STATEMENTS OF POLICY
Title 55--PUBLIC WELFARE
DEPARTMENT OF PUBLIC WELFARE
[55 PA. CODE CH. 1163]
Inpatient Hospital Drug and Alcohol Services Under the MA Program
[28 Pa.B. 2150] Purpose
The purpose of these statements of policy is to inform hospitals of the Department of Public Welfare's (Department) adoption of the Pennsylvania Client Placement Criteria (PCPC) for adults 18 years of age and older, developed by the Bureau of Drug and Alcohol Programs (BDAP) in the Department of Health, as the utilization guidelines for inpatient drug and alcohol services rendered to adult Medical Assistance (MA) recipients.
Scope
These statements of policy apply to physicians, acute care general hospitals, drug and alcohol rehabilitation units of general hospitals and drug and alcohol rehabilitation hospitals enrolled in the MA Program. The statements of policy apply for all inpatient drug and alcohol services for adults 18 years of age and older rendered by these providers, whether the services are provided through voluntary or mandatory managed care programs or through the fee-for-service program.
Background
In November 1995, the Department amended §§ 1163.59 and 1163.455 (relating to noncompensable services, items and outlier days; and noncompensable services and items) to limit payment for inpatient hospital admissions for drug or alcohol services to situations in which there was a complication or an anticipated complication that along with detoxification or rehabilitation required inpatient medical treatment.
At that time, the Department issued two statements of policy codified in §§ 1163.59a and 1163.455a (relating to utilization guidelines for inpatient hospital drug and alcohol services under the MA Program--statement of policy). See 25 Pa.B. 4704 and 4705 (November 4, 1995). When the Department adopted the statements of policy, BDAP was in the process of developing criteria for drug and alcohol treatment services, and the Department agreed that it would adopt the BDAP criteria for inpatient services when those criteria were formalized.
The BDAP has now finalized its criteria, which are known as the PCPC. The PCPC provides the structure for a comprehensive assessment of the client throughout the continuum of care, to ensure that the client is placed in the most appropriate level of care which has the necessary resources to treat the client. Since September of 1996, the BDAP has conducted extensive outreach and training activities for single county authorities, drug and alcohol providers and managed care organizations (MCOs) in the use of the PCPC. Effective July 1, 1997, the BDAP mandated use of the PCPC for adults by licensed drug and alcohol clinics, and any other entities (such as MCOs) responsible for service authorization, placement, continued stay reviews and discharge decisions for the public client. In the HealthChoices Southeast area, mandated use of the PCPC criteria began on February 1, 1997.
Public Comments
Comments and questions regarding these statements of policy should be directed to Office of Medical Assistance Programs, Division of Medical Review, Joyce G. Grix, Director, P. O. Box 2675, Harrisburg, PA 17105 (717) 772-6020.
Effective Date
These statements of policy shall take effect upon publication and apply retroactively to May 1, 1998.
(Editor's Note: The regulations of the Department are amended by amending §§ 1163.59a and 1163.455a to read as set forth in Annex A.)
FEATHER O. HOUSTOUN,
SecretaryFiscal Note: 14-BUL-054. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 55. PUBLIC WELFARE
PART III. MEDICAL ASSISTANCE MANUAL
CHAPTER 1163. INPATIENT HOSPITAL SERVICES
Subchapter A. ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PAYMENT FOR HOSPITAL SERVICES § 1163.59a. Utilization guidelines for inpatient hospital drug and alcohol services under the MA Program--statement of policy.
(a) For inpatient adult drug and alcohol services rendered on or after May 1, 1998, the Department will use the Pennsylvania Client Placement Criteria (PCPC) developed by the Bureau of Drug and Alcohol Programs (BDAP) in the Department of Health as utilization guidelines, both for prospective and retrospective reviews of patient care.
(b) If the BDAP modifies the PCPC guidelines, the Department will also adopt those modifications.
(c) Providers who do not already have a copy of the PCPC may obtain one by contacting the Department of Health, Bureau of Drug and Alcohol Programs, Room 929, Health and Welfare Building, Harrisburg, Pennsylvania 17108.
Subchapter B. HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES PAYMENT FOR COST REIMBURSED HOSPITAL SERVICES § 1163.455a. Utilization guidelines for inpatient hospital drug and alcohol services under the MA Program--statement of policy.
(a) For inpatient adult drug and alcohol services rendered on or after May 1, 1998, the Department will use the Pennsylvania Client Placement Criteria (PCPC) developed by the Bureau of Drug and Alcohol Programs (BDAP) in the Department of Health as utilization guidelines, both for prospective and retrospective reviews of patient care.
(b) If the BDAP modifies the PCPC guidelines, the Department will also adopt those modifications.
(c) Providers who do not already have a copy of the PCPC may obtain one by contacting the Department of Health, Bureau of Drug and Alcohol Programs, Room 929, Health and Welfare Building, Harrisburg, Pennsylvania 17108.
[Pa.B. Doc. No. 98-728. Filed for public inspection May 8, 1998, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
