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PA Bulletin, Doc. No. 96-1754

NOTICES

DEPARTMENT OF PUBLIC WELFARE

General Assistance and General Assistance-Related Medical Assistance; Notice of Rule Change

[26 Pa.B. 5058]

   The Department of Public Welfare announces that effective October 1, 1996, all recipients of general assistance (GA) and GA-related medical assistance are responsible for a $150 deductible each fiscal year for compensable ambulatory surgical center services, inpatient hospital services and outpatient hospital services, except laboratory and x-ray services. This Rule Change is required by section 448 of Act No. 1996-35, signed into law on May 16, 1996. This Rule Change will be adopted by final rulemaking to 55 Pa. Code Chapter 1101.

   Failure to implement this Rule Change will result in noncompliance with State statute.

   This Rule Change has been reviewed by the Office of General Counsel and the Office of the Attorney General.

   This Rule Change is made under the Joint Committee on Documents Resolution 1996-1 (2) 26 Pa.B. 2374 (May 18, 1996) and will be in effect for 365 days pending adoption of final rulemaking by the Department.

   Public comments to this 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 a 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,   
Secretary

Purpose

   The purpose of this notice is to notify providers that effective October 1, 1996, all general assistance (GA) and GA-related categories of medical assistance recipients will be required to pay a $150 deductible per fiscal year for compensable ambulatory surgical center services and inpatient and outpatient hospital services, except for laboratory and x-ray services.

Scope

   This notice applies to all short procedure units (SPU), ambulatory surgical centers (ASC), general hospitals (inpatient and outpatient), rehabilitation hospitals (inpatient and outpatient), private psychiatric hospitals, and extended acute psychiatric inpatient care providers enrolled in the Medical Assistance Program.

Background/Discussion

   Act No. 1996-35, signed into law on May 16, 1996, established a medical assistance deductible for recipients of GA and GA-related medical assistance benefits.

   Section 448 of Act No. 1996-35 states: ''Recipients of general assistance and general assistance-related medical assistance shall be responsible for a $150 deductible each fiscal year for medical assistance-compensable ambulatory surgical center services, inpatient hospital services or outpatient hospital services, excluding laboratory and x-ray services.''

   The deductible, if applicable, will be deducted by medical assistance before it makes payment to the provider.

Policy

   Effective October 1, 1996, Chapter 1101 (General Provisions) will be amended as follows:

§ 1101.63.  Payment in full.

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   (c)  Medical assistance deductible.

   (1)  Recipients of general assistance and general assistance-related medical assistance are responsible for a $150 deductible each fiscal year for compensable ambulatory surgical center services, inpatient hospital services and outpatient hospital services, except laboratory and x-ray services.

   (2)  A provider participating in the program may not deny covered care or services to an eligible MA recipient because of the recipient's inability to pay the deductible amount. This paragraph does not change the fact that the recipient is liable for the deductible, and it does not prevent the provider from attempting to collect the deductible amount. If a recipient believes that a provider has charged the recipient incorrectly, the recipient shall continue to pay deductible amounts charged by the provider until the Department determines whether the deductible charges are correct.

   (3)  If a recipient is covered by a third-party resource and the provider is eligible for an additional payment from MA, the deductible required of the recipient may not exceed the amount of the MA payment for the item or service.

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Next step

   Providers will be notified of the procedures for collecting the $150 deductible in a separate Medical Assistance Bulletin.

   Fiscal Note: 14-NRC-065. No fiscal impact; (8) recommends adoption. Implementation of this Notice is ex-pected to result in savings to the Medical Assistance--Inpatient Appropriation of $5,605,000 during fiscal year 1996-1997 and $9,610,000 annually thereafter.

[Pa.B. Doc. No. 96-1754. Filed for public inspection October 18, 1996, 9:00 a.m.]


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