Government Relations
Credentialing At PDA ’ s request , Rep . Steven Mentzer introduced HB 2613 , legislation that will improve the credentialing process for healthcare practitioners in Pennsylvania . HB 2613 will :
• Require use of the CAQH system for credentialing .
• Require insurers to notify applicants within a reasonable timeframe when an application is incomplete , and more information is needed .
• Limit the credentialing period to 60 days for complete applications .
• Streamline the process for health practitioners practicing in multiple locations .
PDA will spend the summer lobbying members of the House Health Committee to vote in support of HB 2613 when session resumes in the fall . The committee must first vote on the bill before it moves to the full House .
Other News
Medical Assistance Plan Changes Pennsylvania ’ s Department of Human Services ( DHS ) is changing which physical health managed care organizations are available for Medical Assistance ( MA ) patients . The plans offered to patients in your area may change . Some patients will have the option of selecting a new plan or remaining with their existing plan ( if still offered ) between June 22-August 16 , and new plans take effect on September 1 .
Log on to https :// www . dhs . pa . gov / HealthChoices / Pages / HealthChoices-Plan-Selection . aspx to find out more about the potential changes in your area . DHS also offers a toolkit to help patients , providers and other stakeholders navigate these changes .
Medical Assistance Teledentistry The Department of Health ’ s Office of Medical Assistance Programs ( OMAP ) recently issued a bulletin that updates its post-pandemic policy on teledentistry . OMAP will continue to cover a limited , problem-focused exam , the topical application of fluoride varnish , and tobacco counseling offered via teledentistry . OMAP also added two entirely new procedure codes that can be offered in-person or via teledentistry : nutritional counseling for control of oral disease and oral hygiene instruction .
This policy is applicable to the Medical Assistance program only , but please note that there are currently no laws or regulations in PA authorizing or prohibiting other insurers from covering teledental services . PDA is tracking and responding to several bills in the General Assembly that would codify the practice and further regulate teledental services , but for now , insurers are developing their own policies and exercising discretion on which procedures to cover .
Work Stoppage DHS was planning to include a new contract provision that Medicaid managed care plans may not include in their networks any practitioner with a history of one or more work stoppages during the preceding five years , unless the practitioner signs a collective bargaining agreement or labor peace agreement .
This proposed contract provision would potentially preclude hospitals — including sole community hospitals in rural areas of the state — from providing services to Medicaid beneficiaries . In addition , the provision essentially mandates health care unionization into a program that is designed to provide access to care to our most vulnerable population . And it could have potentially impacted dentists who are MA providers , especially dental residents who are associated with large health care systems .
Through the collaborative efforts of the health care practitioner stakeholder community , the administration recently reversed its decision to include this provision in its contracts with the MCOs .
8 JULY / AUGUST 2022 | PENNSYLVANIA DENTAL JOURNAL