 percent rate increase for services. This rate increase went into effect on July 1, 2021.
  • OMAP will use the recommendations of its pediatric shift care nursing work group to inform ARPA spending with a focus on achieving the following goals: improve care and service coordination for children with complex medical needs; support training of private duty nurses; leverage health information technology to allow for the sharing of clinical information; use a value-based payment structure for managed care organizations to improve outcomes of children receiving pediatric shift care nursing services; and facilitate co-training opportunities for both shift nurses and families to help improve coordination, continuity, and support among caregivers.

“When we invest in the caring workforce, Pennsylvania benefits both socially and economically,” said Acting Secretary Snead. “Having care provided in your own home or within your community allows family caregivers to be part of the workforce themselves and it allows those needing home and community-based services to stay safe, healthy, and to thrive.”

More information about Pennsylvania’s home and community-based services spending plan is available on DHS’s website.

RCPA continues to meet with DHS advocating for members on the spending plan and distribution strategies to ensure the workforce issues are front and center of the plan. If you have any questions, please contact your RCPA Policy Director.

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On October 1, 2019, the PROMISe Service Location Enrollment process was effectuated. RCPA understands that many providers have submitted their requests and are awaiting the PROMISe numbers for their programs.

In conversations with the Office of Medical Assistance Programs (OMAP) and the Office of Mental Health and Substance Abuse Services (OMHSAS), we have been advised that as providers await confirmation on program PROMISe numbers for service locations, providers can continue to utilize their main physical site address for billing pending site enrollment.

This link will provide access to the bulletin. If you have any questions, please contact RCPA Children’s Division Director Jim Sharp.

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