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Tags Posts tagged with "PHE"

PHE

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The Pennsylvania Health Law Project (PHLP) is pleased to offer series of upcoming webinars focusing on various Medicaid-related topics. During each session, experts from PHLP will share what advocates and providers need to know about the unwinding of the COVID-19 public health emergency (PHE).

Please register for each training using the separate links below. Closed captioning will be available for each session. If you have any questions about the series or problems with registration, please email Danna Casserly.

UPCOMING TOPICS:

Getting Ready for Medicaid & SNAP Changes
Tuesday, March 21, 2023
9:30 am ET

Medicaid Eligibility 101
Tuesday, March 28, 2023
10:00 am ET

Medicaid Appeals, Reconsideration, & Troubleshooting Coverage Denials
Tuesday, April 11, 2023
10:00 am ET

Revisiting MAWD (Medical Assistance for Workers With Disabilities) & Introducing Workers With Job Success
Thursday, April 20, 2023
11:00 am ET

Dual Eligibles & Medicare Savings Programs
Wednesday, May 17, 2023
11:00 am ET

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Resources for Integrated Care (RIC) recently released a brief on telehealth and its impact on dually eligible people with intellectual and developmental disabilities (I/DD). As noted by RIC, people dually eligible for Medicare and Medicaid, as well as people with I/DD, are diagnosed with multiple chronic conditions at higher rates than the general population and often face barriers with access to healthcare.

Telehealth services have been increasing in popularity and usage and have the potential to positively impact people with I/DD. Health plans can utilize this information to further their understanding of how telehealth modalities can improve access to person-centered care for people with I/DD.

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Image by PIRO4D from Pixabay

ODP Announcement 23-019 is to advise all stakeholders that the COVID-19 PHE is officially ending May 11, 2023. All provisions made under Appendix K will expire on November 11, 2023.

The Office of Developmental Programs (ODP) will release more detailed information regarding transition activities as they develop. A link to the Department of Health and Human Services (HHS) statement is provided here.

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Pennsylvania is preparing for a major change in renewal processes for Medicaid and Children’s Health Insurance Program (CHIP) recipients.

Starting April 1, 2023, Pennsylvania is required by federal law to review Medicaid and CHIP recipients’ eligibility every year, which means that recipients must submit a renewal. While the Department of Human Services (DHS) still sent renewals during the height of the COVID-19 pandemic, most people were not disenrolled from Medicaid or CHIP because of a change in eligibility.

DHS encourages everyone to share the following information with Medicaid and CHIP recipients to help them stay informed about renewals.

What Should I Do Right Now?

The best thing that Medicaid and CHIP recipients can do right now to prepare for their renewal is to make sure that their contact information is up-to-date with DHS. By making sure that their information is current, recipients can receive timely updates about their renewal. They also can opt-in to receiving text and email alerts about their benefits.

  • Visit COMPASS and log into their My COMPASS Account.
  • Use the free myCOMPASS PA mobile app.
  • Call 877-395-8930 or 215-560-7226 (Philadelphia), Monday – Friday from 8:00 am – 4:30 pm.

What Else Do I Need to Know?

Completing Medicaid and CHIP Renewals
Renewals should be completed when they are received, even if recipients receive them before April 1, 2023. Recipients will receive a renewal packet in the mail when it is time to renew their coverage. Information about their renewal will start to arrive 90 days before it is due. It is very important that renewal forms are completed and returned even if nothing has changed. Completing a renewal allows DHS to determine eligibility for MA or CHIP coverage. Coverage will continue for recipients who are still eligible.
There are a few ways for recipients to complete a renewal:

  • Complete the forms DHS sends and mail them back in the envelope included in the packet.
  • Drop completed forms off at the local county assistance office (CAO).
  • Complete the renewal online.
  • Complete the renewal over the phone by calling 866-550-4355.

What is Continuous Coverage?

Under the continuous coverage requirement, individuals covered by Medicaid and/or CHIP have been able to keep their health coverage even if they would have otherwise become ineligible for the program based on other factors.

Evaluating Eligibility

Once the continuous Medicaid and CHIP coverage requirement ends, recipients will have to complete a renewal to maintain their coverage as long as they are eligible.

Are You Ineligible for Coverage?

DHS will provide instructions on how to re-enroll or share options for coverage if individuals are no longer eligible. Options for free or low-cost health coverage are available online.

Get more information and resources at DHS’s website.

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The Centers for Medicare and Medicaid Services (CMS) has published resources to assist healthcare workers prepare for the end of the public health emergency (PHE) on May 11, 2023. Included in these resources are a number of provider-specific fact sheets for information about COVID-19 PHE waivers and flexibilities; two specific documents included are the Long-Term Care Facilities and Inpatient Rehabilitation Facilities fact sheets.

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Hole torn in a dollar bill with medicaid text

Because of the continuous coverage requirement, states were able to use additional money from the federal government during the federal public health emergency (PHE) for health care programs like Medicaid if they kept people covered. Therefore, Pennsylvanians did not lose their Medicaid/Medical Assistance (MA) or CHIP coverage if their income changed or they did not complete a renewal during the PHE.

However, starting April 1, 2023, Pennsylvania and other states will have to start disenrolling people if households are ineligible for MA at the time of their renewal or do not complete their renewal. The Pennsylvania Department of Human Services (DHS) will have to return to normal renewal processing procedures for Pennsylvanians enrolled in MA and the CHIP. Renewals will be completed over 12 months. Everyone with MA or CHIP coverage will need to submit a renewal to see if they are still eligible.

In Pennsylvania, approximately 3.5 million people rely on Medicaid. Last year, it was estimated that about 500,000 of those would lose coverage when the continuous coverage requirement ended, creating access issues for individuals and exacerbating financial challenges for providers.

The Pennsylvania Department of Human Services has created an online resource, including a stakeholder toolkit as well as a guide on how to become a helper, that provides resources for groups like providers to communicate ways for Pennsylvanians who receive MA or CHIP coverage to continue their coverage.

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ODP Announcement 23-012 shares an updated AAW Provider Information Table to reflect changes made with the January 1, 2023, waiver amendment. This information includes waiver language, guidance, and provider qualifications. The requirements in the AAW will become effective when Appendix K flexibilities expire, six months after the expiration of the federal COVID-19 public health emergency.

The updated Provider Information Table includes these highlights:

  • Providing information on the delivery of direct services using remote technology (teleservices);
  • Introducing the AAW Travel Policy;
  • Introducing Remote Services, a new service in the AAW;
  • Adding waiver language and guidance on relatives providing the Life Sharing component of Residential Habilitation;
  • Providing clarification on the requirements for Supports Coordinators and in-person monitoring;
  • Noting the responsibility of Residential Habilitation providers to complete and update the Health Risk Screening Tool (HRST) for the individuals they serve;
  • Including the Place of Service codes and Electronic Visit Verification information for each service definition;
  • Adding other changes designed to align the AAW, where practical, more closely with the Consolidated, Person/Family Directed Support and Community Living waivers; and
  • Expanding sections on provider qualifications for each service.

Providers are reminded that they are responsible for being aware of any changes to definitions of services they provide and ensuring that individuals who furnish direct services are fully qualified prior to providing services to AAW participants. Questions or comments about this communication should be addressed to Tom Flynn.

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Image by StockSnap from Pixabay

The Office of Development Programs held a webinar to provide an overview of the Adult Autism Waiver Amendment that went into effect January 1, 2023. The session was recorded and will be available for viewing in the near future.  Many of the changes will go into effect six months after the Public Health Emergency and Appendix K flexibilities end. The slides from the session provide clarification regarding Remote Supports, Teleservices and Assistive Technology.

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On January 30, the Biden Administration announced that the COVID-19 national emergency and public health emergency (PHE) will both expire on Thursday, May 11, 2023. Under Act 30 of 2022, the Department of Drug and Alcohol Programs’ (DDAP) regulatory suspensions that are “related to federal exemptions granted under the federal public health emergency declaration” were extended until “the last day federal exemptions granted under the federal public health emergency declaration are authorized.” In other words, Act 30 aligned the timing for DDAP’s regulatory suspensions with the deadline for flexibilities granted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) — not with the deadline of the PHE itself.

Below is a description of each currently suspended regulation and what DDAP knows about efforts to make these changes permanent at the federal level.

Methadone Take-Home Supply

Current regulatory suspension: Under the federal PHE, SAMHSA is currently allowing up to 28 days of take-home medications for patients on stable dosages, as deemed appropriate by their physician. DDAP’s regulation 28 Pa. Code § 715.16(e) (prohibiting narcotic treatment programs [NTPs] from permitting a patient to receive more than a two-week take-home supply) is currently suspended under Act 30.

Expiration of the PHE: In November 2021, SAMHSA announced that the methadone take-home flexibilities will be extended for one year after the end of the PHE (now May 11, 2024). DDAP submitted its written concurrence with this exemption in February 2022. Furthermore, SAMHSA issued a notice of proposed rulemaking in December 2022 that proposes modifying regulations related to methadone take-home supply up to 28 days, among other changes.

Buprenorphine Telehealth

Current regulatory suspension: Under the federal PHE, SAMHSA and the DEA are currently allowing initial evaluations for a patient who will be treated with buprenorphine to be completed via telehealth. DDAP has two related regulations that are currently suspended under Act 30:

  • 28 Pa. Code § 715.9(a)(4): Requires NTPs to make a face-to-face determination before admission to treatment for those clients who will receive medication to treat opioid use disorder (OUD).
  • 28 Pa. Code § 715.6(d): Requires NTPs to have narcotic treatment physician services onsite.

Expiration of the PHE: In March 2022, the DEA announced that it is currently working to make its teleprescribing regulations permanent. In June 2022, SAMHSA announced to State Opioid Treatment Authorities that flexibilities around telehealth evaluations before buprenorphine treatment at NTPs, specifically, will be extended for one year after the end of the PHE (now May 11, 2024).

SAMHSA and DEA have made clear that support for these flexibilities has been overwhelmingly positive, decreased stigma associated with OUD, and enhanced care for patients. Given the information above, DDAP does not anticipate any lapses in these flexibilities at either the federal or state level but will continue to provide updates and guidance as available.

Resources

If you have any further questions, please contact the Bureau of Program Licensure at (717) 783-8675 or via email.

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