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DHS COVID-19 PROVIDER RESOURCES // OMAP

Managed Care Ops Memo 05/2020-012:
Elective Services

Issued: May 7, 2020

Audience

: All HealthChoices Physical Health Managed Care Organizations — Statewide

Purpose

The Office of Medical Assistance Programs (OMAP) is issuing this Operations Memorandum to provide revised direction regarding the authorization of elective services during the COVID-19 emergency.  

Background

On March 6, 2020, Governor Tom Wolf issued a public health emergency declaration in response to the presence of the COVID-19 virus in Pennsylvania. The COVID-19 outbreak was declared a national emergency under the Stafford Act on March 13, 2020, and a nationwide public health emergency on January 31, 2020 (retroactive to January 27, 2020).

Discussion

On April 27, 2020 the Department of Health issued updated guidance on Hospitals’ Response to COVID-19. Hospitals may begin to allow elective admissions and may begin performing elective surgeries and procedures if the hospital makes an affirmative decision that it is able to do so without jeopardizing the safety of patients and staff or the hospital’s ability to respond to the COVID-19 emergency. 

On April 27, 2020 the Department of Health also issued updated guidance on Ambulatory Surgical Facilities’ (ASFs) Responses to COVID-19. ASFs may begin performing elective surgeries and procedures if the ASF makes an affirmative decision that it is able to do so without jeopardizing the safety of patients and staff or the ASF’s ability to respond to the COVID-19 emergency.

Next Steps

PH-MCOs should review the guidance issued by the Department of Health included in the Operations Memorandum and resume normal practices for review and approval of elective procedures. If a PH-MCO issued any authorizations with the future effective date of July 1, 2020 those authorization must be reissued with a current effective date.