SARS-CoV-2 Vaccine Administration by Pharmacists, December 30, 2020
- Exceptions to Maintaining Medical Assistance (MA), Including Long-Term Care (LTC) and Home and Community-Based Services (HCBS) Enrollment during the Public Health Emergency (PHE) - Coronavirus (COVID-19), December 7, 2020
- MA Benefits for Beneficiaries Turning 21 During the COVID-19 Emergency, July 2020
- Bureau of Hearings and Appeals COVID-19 Procedures , July 20, 2020
- "Payment in Full" and Personal Protective Equipment, June 12, 2020
- Pharmacy Services for Medical Assistance Beneficiaries Related to the COVID-19 Public Health Emergency, May 27, 2020
- Families First Coronavirus Response Act - COVID-19 Emergency - Revised, May 19, 2020
- MATP Consumer Notice, May 8, 2020
- MATP Guidance for COVID-19, May 8, 2020
- Managed Care Operations Memo 05-2020-12: Elective Services, May 7, 2020
- MAWD Reinstatement for Individuals Who Self-Attest to Paying Premium During the COVID-19 Emergency, May 5, 2020
- OPS-20-05-02 - "Unemployment Income & COVID-19", May 5, 2020
- COVID-19 Testing and Related Treatment Exempt from MA Copayment Requirements, May 1, 2020
- Request for State Plan Amendments Related to COVID-19, April 22, 2020
- MA Eligibility During COVID-19 Emergency, April 20, 2020
- DHS Stakeholder COVID-19 Update, April 19, 2020
- Telemedicine Guidelines Related to COVID-19, April 17, 2020
- CARES Act Economic Stimulus Payments, April 15, 2020
- Emergency Medical Assistance (EMA) during COVID-19, April 14, 2020
- New ICD-10-CM Code for COVID-19, April 13, 2020
- Families First Coronavirus Response Act - Coronavirus (COVID-19) Emergency, April 8, 2020
- Teledentistry Guidelines Related to COVID-19, April 7, 2020
- MATP Mileage Reimbursement Increase, April 7, 2020
- 90-day supplies of medications – COVID-19, April 7, 2020
- Federal Approval of PA's 1135 Waiver Request, March 30, 2020
- PA's 1135 Waiver Request Checklist & Request Letter, March 25, 2020
- MAWD Premium Payments during COVID-19 Emergency, March 25, 2020
- FAQs: MA Coverage of COVID-19 Testing & Related Services, March 24, 2020
- Cobertura de las Pruebas de Coronavirus (COVID-19) y Servicios Relacionados Bajo el Programa de Asistencia Médica: Preguntas Más Frecuentes, March 24, 2020
- Early Refills of Prescriptions, March 13, 2020
We're here to help.
Last Update: January 14, 2021
As the COVID-19 public health emergency continues, 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 email@example.com.
Federal & State Updates
Pennsylvania DOH Releases Vaccine Information
The COVID-19 vaccine will be distributed to Pennsylvanians in a phased approach. To learn about this phased approach, visit the Department of Health's Vaccine Site. In releasing its plans for vaccine distribution, the Department of Health noted: "Many components of the COVID-19 vaccine plan remain fluid and continue to be modified and adapted as more announcements and decisions are made at the federal level. The department is continuing to receive feedback and will be modifying this plan and posting public updates to this in the coming weeks."
Governor Wolf Signs Third Renewal to COVID-19 Disaster Declaration
On November 24, 2020, Governor Tom Wolf signed a third renewal of his 90-day disaster declaration for the COVID-19 pandemic. The disaster declaration was originally signed on March 6, following the announcement of the first two presumptive positive cases of COVID-19 in our state.
MA Beneficiaries Turning 21 During the COVID-19 Emergency Continue to Qualify for EPSDT Services
Medical Assistance (MA) beneficiaries turning 21 on or after March 18, 2020 continue to be eligible for the same MA services provided to individuals on MA under 21 years of age until the end of the month in which the national public health emergency ends. This means beneficiaries who turn 21 and otherwise age out of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) MA benefit, continue to be eligible for the same scope of services they received before turning 21. This includes services that are not covered for adults over age 21 otherwise, such as private duty shift nursing and Intensive Behavioral Health Services (IBHS).
Renewal of Federal PHE Allows State to Continue Pediatric Shift Nursing “Freeze”
The Department of Human Services (DHS), with the extension of the federal Public Health Emergency, will continue the protections currently in place for pediatric skilled nursing services. The federal Public Health Emergency was most recently renewed effective October 23, 2020 and for 90 days thereafter (i.e. through the end of January 2021.)
As part of its response to the COVID-19 emergency, DHS in early April removed prior authorization requirements for certain services and effectively “froze” existing authorizations for in-home pediatric skilled nursing services. According to this guidance, shift nursing authorizations in place as of early April are continued at the same level of hours until further notice from DHS. New requests for services and requests for additional hours are not covered by this guidance and still require prior authorization. Any shift nursing requests newly approved since April are covered by these protections.
In taking this action to suspend prior authorization requirements, DHS is exercising authority temporarily available through federal approval of its 1135 Waiver requests. The ability to waive or modify normal requirements under this section of the Medicaid Act is conditioned on a federal Public Health Emergency being in effect.
Families or advocates with questions regarding these shift nursing protections should contact our Helpline at (800) 274-3258.
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. Most 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. Details on the few exceptions to continuous coverage are detailed in this Operations Memorandum.
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 Clarification 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
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.
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 (CHC) 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 the CHC Waiver 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 conducted using phone or video conferencing. The face-to-face requirement is temporarily waived for these assessments in Counties in the Yellow and Red Phases of Reopening. When counties are in the Green Phase of Reopening, participants must be offered an in-person assessment or reassessment and told that waiver services might be reduced or changed. Knowing that the assessment may impact services may influence whether someone wants an in-person or telephone assessment.
Additionally, for the duration of the COVID-19 emergency, OLTL has temporarily allowed certain 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. This exception will be reviewed on a case-by-case basis by OLTL.
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
Previously, CHC-MCOs could not reduce PAS and other Waiver services. However, that moratorium has been lifted. CHC-MCOs can now reduce both waiver and non-waiver services. Physical and Behavioral Health MCOs can also reduce or terminate services during the crisis. Normal Grievance and Fair Hearing rights apply to any reduction or termination of services.
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.
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 During COVID-19
In addition to mail, Medicare beneficiaries can now enroll into Medicare Part B coverage by fax, and in some cases, online.
CMS added a new online enrollment option for people age 65 or older and who have or had group health plan (GHP) coverage within the last 8 months through their or their spouse’s current employer. To apply online, you will need your Medicare number, your current address and phone number, a valid e-mail address, and documentation verifying your Group Health Plan (GHP) coverage through your or your spouse’s current employment.
To apply by fax, send the Medicare Part B form, CMS-40B and CMS L564—Request for Employment Information, along with proof of employment, GHP coverage, 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.
State Policy Documents
- FAQs: CHIP Coverage of COVID-19 Testing & Related Services, May 19, 2020
- Aviso del Programa de Seguro Médico Infantil, April 16, 2020
- Self-attestation on applications and renewals; enrolling prior to premium payment; continuation of coverage, April 1, 2020
- Early Refills of Prescriptions, March 27, 2020
- FAQs: CHIP Coverage of COVID-19 Testing & Related Services , March 26, 2020 (en español)
Guidance on COVID-19 for Personal Care Homes, Assisted Living Residences and Private Intermediate Care Facilities —
Updated September 18, 2020
- Transition Plan to Phase Out Temporary Changes to the Community HealthChoices (CHC) Waiver, June 25, 2020
- Transition Plan to Phase Out Temporary Changes to the OBRA 1915(c) Waiver, June 25, 2020
- Temporary Changes to the OBRA 1915(c) Waiver - May 8, 2020
- Temporary Changes to the Act 150 Program, May 8, 2020
- Temporary Changes to the Community HealthChoices (CHC) Waiver - Revised, April 30, 2020
- Appendix K Waiver Application, April 13, 2020
- LIFE Provider Guidance Related to COVID-19, April 8, 2020
- Electronic Visit Verification (EVV) Implementation Date, March 26, 2020
- LTSS Providers are Life Sustaining Businesses, March 23, 2020
- Interim Guidance on Visitation in Nursing Facilities During COVID-19, March 20, 2020
- Operational Recommendations for LTSS Providers, March 13, 2020
- Transition Plan to Phase Out Temporary Changes to the Community HealthChoices 1915(c) Waiver, June 25, 2020
Temporary Suspension of Specified Regulatory Requirements for Inpatient Psychiatric Services, Outpatient Psychiatric Services, Intensive Behavioral Health Services, Outpatient Drug and Alcohol Services, Mental Health Procedures, Partial Hospitalization, Intensive Case Management, Psychiatric Rehabilitation Services, Community Residential Rehabilitation Services, and Long-Term Structured Residences — August 14, 2020
COVID-19 Frequently Asked Questions (FAQs) Supplement 1 — May 5, 2020
Telehealth Guidelines Related to COVID-19 — May 5, 2020
- Instructions and Guidelines for the Delivery of BHRS and IBHS Through Telehealth, May 5, 2020
- OMHSAS COVID-19 Frequently Asked Questions (FAQs), May 5, 2020
- Suspension of Certain ODP Functions, April 3, 2020
- Behavioral Health MCOs, Fee-For-Service Providers, and County Mental Health Authorities - COVID-19 Frequently Asked Questions, March 26, 2020
- Department of Drug and Alcohol Programs (DDAP) COVID-19 Resources, March 23, 2020
- Telehealth Guidelines for All Behavioral Health MCOs, Fee-For-Services Providers, and County Mental Health Authorities, March 17, 2020
- Guidance for County Mental Health Programs, Behavioral Health Service Providers, Primary Contractors, Behavioral Health MCOs, March 14, 2020
- Enrollment Issues for COVID-19 Pandemic-Related National Emergency Q&As for Medicare Beneficiaries, May 7, 2020
- Guidance for Medicare Advantage and Part D Plans, April 10, 2020
- Video: Medicare Coverage and Payment of Virtual Services, April 5, 2020
- Coverage and Payment Related to COVID-19 Medicare, March 23, 2020
- Medicare Telehealth FAQs, March 17, 2020
- Medicare Coverage of Telemedicine: Fact Sheet, March 17, 2020
Other COVID-19 Resources
COVID-19 Resources, PALawHelp.org
Translated COVID-19 Resources, Department of Health
Stimulus Payments; Unemployment; Health Insurance Options
Health Insurance Coverage Options for People Not Working, Community Legal Services
Impact of COVID-19 Stimulus Payments and Pandemic Unemployment Benefits on Health Insurance Eligibility, Pennsylvania Health Law Project
COVID-19 Job Portal, PA CareerLink
How to Apply for Unemployment Compensation During the Coronavirus Crisis / Español / Chinese / 中文, Philadelphia Legal Assistance
Economic Stimulus Payments: Your Questions Answered, Community Legal Services
Expanded Unemployment Compensation Benefits, Northwestern Legal Services
Information for Immigrants During Coronavirus, Community Legal Services
Immigrant Eligibility for Public Programs During COVID-19: Quick Reference Guide / Español, Protecting Immigrant Families
Find a Food Pantry in Pennsylvania, Department of Human Services
Find a Food Pantry in the Philadelphia Area, Coalition Against Hunger
Coronavirus Federal Protections for Renters, Regional Housing Legal Services
No Foreclosures or Evictions Through July 10, 2020, Governor.PA.gov
How Does COVID-19 Affect My Mortgage Situation?, Northwestern Legal Services
People with Disabilities
Health Care Rationing: What Patients with Disabilities Need to Know During the COVID-19 Pandemic, Disability Rights Pennsylvania
Mental Health Resources
Get Mental Health Services in PA, Department of Human Services
Medicare Coverage & COVID-19 Webinar Recording, Justice in Aging
COVID-19 Resource Guide for Older Adults, Department of Aging
COVID-19 Resoures for Older Adults & Caregivers, Nat'l Council on Aging
- Coronavirus Updates, Department of Human Services (DHS)
- Coronavirus Updates, Office of Developmental Programs (ODP)
- Coronavirus Updates, Department of Health
- Insurance Coverage & COVID-19: FAQs, Department of Health
- Translated consumer materials, Department of Health
- Information about WIC Clinics, Department of Health
- COVID-19 Medicaid & CHIP FAQs, Centers for Medicare & Medicaid Services (CMS)
- Coronavirus Updates, Centers for Disease Control and Prevention (CDC)
- Mental Health and Coping During COVID-19, CDC
- Medicare and Coronavirus, Medicare.gov
- COVID-19: An Advocates Guide to Medicare Changes, Center for Medicare Advocacy
- Medicaid Emergency Authority Tracker, Kaiser Family Foundation
- CARES Act: Summary of Key Health Provisions, Kaiser Family Foundation
- Families First Act: Summary of Key Provisions, Kaiser Family Foundation
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Línea Nacional de Prevención del Suicidio: 1-888-628-9454
Crisis Text Line: Text "PA" to 741-741
Veteran Crisis Line: 1-800-273-TALK (8255)
Disaster Distress Helpline: 1-800-985-5990
- Get Help Now Hotline (for substance use disorders): 1-800-662-4357
- United Way of Pennsylvania: Text your zip code to 898-211 for resources and information in your community.