The PA Department of Public Welfare (DPW) has notified fifty (50) organizations providing services under contract with various DPW offices that they will face an examination to be conducted by the certified public accounting firm Maher Duessel. The scope of the examination is described in a contract between the Department of Public Welfare and the public accounting firm Maher-Duessel. Organizations to be examined are listed. The contract beginning January 2 and ending June 30, 2012 requires Maher Duessel to follow an examination process and report on various compliance areas, including: Real estate – rental and owned, cost allocation plan, related party transactions, motor vehicles, and direct/indirect administrative costs. The listed amount of DPW and/or county funding for providers under review totals is near $594 million. The number of providers contracting with state offices include one (1) provider contracted with the Office of Child Development and Early Learning (OCDEL, 23 providers with the Office of Children, Youth and Families (OCYF), 14 providers with the Office of Developmental Programs (ODP), three providers with the Office of Long Term Living (OLTL), and the nine (9) with the Office of Mental Health and Substance Abuse Services (OMHSAS). The examination process will be in accordance with the American Institute of Certified Public Accountants’ Statement on Standards for Attestation Engagements (SSAE) No. 10 and 11, Agreed-Upon Procedures Engagements,. These standards are at http://www.aicpa.org/Research/Standards/AuditAttest/Pages/SSAE.aspx. FMI: The contract can be accessed online at http://contracts.patreasury.gov/View.aspx?ContractID=171867.
The Pennsylvania House of Representatives Human Services Committee is scheduled to hold a hearing on the new assets test that the PA Department of Public Welfare is planning to impose in determining an individual’s eligibility for federal food stamps. The hearing will be held on Thursday, March 15 at 9:30 a.m. in Room 60 in the East Wing of the Sate Capitol. FMI: See www.legis.state.pa.us.
On December 28 the PA Department of Insurance submitted a request for $33 million in federal funding to complete planning and begin development and design of a health insurance exchange. On January 22 the PA Department of Insurance announced its intent to move forward with the exchanges which are scheduled to be established in 2014 under the Patient Protection and Affordable Care Act (PPACA). States are given the right of first refusal regarding implementation of the exchanges, but if a state refuses, the federal government will operate the exchange as well as the eligibility determinations for a state’s Medicaid program. The exchanges will operate as insurance regulators, as gatekeepers to the state’s Medicaid program and as administrators for a new federally-funded income subsidy program related to health insurance. The Commonwealth faces a deadline of January 1, 2013 deadline. If a state is not deemed ready for the 2014 exchange implementation deadline, the states will be placed under the federally-operated exchange.
On January 26 the Department of Public Welfare (DPW) Medical Assistance Advisory Committee (MAAC) was updated on the implementation of new co-payments as well as limits on pharmacy and dental services. The DPW Office of Medical Assistance (OMAP) reported that pharmacy limits were implemented on January 3, and since then, there have been 934 appeals, none of which cited circumstances based on the specific criteria which would permit benefits to continue. There have been 246 exception requests involving 294 medications, and of those requests approximately 50 percent have been approved. OMAP says that consumers will be charged for a prescription only when DPW has made the determination not to pay and has informed the provider of its decision, the provider has offered the consumer the choice to receive or not receive the prescription, and the consumer has chosen to receive the prescription. At this point, two MCOs are implementing the prescription limits. Concerning limits on dental services, from September 30 through November 30, there were exception requests for 2,219 total line items. Of those, 85 were approved and 54 are still under review. There have been 24 appeals with five (5) hearings being scheduled. DPW also reported that it has identified 38,107 families with incomes greater than or equal to 200% of the FPL and therefore subject to a co-payment under Act 22. DPW is working on the changes necessary in the system to implement the co-pay requirements, subject to federal and state requirements and expects to implement the co-pay in September. Implementation will occur under provisions of the Deficit Reduction Act rather than Medical Assistance rules. There will be an overall cap of five percent of family income and no co-pay will exceed 20% of the cost of the service or item at the time the service is provided or the item purchased. DPW said that providers will be responsible for collecting co-pays and DPW will be outlining the methods which providers may use. FMI: See www.dpw.state.pa.us. See http://www.dpw.state.pa.us/provider/doingbusinesswithdpw/medicalassistance/whatsnew/S_001492
On January 26 the PA Department of Public Welfare (DPW) Office of Income Maintenance provided data to the DPW Medical Assistance Advisory Committee (MAAC) on MA enrollment relating to efforts to deal with the backlog. The data included only annual reviews, semi-annual reviews, letters which the system might generate, and information exchanges with other systems. OIM said that at this point, reviews of 304,000 cases (579,000 people) have been completed, and of those completed 230,000 cases (443,000 people) have been determined eligible. The number of eligible people includes 196,000 children and 247,000 adults. A total of 74,000 cases (136,000 people) have been discontinued. Of those, 71,000 are children and 65,000 are adults. A total of about 48,000 people have been reopened including 23,000 children and 25,000 adults. Renewals represent about one-third of the cases. OIM said it is reviewing all individuals who have been closed, beginning with high risk populations, in order to determine if the actions taken are correct. In response to news reports on MA enrollment changes OIM noted that previous individual level data included duplicate counts although budget level data are accurate. OIM said that DPW changed its method of counting individuals in its December MA eligibility statistics. OIM provided no details on the nature of the change in methodology. FMI: See http://www.dpw.state.pa.us/provider/doingbusinesswithdpw/medicalassistance/whatsnew/S_001492
In the January 28, 2012 edition of the Pennsylvania Bulletin, the PA Department of Transportation (PennDOT) announced that it will not accept applications for funding under the Section 5310 program fiscal year 2011-2012 until further notice. PennDOT says that because of changes being made in the application process, applications will not be received until further notice. The notice in the December 17, 2011 Pennsylvania Bulletin relating to the receipt of applications for the State-administered Section 5310 Program has been rescinded. Under the Section 5310 program, private nonprofit organizations and designated public bodies may apply for federal capital assistance to pay up to 80% of the purchase cost of new wheelchair accessible small transit vehicles and other equipment used to provide needed transportation services for senior citizens and persons with disabilities who cannot be reasonably accommodated by existing transportation providers. FMI: Contact Ben Brosius, Bureau of Public Transportation, (717) 787-1211, bbrosius@pa.gov. See http://www.pabulletin.com/secure/data/vol42/42-4/156.html.
