NOTICES
Medical Assistance Program Fee Schedule; Childhood Nutrition and Weight Management Services Purpose of Notice
[37 Pa.B. 5863]
[Saturday, October 27, 2007]The Department of Public Welfare (Department) announces that it is adding Childhood Nutrition and Weight Management Services for Medical Assistance (MA) recipients under 21 years of age to the MA Program Fee Schedule, effective November 1, 2007.
Description of Services
Children who are overweight or obese are at risk of developing serious health problems such as high cholesterol, high blood pressure and type 2 diabetes. At times, children who have weight management problems, such as significant fluctuations in weight over a period of time, are also susceptible to serious health complications. In an effort to achieve better health outcomes for MA recipients under 21 years of age, the Department will make payment for Childhood Nutrition and Weight Management Services, which address the child's nutrition and weight management activities and are intended to reduce the occurrence of the serious health problems described previously. Specific services include: initial assessment, re-assessment, individual counseling, family counseling, group counseling and nutritional counseling.
Fee Schedule
Effective November 1, 2007, Physicians, Certified Registered Nurse Practitioners, registered nurses, nutritionists, outpatient hospitals, independent medical-surgical clinics, Federally Qualified Health Centers and Rural Health Clinics enrolled in the MA Program who serve as Primary Care Practitioners may bill for Childhood Nutrition and Weight Management Services when the services are medically necessary and rendered to MA recipients under 21 years of age who are overweight, obese or experiencing weight management problems. The Department is adding the following procedure codes to the MA Program Fee Schedule for initial assessment, reassessment, counseling and nutritional counseling services:
Procedure Code Procedure Description MA Fee 96150 Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes, face-to-face with the patient; initial assessment $20.38 T1015 *** Clinic visit defined as = Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes, face-to-face with the patient; initial assessment Encounter rate 96151 Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes, face-to-face with the patient; re-assessment $20.38 T1015 *** Clinic visit defined as = Health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes, face-to-face with the patient; re-assessment Encounter rate 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual $19.60 T1015 ***Clinic visit defined as= Health and behavior intervention, each 15 minutes, face-to-face; individual Encounter rate 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) $5.39 T1015 ***Clinic visit defined as= Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) Encounter rate 96154 Health and behavior intervention, each 15 minutes, face-to-face; family (with patient present) $19.60 T1015 ***Clinic visit defined as= Health and behavior intervention, each 15 minutes, face-to-face; family (with patient present) Encounter rate S9470 Nutritional counseling, dietitian visit $26.46 T1015 ***Clinic visit defined as= Nutritional counseling, dietitian visit Encounter rate Specific instructions for billing these procedure codes will be included in a MA Bulletin that will be issued to affected providers before November 1, 2007.
Enrollment of Nutritionists
A nutritionist who possesses current licensure as a dietitian-nutritionist from the Department of State and current certification from the Commission on Dietetic Registration, the credentialing agency for The American Dietetic Association, may apply to enroll as a provider of nutritional counseling. Interested persons may obtain an enrollment application by:
* visiting the Department's website at www.dpw.state.pa.us/omap/promise/enroll/omappromiseenroll.asp;
* calling (800) 537-8862; or
* writing to DPW Enrollment Unit, P. O. Box 8045, Harrisburg, PA 17105.
Nutritionists currently enrolled in the MA Program to provide nutritional consultation services under the Aids Waiver Program may provide the nutritional counseling component of Childhood Nutrition and Weight Management Services without submitting another enrollment application.
Fiscal Impact
It is estimated that the addition of these services to the MA Program Fee Schedule will result in costs to the MA-Outpatient Program of $0.382 million ($0.176 million in State funds) in Fiscal Year (FY) 2006-2007 and $1.530 million ($0.704 million in State funds) in FY 2008-2009. It is expected that these additional costs will be offset by savings achieved through the improved health of the target population.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, Attention: c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service should submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-531. (1) General Fund; (2) Implementing Year 2007-08 is $ 176,000; (3) 1st Succeeding Year 2008-09 is $704,000; 2nd Succeeding Year 2009-10 is $1,760,000; 3rd Succeeding Year 2010-11 is $3,519,000; 4th Succeeding Year 2011-12 is $3,519,000; 5th Succeeding Year 2012-13 is $3,519,000; (4) 2006-07 Program--$671,472,000; 2005-06 Program--$945,950,000; 2004-05 Program--$842,991,000; (7) Medical Assistance--Outpatient; (8) recommends adoption. Funds have been included in the budget to cover these increases.
[Pa.B. Doc. No. 07-2005. Filed for public inspection October 26, 2007, 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.
