NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Notice of Rule Change; Limits on Office Visits Under General Assistance Basic Health Care Package
[26 Pa.B. 2132] The Department of Public Welfare announces that effective November 1, 1995, family planning clinics will no longer be included in the combined limit of 18 visits per year for practitioner's office and clinic visits under the General Assistance Basic Health Care Package.
This Rule Change has been reviewed by the Office of General Counsel and the Office of Attorney General.
This Rule Change is made under the Joint Committee on Documents Resolution 1994-1(3) 24, No. 18, Pa.B. 2348 and will be in effect for 180 days pending adoption of rulemaking by the Department.
Public comments to the Rule Change can be made by contacting Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120.
Persons with a disability may use the AT&T Relay Service by calling 1 (800) 654-5984 (TDD users) or 1 (800) 654-5988 (Voice users), or may use the Department of Public Welfare TDD by calling (717) 787-3616. Persons who require another alternative should contact India Wood at (717) 783-2212.
FEATHER O. HOUSTOUN,
SecretaryPurpose
To notify family planning clinic providers that, effective November 1, 1995, the limit on clinic visits under the GA Basic Health Care Package will no longer apply to them.
Scope
Applies to all family planning clinics enrolled in the Medical Assistance Program.
Background/Discussion
On January 1, 1993, the Department amended 55 Pa. Code Chapter 1101 to preserve a basic health care package for GA recipients, ages 21 to 65, that provides a primary care package of medical services.
As part of the GA Basic Health Care Package, practitioner's office and clinic visits were limited to a combined maximum of 18 visits per year. Clinics include independent medical clinics, rural health clinics, general and rehabilitation hospital clinics, family planning clinics, and Federally qualified health centers.
The Department established criteria and a process to grant exceptions to the limits of 18 practitioner/clinic visits per year. Exceptions are granted for recipients with serious chronic systemic illnesses or other serious health conditions which by themselves or in combination with other illnesses, conditions, or major trauma could lead to hospitalization, nursing home admission, complications associated with the illness, a condition which could result in serious deterioration of the health of the individual or death. A toll-free telephone number is available to providers to request an exception to the limits. Requests for exceptions to the 18 visit limit for family planning visits have been routinely granted.
In reviewing the requests for exceptions to the 18 visit limit for family planning visits, the Department has determined that family planning clinics should not be included in the list of practitioner and clinic providers who are limited under the GA Basic Health Care Package.
Policy
Effective November 1, 1995, family planning clinics will no longer be included in the combined limit of 18 visits per year for practitioner's office and clinic visits under the GA Basic Health Care Package.
The Department will amend 55 Pa. Code Chapter 1101, § 1101.31(e)(1)(i) and (2)(i) to reflect this change.
Fiscal Note: 14-NRC-063. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 96-730. Filed for public inspection May 3, 1996, 9:00 a.m.]
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