COVID-19 Resource Center

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Last Update: May 27, 2020.

As COVID-19 spreads, the Pennsylvania Health Law Project (PHLP) is committed to making sure those with Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) coverage have services, and to securing insurance coverage for the uninsured. 

PHLP staff are working remotely through the crisis and are available to counsel and represent Pennsylvanians throughout the state.  Our toll-free Helpline (1-800-274-3258) remains open every Monday, Wednesday, and Friday from 8 AM to 8 PM.  We can also be reached at staff@phlp.org

Our Policy Advocacy

May 6, 2020
We issued a special alert reminding consumers and home health providers that Community HealthChoices (CHC) plans are not allowed to reduce existing home and community-based waiver services, including personal assistance services (PAS) and in-home nursing, during the COVID-19 emergency. This came after PHLP learned that, in April, almost 250 PA Health & Wellness (PHW) Community Health Choices (CHC) participants erroneously received notices cutting their personal assistance services (PAS) hours, even though CHC Plans are not allowed to reduce existing home and community-based waiver services  during the COVID-19 emergency.  We are working with state officials to get the matter resolved and will keep readers updated.

April 24, 2020
We joined the Center for Advocacy for the Rights and Interests of the Elderly (CARIE) and a handful of other stakeholders in sending a letter to Governor Wolf urging stronger action during the COVID-19 pandemic to protect residents and staff of nursing homes, assisted living facilities, and personal care homes. 

April 21, 2020 
We signed onto Disability Rights Pennsylvania (DRP)'s letter to the Wolf Administration requeting increased transparency related to congregate care locations with COVID-19 outbreaks, including requesting that the Administration publicly release a list of the names and locations of nursing homes, assisted living facilities, and personal care homes with COVID-19 positive residents and/or staff as well as the number of deaths at each facility.

March 17, 2020
Prior to the state's submission of the 1135 Waiver and Appendix K requests, we organized organizations across the state to sign a detailed letter to state officials outlining COVID-19 policy recommendations aimed at protecting Pennsylvanians during the crisis.

Federal & State Updates

No Prior Authorization needed for certain services

The Department of Human Services (DHS) has temporarily removed prior authorization requirements for certain services.  The following services will not require prior authorization (permission from the insurer) for the duration of the COVID-19 emergency:

  • Hospice services (prior authorizaiton is required after 30 days for individuals in Physical Health MCOs or Community HealthChoices MCOs);
  • Emergency or urgent inpatient hospital admissions;
  • Long-term care acute hospitalization, for the first 30 days of care;
  • Certain Durable Medical Equipment (DME) and supplies including feeding supplies, respiratory supplies, urinary catheters, and ostomy supplies (see above link for full list of items not requiring prior authorization);
  • CT scans of the chest related to the diagnosis or treatment of COVID-19;
  • Sublocade injections
  • Inpatient rehabilitation, for the first 30 days of care;
  • Nursing home services, for the first 30 days of care;
  • Home health aide services, for the first 28 days of service; and
  • Skilled nursing (i.e. shift nursing) if the request is to continue the currently-authorized number of hours


The Department has also expanded the types of providers that may order home health services during the pandemic. Specifically, licensed practitioners practicing within their scope of practice, including but not limited to nurse practitioners and physician assistants, may order home heath services during the crisis.

No change in MA or CHIP eligibility criteria

In accordance with guidance issued by the Centers for Medicare & Medicaid Services (CMS),  Pennsylvania will maintain Medicaid and CHIP eligibility standards, not charge premiums that exceed those that were in place as of January 2020, and cover any cost sharing, testing, services and treatments related to COVID-19. 

No Termination of coverage during the crisis

Pennsylvania will provide continuous MA, CHIP, LTC (nursing home) and Waiver coverage for the duration of the public health emergency.  People who had MA, CHIP, LTC, or Waiver coverage on or after March 18, 2020 cannot lose that coverage until the end of the emergency.  

Unfortunately, PHLP has already heard from consumers whose coverage was wrongfully terminated during the crisis; the state has committed to reopening these individuals' benefits as soon as possible, in accordance with this Policy Clariffication released on April 24, 2020. 

If you had MA, CHIP, LTC, or Waiver coverage on March 18 and your coverage is terminated while the COVID-19 crisis is still going on, call PHLP's Helpline at 1-800-274-3258!

Feds Approve PA’s Request For Medicaid Flexibility  

1135 Waiver
During a disaster or emergency such as COVID-19, the federal government may temporarily waive or modify certain Medicare, Medicaid, and CHIP requirements to ensure that sufficient health care services are available to meet the needs of consumers.  

Knowing that Pennsylvania Medicaid officials were preparing their waiver application, on March 17, PHLP and dozens of other advocates and providers urged the state to ask for permission to halt all terminations of Medicaid coverage and to direct MCOs insurers to halt all service denials.  The entirely of our recommendations can be found here.   

On March 27, the federal government approved Pennsylvania's request for Medicaid flexibility during the Coronavirus emergency. Click here to view CMS’s approval notice.  The federal government’s “approval” of the waiver does not change all things.  The state must still take action to use the authority granted by the waiver, which applies to the Medicaid Fee-for-Service Program, HealthChoices managed care for physical and behavioral health services, Community HealthChoices (CHC), and Home and Community Based Services (HCBS) waivers. 

Appendix K
Through a different pathway, known as Appendix K, the federal government also approved changes to waivers operated by the Office of Long Term Living (OLTL) and the Office of Developmental Programs (ODP).  The changes are effective for the Adult Autism Waiver and the Community HealthChoices waiver from March 6, 2020 through June 30, 2020; and from March 11, 2020 through March 11, 2021 for the OBRA, Consolidated, P/FDS, and Community Living Waivers.  Click here to see a list of the Appendix K approvals.   

Under Appendix K, initial Level of Care Assessments using the Functional Eligibility Determination (FED) tool, as well as Annual Reassessments and Comprehensive Needs Reassessments, may be conductedusing phone or video conferencing. The face-to-face requirement is temporarily waived for these assessments.

There should be no reduction in waiver services like Personal Assistance Services (PAS) hours, no termination of services, and no reassessments of long-term services and supports during the COVID-19 emergency.  OLTL has also said that consumers who appear to lose their eligibility in the system during the emergency should continue to receive waiver services.  

Additionally, for the duration of the COVID-19 emergency, OLTL has temporarily allowed spouses, legal guardians, and persons with power of attorney to serve as paid direct care workers (e.g. PAS workers) when scheduled workers are not available due to COVID-19 and when the participant’s emergency backup plan cannot be implemented. 

Appeal deadlines extended

The County Assistance Office must give individuals an extra 60 days to appeal MA and Waiver denials or terminations. This means individuals who lose MA or Waiver during the crisis will have 90 days to appeal the decision, rather than the typical 30 day deadline. But remember: anyone who had MA or Waiver on or after March 18 cannot lose that coverage for the duration of the crisis! 

Grievances & Fair Hearings during COVID-19 Crisis

CHC-MCOs are not allowed to reduce or terminate any waiver services (e.g., Personal Assistance Services) during the COVID-19 crisis. CHC-MCOs can reduce non-waiver services, and Physical and Behavioral Health MCOs can reduce or terminate services during the crisis. Normal Grievance and Fair Hearing rights apply to any reduction or termination of services. 

Grievances
The state has directed BH-MCOs to offer telephonic or videoconference Grievance reviews, if a member’s request for an in-person review cannot be accommodated.  PHLP expects the state to issue similar guidance to PH-MCOs and CHC-MCOs.    

Fair Hearings
For the duration of the COVID-19 crisis, DHS Fair Hearings involving MA eligibility matters and service denials will be held exclusively by telephone beginning April 1. The Bureau of Hearings and Appeals (BHA) cancelled all fair hearings scheduled from March 17-31, 2020. Those hearings are being rescheduled to telephone hearings.  

PHLP is advocating for interim benefits for those without continued benefits or services in place while this emergency progresses.  This would mean that if Fair Hearings are delayed a person would be able to temporarily receive their benefits or services while awaiting the hearing.  This is already a requirement when a Fair Hearing decision has not been issued within 90 days of a person first appealing a Medicaid benefits or service denial, but it is not a well-known right.  

No Rationing Medical Care Based On Disability; Age 

On March 28th, the U.S. Department of Health and Human Services’ civil rights office told medical providers that they may not deny medical care to people based on their disabilities or age during the coronavirus emergency.  The directive, released in a bulletin, came days after disability rights advocates filed complaints arguing that protocols to ration lifesaving medical care — adopted by Alabama and Washington State — were discriminatory. 

On March 27th, the Pennsylvania Medical Assistance Advisory Committee (MAAC) unanimously approved a resolution exhorting Governor Wolf to ensure that when it comes to the allocation of life-saving treatment 1) patients are not discriminated against because of their Medical Assistance Insurance status, and 2) people with disabilities are not given lower priority because of preexisting disabilities, even when those conditions require more scarce resources.  The MAAC also requested that any guidelines developed be developed with the stakeholders and experts listed in the resolution, and that they be released to the public once finalized.  

Governor Wolf has also stated his strong commitment to ensuring all Pennsylvanians receive fair and equitable access to lifesaving health care during the COVID-19 pandemic; and will not tolerate discrimination in the allocation of lifesaving resources based on any factor including, but not limited to age, disability and socioeconomic status. 

Disability Rights Pennsylvania (DRP) has opened a Health Care Rationing Hotline during the pandemic. Individuals with disabilities who experience discrimination in health care rationing, who are denied effective communication at the hospital, or who are prohibited from bringing a needed family member or staff with them into the hospital should contact DRP's Hotline at 1-800-692-7443 ext. 402.

EVV Delayed Until October  

Due to the COVID-19 crisis, Pennsylvania announced it is delaying the implementation date for Electronic Visit Verification (EVV) for direct care workers providing Personal Assistance Services (PAS). The new implementation date is October 1, 2020. For more information, visit the DHS EVV website.

Medicare Part B Applications Can Be Faxed to SSA

In addition to mail, Medicare beneficiaries can now fax the Medicare Part B form, CMS-40B and CMS L564—Request for Employment Information, along with proof of employment, Group Health Plan (GHP), or Large Group Health Plan (LGHP) to the Social Security Administration at 1-833-914-2016. This information is reflected on SSA’s How to Apply for Just Medicare page.  As a reminder, the applications for Part A and the Low-Income Subsidy (Extra Help) can be completed online. Source: Justice in Aging.

Frequently Asked Questions

  • Yes. 

    MA & CHIP Coverage of Testing

    Both MA and CHIP will cover testing for COVID-19 when your doctor or health care professional determines it necessary. 

    There is no co-pay for testing, so consumers pay nothing for the test.  No prior authorization (permission) from your insurer is required to get tested.   

    The Pennsylvania Department of Health has released a fact sheet with information about how to get tested for COVID-19.  Testing had been prioritized for people who are severely sick, people in facilities, people in contact with known cases of COVID-19, and health care providers; however, testing kits are becoming more widespread and available.  If you are having symptoms and want to get tested, call your doctor, health insurance company, local health department, or the PA Department of Health at 1-877-PA-HEALTH (1-877-724-2584).  

    MA Coverage of Services to Treat COVID-19 Symptoms

    There is no specific antiviral treatment for COVID-19, but MA covers a broad range of services that treat and/or relieve COVID-19 symptoms, including:  

    • Imaging (e.g., CT Scans, X-Rays) and Diagnostic Testing;
    • Hospital Care (Inpatient & Outpatient);

    • Emergency Ambulance Transportation;

    • Non-Emergency Transportation to MA Covered Appointments (where telehealth is not an option);

    • Home Health Services;

    • Nursing Facility Care; 

    • Prescription Drugs, including over-the-counter medications for fever relief and other medications related to the treatment of virus symptoms - e.g. counter cough and cold preparations. Over-the-counter medications must be prescribed by your doctor or health care practitioner. To ensure you have a 30-day supply of prescriptions, refills may be covered before the refill date
       

    The state has temporarily suspended co-payment requiments for MA services related to testing and treatment of COVID-19 (including vaccines, specialized equipment, and therapies like drugs.)  Specifically, MA copayments are suspended for the following drugs/drug categories, as they may be used in the treatment of COVID-19:

    • Acetaminophen;
    • Antidiarrheals;
    • Antiemetics;
    • Antihistamines (Second Generation);
    • Anti-infectives;
    • Asthma/COPD;
    • Ophthalmic Antihistamines/Decongestants;
    • Ophthalmic Lubricants; and
    • Oral NSAIDs 
       

    Additionally, as of March 1, 2020 the Department will pay for prescriptions for cough and cold medications for MA beneficiaries 21 years of age and older. Prior to the public health emergency, the Department was already paying for over-the-counter (OTC) cough and cold medications for MA beneficiaries under 21 years of age.  If you paid a copay for OTC medications between March 1 and April 21 that you believe you should not have paid, you can request a refund from your pharmacy for this payment. 

    Testing with Medicare Coverage:  Medicare also covers COVID-19-related laboratory testing when ordered by a physician without any co-insurance or deductible.   The standard Part B deductible ($198 in 2020) applies to other COVID-19-related outpatient Medicare services, besides laboratory tests.  CMS released a fact sheet addressing Medicare Coverage and Payment Related to COVID-19. 

  •  Yes.  Health care providers can submit claims for COVID-19 related treatment for the uninsured to HRSA.  If you think you have COVID-19, do not delay seeking treatment because you fear incurring medical bills!

    For more information, visit the the HRSA website,  COVID-19 Claims Reimbursement.

     

  • Generally, no! Most Pennsylvanians who had or get MA, CHIP, MA nursing home or Waiver coverage on or after March 18, 2020 cannot lose that coverage until the end of the public health emergency. The ONLY exceptions are cases where the person:

    • Voluntarily ends their coverage;
    • Is no longer a PA resident;
    • Is deceased;
    • Received MA because they were found presumptively eligible for the program by a hospital or pregnancy provider, but who are ultimately determined ineligible for MA;
    • Is a “lawfully present” immigrant who received MA because they were under 21 and who is not eligible for any other MA category when they turn 21*; or
    • Is a “lawfully present” immigrant who received MA because they were pregnant and is not eligible for any other MA category when their 60-day postpartum period ends*
       

    As indicated above, PHLP has heard from consumers whose coverage was wrongfully terminated during the crisis. But the state has committed to reopening these individuals' benefits as soon as possible, in accordance with this Policy Clarification released on April 24, 2020.

    If you had MA, CHIP, MA nursing home, or Waiver coverage on or after March 18 and your coverage is terminated while the COVID-19 crisis is still going on, call PHLP's Helpline at 1-800-274-3258!

    * For information about immigrant eligibility for Medicaid, please see PHLP’s Health Care for Immigrants:  A Manual for Advocates in Pennsylvania.

  • All County Assistance Offices (CAOs) across the state are closed to the public effective March 17, but are still processing MA applications and requests for other public benefits.  

    Even though CAOs are closed to the public, you can still apply and renew MA and CHIP online at www.COMPASS.state.pa.us.  Applicants can download the MyCompassPA app to their Apple and Android devices.   

    Applicants can also complete a paper MA application (available here) and either mail the application to the CAO, or dropping it off at the CAO’s secure drop box.  Note that there is no way to obtain a receipt for dropping off application paperwork right now; thus, we recommend submitting applications and other documentation online through COMPASS wherever possible.  

    Uninsured individuals with COVID-19 who apply for MA coverage can get a faster decision on their MA application. To do this, mention COVID-19 as the reason for the application in the comment section of the COMPASS application or, on paper applications, in the section asking about medical conditions that affect ability to work.

    The state has instructed caseworkers to accept self-attestation for all eligibility criteria (e.g., income) when documentation is not available. The exceptions to this self-attestation rule include: verification of citizenship and immigration status, verification of Emergency Medical Condition for EMA applications, and verification of functional eligibility for Long Term Care (LTC) and Home and Community Based Services (HCBS), aka Waiver.

    Changes impacting benefits (e.g., new address, change in household size) can and should still be reported through the Statewide Customer Service Center at 1-877-395-8930.

  • No. Stimulus payments to households through the CARES Act  do not count as income for Medicaid, CHIP, Medicaid Long Term Care (Nursing Home and Home & Community Based Services Waiver), and other important public health benefits.  As a reminder, under the CARES Act most folks will receive $1,200 per adult ($2,400 for a married couple) and $500 per dependent, including children age 17 or younger.   

    Importantly, the fair consideration rules that normally apply when determining eligibility for Medicaid long term care benefits either in a nursing home or home and community-based services will not apply to these payments. These payments will also not impact the patient pay amount for someone on Medicaid in a nursing home.

    Note that individuals should still report their receipt of the stimulus money through COMPASS or by calling the Statewide Customer Service Center at 1-877-395-8930, just as they are typically required to do with other changes related to benefits. However, again, the money should not be counted as income or a resource! 

  • Yes. However, the extra $600 per week that individuals can receive under Federal Pandemic Unemployment Compensation (FPUC) will NOT count for MA or Waiver financial eligibility.  See Operations Memorandum #20-05-02.  Besides FPUC, all other kinds of Unemployment Compensation (UC) counts as unearned income, including regular UC benefits, Pandemic Emergency Unemployment Compensation (PEUC) benefits, and Pandemic Unemployment Assistance (PUA) benefits.

    For more information, read our News article, Impact of COVID-19 Financial Assistance to Households on Health Insurance Eligibilityand accompanying Fact Sheet.

  • In Pennsylvania, no one should be denied MA for COVID-19 testing, diagnosis or treatment because of their immigration status.  COVID-19 is a recognized Emergency Medical Condition, therefore Emergency Medical Assistance (EMA) will be available for coverage of COVID-19 testing, diagnosis, and treatment for those who otherwise qualify for EMA. 

    Moreover, using MA for COVID-19 testing, diagnosis and treatment creates no public charge risk.  As has always been the case under the new public charge rule, the very large majority of people who are eligible for MA can receive and use benefits without any public charge risk.  In addition, US Citizen and Immigration Services recently announced that COVID-19 testing, diagnosis and treatment will not be considered during public charge tests, even if MA is used to access these services. 

  • No. Although Medical Assistance for Workers with Disabilities (MAWD) ordinarily requires individuals to work to receive benefits, people with MAWD coverage should ask to be granted a Good Cause exception to keep their benefits when they are furloughed from employment.  In these circumstances, MAWD coverage will not be canceled based on a lack of employment.  As stated in Operations Memorandum 20-03-03, the CAO will not close any MA benefits during the COVID-19 emergency.

    If MAWD was terminated due to non-payment of January or February premiums , the CAO should reinstate MAWD benefits as long as the individual attests that they mailed their January & February premium payments to the MAWD program. See Policy Clarification PMW-19919-316, MAWD Reinstatement for Individuals Who Self-Attest to Paying Premium During the COVID-19 Emergency, May 5, 2020.

    MAWD recipients must report to the CAO if they are no longer working, as with any other changes. The CAO will give a Good Cause exception for each month of the COVID-19 emergency.

    Good Cause can also be granted to waive MAWD premium payments during the COVID-19 emergency. Ordinarily Good Cause is only available for two months; the COVID-19 emergency has extended that limit.  See Policy Clarification PMW-19831-316, MAWD Premium Payments during the COVID-19 Emergency, March 26, 2020

  • The state continues to process applications for MA funded long-term care for older adults and individuals with disabilities served through providers licensed by the Office of Long-Term Living, including personal care homes and in-home care.  The Independent Enrollment Broker (IEB) is still processing applications.  To apply for waiver services, call the PA Independent Enrollment Broker (PA IEB) at 1-877-550-4227.  It has been reported to PHLP that functional eligibility determinations (FED) which assess whether applicants meet the clinical standards to qualify for in-home services, may be conducted remotely using phone or video conferencing; the face-to-face requirement has been temporarily waived.   

    The Office of Long Term Living (OLTL) is suspending long-term care clinical eligibility redeterminations during the COVID-19 emergency. The Office of Developmental Programs (ODP) has extended eligibility redeterminations to 18 months, so participants in ODP’s programs will also not lose services during this period. 

  • In many cases, yes. Medical Assistance (MA) MCOs are making sure their provider networks can handle an increase in health care services related to COVID-19.  If an MA MCO does not have enough health care providers in its network with the appropriate training and experience to meet the needs of its members, the MCO must cover services by providers who are out-of-network. Consumers should call their MCO’s Member Services line (listed below) with any difficulty obtaining services.  Consumers in the MA Fee-for-Service Program should call the Recipient Service Center at 1-800-537-8862 if they are having difficulty obtaining services. 

    Limiting Non-Essential Elective Services
    In accordance with previous Department of Health and CMS recommendations, DHS initially released guidance directing MA insurers to restrict non-essential elective surgery and medical procedures, including dental, until after the public health emergency subsides. However, that guidance was rescinded on May 7, 2020. See Provider Quick Tips: Rescinding Prior Guidance On Elective Services and Managed Care Operations Memo 05-2020-12: Elective Services.

    Expanded Use of Telehealth
    Because COVID-19 is a communicable disease, you may prefer to receive health care services using telehealth instead of in-person. Telehealth is two-way, real time interactive communication between you and your doctor or other provider.  

    The state has strongly encouraged the use of telehealth visits for all MA consumers in Fee-for-Service and MCOs.  Additionally, all MCOs offer a 24/7 nurse phone line available for consumers to consult with various health-related questions. The Office of Long-Term Living has also encouraged providers to use telehealth and telemedicine broadly, including for assessments which otherwise take place in-person at an individual’s home.   

    The Office of Mental Health and Substance Abuse services (OMHSAS) has issued guidance expanded existing mental and behavioral telehealth services to include treatment provided by a number of providers including:

    • Certified Registered Nurse Practitioners (CRNPs);
    • Physician Assistants (PAs) certified in mental health;
    • Licensed Clinical Social Workers (LCSWs);
    • Licensed Professional Counselors (LPCs); and
    • Licensed Marriage and Family Therapists (LMFTs).  
       

    Previously, only Psychiatrists and licensed Psychologists could provide behavioral health via  telehealth services.  Additionally, individuals may now use telehealth directly with their providers by way of smart phones and other electronic devices. 

  • Children under age 21 with authorizations for shift nursing on or after April 9, 2020 can continue to receive their authorized skilled nursing hours without the need for reauthorization. 

    If your child's doctor requests an increase in hours beyond what is currently authorized as of April 9, 2020, or if your child's doctor is requesting nursing hours for the first time, the request will require the typical prior authorization process. Once the increase in services are authorized, the authorized hours of care will continue without need for reauthorization for the duration of the crisis.

  • The Medical Assistance Transportation Program (MATP) continues to operate in every county in Pennsylvania. However, during the COVID-19 emergency, consumers should be prepared for more limited availability of transportation services, and should be prepared to wear PPE like face masks during any MATP rides. To read our fact sheet on MATP during COVID-19, click here.

    DHS has released guidance on use of MATP during the COVID-19 crisis; indicating that telehealth should be used instead of in-person visits where possible, and that only certain types of face-to-face visits should be prioritized by MATP providers. These visits include dialysis, chemotherapy, radiation, IV therapies that cannot be done at home, high-risk pregnancy care, urgent clinical visits, trips to the pharmacy, and medication assisted treatment (methadone, buprenorphine, and naltrexone).

    This guidance also explains that MATP will use screening criteria for drivers and consumers that may make transportation through MATP unavailable or inappropriate for consumers with compromised immune systems or who are otherwise at risk of contracting or communicating COVID-19. Consumers will be asked screening questions about COVID-19 exposure and symptoms, before MATP will schedule their ride.

    DHS has also issued guidance reminding providers that nonemergency ambulance transportation may be used when medically necessary to transport consumers to medical appointments when transportation through MATP is not available or appropriate according to the COVID-19 screening criteria.

    Additionally, DHS increased the mileage reimbursement rate temporarily for the duration of the emergency, from $.12 cents per mile to $.25 cents per mile

    To arrange for transportation using MATP, call your local county MATP provider. 

  • Yes. In fact, your access to prescriptions should improve.  The state notified MA MCOs that they must allow their members to obtain early refills of all prescriptions at the pharmacy during the COVID-19 emergency period.  This includes early refills for opioids for pain management and medication-assisted treatment for opioid use disorder.  The prior authorization requirement based on day supply for short-acting opioids remains in effect.  MCOs can authorize prescriptions for longer than normal durations when medically necessary during the COVID-19 pandemic.  

  • The Office of Long-Term Living (OLTL) requested and received approval from federal officials to amend its Community HealthChoices (CHC) program.  We’ve highlighted below some of the most significant impacts on service delivery to CHC Participants:   

    • No Reductions of Waiver Services: The state has instructed CHC-MCOs not to reduce or terminate all waiver services, including personal assistance, for the next three months.  Services on participants’ Person Centered Service Plan may not be reduced except when requested by the participant or their representative.  However, providers should be given flexibility to ensure delivery of crucial, life-sustaining services and if necessary, delay less crucial services such as laundry and changing linens. 

    • Staffing and Service Delivery: Spouses, legal guardians and person with powers of attorney can now serve as paid direct care workers for participants when scheduled workers are not available due to COVID-19. This applies to consumers under BOTH the agency model AND the consumer-directed model.  While spouses, legal guardians and powers of attorney must still undergo criminal background checks and child abuse clearances, they can be reimbursed for services while those clearances are pending.
    • Comprehensive Needs Reassessments may be conducted remotely using phone or video conferencing when a participant’s needs change, when the participant requests a reassessment, or following trigger events (e.g. hospital or nursing home discharge). The qualifications for the individuals conducting these assessments will not change.
    • Monitoring of the Service Plan: Service Coordinators may monitor participants and service plans remotely by telephone where face-to-face contacts are currently required. Service Coordinators are encouraged to contact participants frequently to ensure participants’ needs are being met during this emergency.
    • Person-Centered Planning Team (PCPT) meetings and plan development may be conducted entirely using telecommunications. Members of the PCPT may also participate remotely using phone or video conferencing and are determined at the discretion of the participant.
    • Personal Protective Equipment (PPE) such as gloves, gowns and masks for participant use can be obtained as Specialized Medical Equipment and Supplies. PPE may be added to a participant’s PCSP without the need for a comprehensive needs assessment or a physician’s prescription. People who self-direct their care who want PPE for their direct care workers should contact their CHC-MCO and PPL to request those supplies.
  • Yes! 

    You can file a Grievance if your Managed Care Organization reduces, denies, or terminates your services. But remember: CHC-MCOs may not reduce or terminate any existing Waiver services -- e.g. personal assistance services -- during the crisis!

    The Bureau of Hearings and Appeals (BHA) is open and holding all hearings by telephone; even if an in-person hearing is requeasted. Additionally, if you had a hearing scheduled during the two-week BHA closure in March, your hering should be rescheduled shortly and you'll be notified of the new date and time.

    The CAO will accept MA appeals filed within 90 days from the date on the denial or termination notice. Usually, the deadline is much shorter-- just 30 days. But remember, anyone who had MA, CHIP, or Waiver coverage as of March 18, 2020 or later should not lose their coverage during the crisis! 

    Ordinarily, you have 15 days to appeal a CAO denial or reduction of MA in order to keep your MA active while the appeal is going on. But during COVID-19, the CAO will continue MA benefits if you appeal after 15 days of the notice mail date, and you request that your MA benefits be reinstated until BHA makes a hearing decision.

  • No. After May 1, 2020, you can no longer change your CHC Plan during COVID-19. The state has applied a “lock in” and the CHC Plan you are enrolled in as of April 30th will remain your plan until the emergency declaration is over.  

    Note: This lock-in does NOT apply to Physical HealthChoices MCOs. Individuals in these MCOs can change their plan as always by calling PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225). 

State Policy Documents

Other COVID-19 Resources

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