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COMMONWEALTH OF PENNSYLVANIA

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PA Bulletin, Doc. No. 14-2086e

[44 Pa.B. 6315]
[Saturday, October 4, 2014]

[Continued from previous Web Page]

INTERNAL GUIDELINES (Contact: James B. Allen) (717) 787-2065:

• Actuarial Reports (Annual Evaluation and 5 year Experience Study Report)
• Actuarial Tables
• Comprehensive Annual Financial Report
• Investment Consultant Quarterly Reports
• PMRS Board Minutes and Resolutions
• Sample Domestic Relations Order and Instruction Memo
• Template Pension Plan Contract for Police, Municipal and Firefighter

PUBLIC WELFARE

 (Editor's Note: Statements of Policy are in upper and lower case. Notices of Rule Change are in all capitals. Notices of Rule Change adopted more than 180 days before deposit are starred (*).

Office of Income Maintenance—Contact: Matthew J. McLees (717) 787-4081

POLICY STATEMENTS:

Year Code
Citation 		Subject Date Issued Bulletin Number
1983 Ch. 166 Computation of CWEP Hrs. 10/25/83 166-83-57
Ch. 275 Postmark Date as the ReceiptIndicator for Appeals and for Requests for Reconsideration 03/15/84 275-84-10
1993 *CH. 166 PROVIDING SUPPORTIVE SERVICES TO PARTICIPANTS IN THE COMMUNITY WORK EXPERIENCE PROGRAM 08/21/93 166-93-01
1995 *CH. 257 MA ESTATE RECOVERY—CHAPTER 178—MEDICAL ASSISTANCE RESOURCES; CHAPTER 257—REIMBURSEMENT 06/01/95 257-95-01
1996 CH. 125 ACT 1995-20 PROVISIONS RELATING TO PERSONS SENTENCED OR CHARGED FOR A FELONY OR MISDEMEANOR 04/05/96 125-96-01

GUIDANCE MANUALS:
• Cash Assistance Handbook
• Supplemental Nutrition Assistance Program (SNAP) Handbook
• Medical Assistance Eligibility Handbook
• Long Term Care Handbook
• Supplemental Handbook
• Medicaid in Pennsylvania
• Low-Income Home Energy Assistance Program Final State Plan
• Actions for Support
• TANF State Plan
• Homeless Assistance Program—Instructions and Requirements
• Summary of Pennsylvania's State Food Stamp Employment and Training Program
• TANF Work Verification Plan
• LIHEAP Handbook
• Pennsylvania Child Support Handbook
• Employment, Advancement and Retention Network (EARN) Program and Policy Procedures Manual
• WORK READY Program and Policy Procedures Manual
• Keystone Education Yields Success (KEYS) Program Policy and Procedures Manual
• Maximizing Participation Project (MPP) Program Policy and Procedures Manual
• Human Services Development Fund Instructions and Requirements
• Early Intervention Annual Expenditure Report Instructions
• Human Services Block Grant Annual Expenditure Report Instructions
• Human Services Non-Block Grant Annual Expenditure Report Instructions

Office of Medical Assistance—Contact: Dan De Lellis (717) 772-6341

POLICY STATEMENTS:

Year Code
Citation 		Subject Date Issued Bulletin Number
1981 Ch. 1251 Clarification of M.A. Bulletin # 22-80-01 08/19/81 22-81-01
Ch. 1121 Info. Concerning Claims Submitted as Compounded Prescriptions 06/30/82 19-82-02
1984 Ch. 1251 Revisions to MA Chapter 1251 (Funeral Directors' Services) 05/11/84 22-84-01
1984 Ch. 1101 Third Party Resource and Copay 11/01/84 99-84-15
1985 Ch. 1141 Physician Assistant Use 04/22/85 01-85-05
Ch. 1245,
  1163 		Ambulance Transportation 04/22/85 11-85-08
Ch. 1163 Psych. Inpatient Adm of Patients with D/A and Psychiatric Diagnoses 05/31/85 13-85-04
Ch. 1149 Clarification of Treatment Plan Requirements for Orthodontists 02/11/86 03-86-1
Ch. 1163
Ch. 1151 		Offset of Investment Income 02/21/86 11-86-04
12-86-02
13-86-01
1986 Ch. 1101.75
(a)(5) 		Policy Clarification 07/23/86 19-86-06
Ch. 1101 Policy Clarification Re: Provider's Signature 09/19/86 99-86-06
Ch. 1101 Professional License No. 10/13/86 11-86-12
12-86-05
Ch. 1101 Preclusion of Convicted Persons, Not Providers, from Participation or Involvement in the MA Program 10/24/86 99-86-09
Ch. 1123 Durable Medical Equipment Warranties 10/28/86 05-86-02
19-86-07
Ch. 1101 Records Maintenance and Avail. Requirements 11/05/86 23-86-02
1987 Ch. 1101 Physicians' Response. Home Health Services 01/12/87 01-87-01
Ch. 1223 Single County Authorities 12-87-01
13-87-01
Ch. 1149 Palliative Emerg. Treat. 04/24/87 03-87-02
27-87-01
Ch. 1223 Nonrecompensable Services Drug Screens07/29/87 11-87-05
12-87-04
16-87-01
28-87-02
Ch. 1101/
Ch. 1123 		Coverage for Motorized Wheelchairs 07/30/87 05-87-02
01-87-08
19-87-06
Ch. 1123 Policy Relating to Apnea Monitors 09/02/87 01-87-15
05-87-04
19-87-09
Ch. 1150 Spec. Enroll. Req. to Bill Tech. Comp. of Ped. Pneumograms 10/07/87 05-87-05
19-87-10
1988 Ch. 1101 Policy Clarification Regarding Physician License 07/01/88 1101-88-01
1989 Ch. 1101Policy Reminder Regarding Practitioner License Requirements 09/09/89 1101-89-02
1990 Ch. 1150 Payment Policy for Consultations 04/27/90 1150-90-01
1991 *CH. 1101
CH. 1121
CH. 1123
CH. 1241
EPSDT—OBRA '89 08/02/91 1101-91-01 1121-91-02
1123-91-01
1241-91-01
1992 *CH. 1141
*CH. 1153 		CLOZAPINE SUPPORT SERVICES 01/31/92 1141-92-01
1153-92-01
Ch. 1241 Revised EPSDT Immunization Guidelines 12/11/92 1241-92-01
*CH. 1121 CHANGES IN THE MEDICAL ASSISTANCE PHARMACEUTICAL BENEFITS 07/09/93 1121-93-01
*CH. 1149 DENTAL SERVICES FOR ADULTS 07/09/93 1149-93-01
*CH. 1101 BASIC HEALTH CARE FOR ADULT GENERAL ASSISTANCE RECIPIENTS (FELIX ET. AL. V. CASEY ET. AL.) STIPULATION OF SETTLEMENT 07/21/93 1101-93-03
*CH. 1101 UPDATE TO EXCEPTIONS PROCESS AND CRITERIA UNDER THE GENERAL ASSISTANCE BASIC HEALTH CARE PACKAGE 07/21/93 1101-93-04
Ch. 1241 Centers for Disease Control Blood Lead Testing 09/03/93 1241-93-01
Ch. 1101 Business Arrangements Between Nursing Facilities and Pharmacy Providers 10/08/93 1101-93-05
1994 Ch. 1241 Update to Blood Lead Testing Guidelines 04/08/94 1241-94-01
*CH. 1239 M.A. CASE MANAGEMENT SERVICES FOR RECIPIENTS UNDER THE AGE OF 21 05/17/94 1239-94-01
*CH. 1121 PHARMACEUTICAL SERVICES DRUG COVERAGE FOR MEDICALLY NEEDY IN NURSING FACILITIES 06/24/94 1121-94-01
*CH. 1121 PHARMACEUTICAL SERVICES PRIOR AUTHORIZATION REQUIREMENT MULTISOURCE BRAND NAME DRUGS 08/26/94 1121-94-02
*CH. 1121
CH. 1141
CH. 1163
CH. 1221
CH. 1225
CH. 1242
TREATMENT OF INFERTILITY— DISCONTINUED COVERAGE FOR DRUGS AND RELATED SERVICES08/30/94 1121-94-03
1126-94-01
1129-94-01
1141-94-01
1163-94-01
1221-94-01
1225-94-01
1242-94-01
*CH. 1101 GENERAL ASSISTANCE RESTRUCTURE AS A RESULT OF ACT 49 09/02/94 1101-94-01
1995 *CH. 1153 PRIOR AUTHORIZATION OF PARTIAL HOSPITALIZATION 12/30/94 1153-94-01
CH. 1163 PAYMENT POLICY FOR ABORTION SERVICES 12/15/95 1163-95-02
1997 Ch. 1141 Revision to Physician Assistant and Nurse Midwife Supervision Requirement 07/30/97 1141-97-01
1998 Ch. 1101
Ch. 1141
Ch. 1150
Ch. 1221
Regulation Changes Regarding
''Emergency Medical Condition'' 		07/01/98 1101-98-01
1141-98-01
1150-98-01
1121-98-01
Ch. 1141
Ch. 1153 		Clozapine Support Services 12/29/98 33-98-08
29-98-08
01-98-19
1999 Ch. 1101 ''Payment in Full'' 09/17/99 99-99-06
2001 Ch. 1101 Clarification of Coverage for Motorized Wheelchairs and Other Durable Medical Equipment 02/16/01 01-01-02
05-01-01
17-01-01
19-01-02
49-01-02
50-01-01
1101-01-01
1123-01-01
Ch. 1241 Revision to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program 07/01/01 01-01-10
10-01-03
11-01-05
17-01-04
26-01-03
49-01-07
Breast and Cervical Cancer Prevention and Treatment Program 12/26/01 99-01-12
2002 Ch. 1241 Revision to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program01/22/02 01-02-01
10-02-01
11-02-01
17-02-01
26-02-01
49-02-01
— Breast and Cervical Cancer Prevention and Treatment Program 05/03/02 99-02-06
Ch. 1241 Addition of Procedure Code 90732 to Medical Assistance Fee Schedule for Administration of Pneumococcal Vaccine 11/18/02 01-02-13
10-02-04
11-02-06
17-02-07
26-02-04
49-02-06
2003 Ch. 1241 2003 Recommended Childhood Immunization Schedule 03/31/03 01-03-04
10-03-01
11-03-01
17-03-01
26-03-01
49-03-02
Ch. 1241 Coverage of Pediarix and Addition of Procedure Code 90723 to Medical Assistance Fee Schedule for Administration of Pediarix Vaccine 05/15/03 01-03-06
10-03-02
11-03-02
17-03-03
26-03-02
49-03-03
Ch. 1241 Elimination of the Pennsylvania Children's Check-up (EPSDT) Form (MA-517) 09/05/03 01-03-08
10-03-03
11-03-05
17-03-04
26-03-03
49-03-05
Ch. 1101 Liability for Cost Sharing for Recipients Enrolled in Medical Assistance through Fee for Service or Managed Care and a Private Third Party Insurer 09/01/03 99-03-12
— Continuity of Care for Recipients Transferring Between and Among Fee for Service and Managed Care Organizations 09/01/03 99-03-13
2005 Ch. 1121 Pen and Ink Change-Medical Assistance Handbook, Prior Authorization of Pharmaceutical Services, Preferred Drug List 12/30/05 02-05-06
Ch. 1121 Preferred Drug List-Phase 3 12/01/05 30-05-06
Ch. 1121 Scope of Coverage of Pharmacy Services for Dual Eligibles in the Medical Assistance (MA) Program 11/17/05 99-05-21
Ch. 1121 Preferred Drug List-Phase 2 11/08/05 02-05-03
Ch. 1241 Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Periodicity Schedule 10/25/05 01-05-04
Ch. 1121 Preferred Drug List-Phase 1 10/07/05 02-05-01
Ch. 1121 Prior Authorization of Drugs That Exceed Established Quantity Limits- Phase 2 Enforcement 09/16/05 99-05-17
Ch. 1101 Copayment Changes for Brand Name and Generic Prescription Drugs 08/26/05 24-05-05
Ch. 1121 Prior Authorization of Drugs That Exceed Established Quantity Limits- Phase 1 Enforcement 08/10/05 99-05-14
2005 Recommended Childhood & Adolescents Immunization Schedule 05/26/05 33-05-01
2006 Implementation of the CMS-1500 Health Insurance Claim Form (Version 08/05) 12/18/06 99-06-16
Ch. 1101 Change to copayment requirements for recipients eligible under the Breast and Cervical Cancer Prevention and Treatment coverage group and Titles IV-B & IV-E Foster Care and Adoption Assistance 12/10/06 99-06-12
Ch. 1101 Clarification of Exclusions from Copayment Requirements 12/10/06 99-06-13
Ch. 1153 Clarification of Payment Policy for Abortion Services 11/28/06 99-06-15
Ch. 1245 Reimbursement for Non-Emergency Transportation Services 11/17/06 03-06-15
Ch. 1245 Implementation of ACCESS Plus Referral Requirements 10/20/06 99-06-11
Ch. 1101 Revised HealthCare Benefits Packages Provider Reference Chart (MA 446) 10/06/06 99-06-10
Ch. 1163 Medical Assistance Payment for Services of Teaching Physicians in Hospitals, Clinics and Emergency Rooms 09/16/06 1141-06-01
Ch. 1153 Federal Medicaid Citizenship and Identity Eligibility Requirements 07/24/06 99-06-07
Ch. 1121 Preferred Drug List-Quarterly Update 04/24/06 02-06-07
Ch. 1241 2006 Recommended Childhood and Adolescent Immunization Schedule 04/16/06 01-06-03
Ch. 1150 Prudent Payment of Claims 04/03/06 99-06-04
Ch. 1121 Federal Clarification-Elimination of Medicaid Coverage of Drugs for Treatment of Erectile Dysfunction 03/07/06 03-06-03
Ch. 1150 Disenrollment of Dual Eligibles from Physical Health Managed Care 01/27/06 99-06-01
Ch. 1121 Prior Authorization of Drugs that Exceed Est. Quantity Limits—Phase 3 Enforcement and Additional Drugs With Quantity Limits 01/27/06 02-06-03
03-06-02
08-06-02
09-06-02
11-06-02
14-06-03
24-06-02
27-06-05
30-06-02
31-06-04
32-06-02
Ch. 1121 Preferred Drug List-Phase 4 01/25/06 02-06-02
Ch. 1163 Place of Service Review Procedures 01/03/06 14-06-01
2007 Ch. 1249 Rescission of the Statement of Policy Clarifying the Conditions Under Which Medical Assistance
Recipients May Be Considered Homebound 		1249-07-04
Ch. 1150 The Addition of Isentress (raltegravir) to the Special Pharmaceutical Benefits Program 12/21/07 09-07-16
21-07-04
24-07-16
31-07-22
Ch. 1150 Medical Assistance Program Fee Schedule: Addition
of Telehealth Technology Code and Informational Modifier for Consultations Performed Using Telecommunication Technology 		11/30/07 09-07-15
Ch. 1123 MA Program Outpatient Fee Schedule Revisions for Speech Generating Devices11/29/07 24-07-11
25-07-05
31-07-18
Ch. 1121 Preferred Drug List—Fall Update—Part 2 11/29/07 02-07-06
11-07-07
30-07-07
03-07-09
14-07-06
31-07-20
08-07-15
24-07-14
32-07-07
09-07-14
27-07-09
Ch. 1101 Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 11/01/07 99-07-19
Ch. 1121 Preferred Drug List—Fall 2007 Update 11/01/07 02-07-05
11-07-06
30-07-05
03-07-08
14-07-05
31-07-17
08-07-14
24-07-13
32-07-06
09-07-12
27-07-07
Ch. 1121 Delay in Implementation of the Tamper-Resistant
Pad Requirements 		10/29/07 99-07-18
Ch. 1121 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling for HIV Applicants10/15/07 09-07-10
21-07-03
24-07-10
31-07-14
Ch. 1121 Tamper Resistant Prescription Pads 09/28/07 99-07-16
Ch. 1123 2007 Power Mobility Device HCPCS Updates; Prior Authorization Requirements 09/19/07 99-07-15
Ch. 1163 Medicare Inpatient Pricing Logic Modification 08/17/07 01-07-08
Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser Requirement and Updated Medical Assistance
Program Fee Schedule for Hearing Aid Supplies		08/03/07 01-07-07
24-07-09
31-07-12
20-07-03
25-07-04
Ch. 11221 Preferred Drug List—May 2007 Technical Correction07/31/07 02-07-04
11-07-05
30-07-04
03-07-07
14-07-04
31-07-11
08-07-12
24-07-08
32-07-05
09-07-09
27-07-06
Ch. 1149 Discontinuance of the Prior Authorization Requirement for Dental Procedure Codes D7140 and D7210 07/11/07 27-07-04
Ch. 1121 Preferred Drug List—Updates to Prior Authorization
of Pharmaceutical Services Handbook Pages		07/27/07 02-07-03
11-07-04
30-07-03
14-07-03
31-07-10
08-07-11
24-07-07
32-07-04
09-07-08
27-07-05
Ch. 1123 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling Increase for HIV Applicants07/01/07 09-07-05
21-07-02
24-07-04
31-07-07
Ch. 1101 The Elimination of Paper Vouchers 06/14/07 99-07-10
Ch. 1123 Requirements for Coverage of Enteral Nutritional Supplements and Issuance of Enteral Nutritional Supplements MA Program Outpatient Fee Schedule 06/01/07 08-07-10
09-07-07
24-07-06
25-07-03
31-07-09
Ch. 1121 Preferred Drug List—July 2007 Quarterly Update06/01/07 02-07-02
03-07-03
08-07-08
09-07-06
11-07-02
14-07-02
24-07-05
27-07-03
30-07-02
31-07-08
32-07-03
Ch. 1101 Co-pay/Deductibles on Exceptional Durable Medical Equipment (DME) 06/01/07 03-07-04
Ch. 1249 Rescind MA Program Statement of Policy Regarding the Clarification of Conditions Under Which MA Recipients May be Considered Homebound 07/10/07 1249-07-04
Ch. 1150 Medical Assistance Program Fee Schedule Revision; Change to Conversion Factor for Anesthesia Services 05/10/07 31-07-05
Ch. 1121 Preferred Drug List—Quarterly Update 05/01/07 02-07-01
03-07-02
08-07-07
09-07-04
11-07-01
14-07-01
24-07-03
27-07-02
30-07-01
31-07-06
32-07-02
Ch. 1101 Clarification Regarding the Definition of Medically Necessary—Statement of Policy 04/21/07 99-07-04
Ch. 1241 2007 Recommended Childhood and Adolescent Immunization Schedules 03/23/07 01-07-05
Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser) Requirement 03/01/07 01-07-03
Ch. 1123 Behavioral Health Fee For Service (BH-FFS) Transfer from Office of Medical Assistance Programs (OMAP) To Office of Mental Health and Substance Abuse Services (OMHSAS) 01/31/07 OMHSAS-06-07
Ch. 1150 Policy Reinforcement Regarding Billing For Tobacco Cessation Counseling Services 01/04/07 99-07-02
2008 Ch. 1121Preferred Drug List—Fall 2007 Update Part 2 Technical Correction01/11/08 02-07-08
03-07-11
08-07-17
09-07-17
11-07-08
14-07-07
24-07-17
27-07-10
30-07-08
31-07-23
32-07-08
Ch. 1149 Implementation of ADA Claim Form—Version 2006 and Elimination of Dental Prior Authorization Forms 01/11/08 17-08-01
Ch. 1163 Preventable Serious Adverse Events 01/14/08 01-07-11
Ch. 1101 Implementation of SelectPlan for Women 02/01/08 01-08-02
Ch. 1241 Clarification of Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 02/15/08 99-08-01
Ch. 1241 The Addition of Selzentry (maraviroc) and Intelence (etavirine) to the Special Pharmaceutical Benefits Program02/29/08 09-08-03
24-08-04
21-08-01
31-08-04
Ch. 1121 Medical Necessity Guidelines for Lyrica for Fibromyalgia 03/05/08 02-08-01
03-08-01
08-08-01
09-08-01
11-08-01
14-08-01
24-08-02
27-08-02
30-08-01
31-08-02
32-08-01
Ch. 1121 Tamper Resistant Prescription Pads 03/21/08 99-08-03
Ch. 1101 SelectPlan for Women Program—Addition of Covered Services 04/23/08 01-08-05
Ch. 1150 Prudent Payment of Claims—Updated 04/25/08 99-08-05
Ch. 1121 Preferred Drug List—Spring 2008 Update06/02/08 02-08-03
03-08-03
08-08-07
09-08-08
11-08-03
14-08-03
24-08-07
27-08-04
30-08-03
31-08-10
32-08-03
Ch. 1149 ADA Claim Form—Version 2006 and
Discontinuance of P. O. Box 8186 		06/16/08 17-08-02
Ch. 1150
Ch. 1141
Ch. 1147 		Medical Assistance Program Fee
Increase for Select Ophthalmological
Examinations 		07/22/08 18-08-04
31-08-12
Ch. 1150
Ch. 1249 		Medical Assistance (MA) Program Fee
Increases for Select Home Health Agency Services 		07/22/08 05-08-02
Ch. 1150
Ch. 1141
Ch. 1147 		Medical Assistance Program Fee
Increases for Select Office Visits and
Consultations for Vision Services 		07/22/08 18-08-03
Ch. 1150
Ch. 1249 		Medical Assistance Program Fee Increases for Select Private Duty/ Shift Nursing Services to MA Recipients Under 21 Years of Age 07/22/08 05-08-03
16-08-01
Ch. 1150
Ch. 1149 		Medical Assistance Program Fee Increases for Select Dental Services 07/22/08 27-08-06
Ch. 1150 Medical Assistance Program Fee Increases for Select Office Visits and Consultations07/22/08 09-08-09
31-08-11
33-08-05
Ch. 1150
Ch. 1243 		Medical Assistance Program Fee Schedule Changes for Select Laboratory Procedure Codes 07/22/08 08-08-09
09-08-10
28-08-04
31-08-13
33-08-06
Ch. 1150
Ch. 1141 		Medical Assistance Program Outpatient Fee Schedule Increase for a Select Colonoscopy Procedure 07/22/08 01-08-07
Ch. 1150 Fee Increases for Select Healthy Beginnings Plus Services07/25/08 05-08-04
08-08-13
31-08-17
33-08-08
47-08-11
Ch. 1150
Ch. 1241 		Screening for Developmental Delays and Autism Spectrum Disorders 07/25/08 99-08-10
Ch. 1145 Recipient Access to Chiropractic Services 08/04/08 99-08-11
Ch. 1150 Prior Authorization of Advanced Radiologic Imaging Services 08/05/08 99-08-08
Ch. 1150
Ch. 1225 		Medical Assistance Program Family Planning Clinic Select Fee Increases and Updates 08/29/08 08-08-08
Ch. 1101
Ch. 1150
Ch. 1221 		SelectPlan for Women Updated Covered Services Chart09/05/08 01-08-09
08-08-17
09-08-17
24-08-12
28-08-06
31-08-21
33-08-09
Ch. 1163 Payment Policy for Hospital Readmissions 09/12/08 01-08-10
Ch. 1241 Updates for Early Periodic Screening, Diagnosis and Treatment Program 09/18/08 99-08-13
Ch. 1150
Ch. 1121 		Reminder of Implementation of Tamper Resistant Prescription Pad Requirements 09/24/08 99-08-14
Ch. 1101
Ch. 1150 		Implementation of Claim Check 10/02/08 99-08-17
Ch. 1150
Ch. 1147 		Addition of Procedure Code 67820 to Optometrist Medical Assistance Program Outpatient Fee Schedule 11/14/08 18-08-07
Ch. 1150 Preventable Serious Adverse Events 11/26/08 01-08-11
Ch. 1150
Ch. 1147 		Addition of Procedure Codes to the Medical Assistance Program Fee Schedule for Office Visits for Optometrists 12/29/08 18-09-01
2009 Ch. 1150
Ch. 1123
Ch. 1147 		Removal of Prior Authorization Requirement for Eyeglass Lenses 02/09/09 18-09-02
24-09-01
25-09-01
31-09-01
Ch. 1101
Ch. 1150
Ch. 1241 		Pentacel® (DTaP-IPV/Hib), Kinrix® (DTaP-IPV) and Rotarix® (Rotavirus) Vaccines 02/09/09 01-09-01
08-09-01
09-09-01
31-09-02
33-09-01
Ch. 1101
Ch. 1150
Ch. 1241 		2009 Recommended Childhood and Adolescent Immunization Schedules 02/20/09 01-09-04
08-09-04
09-09-04
31-09-05
33-09-02
Ch. 1150 Medical Assistance Program Fee Schedule Procedure Code End-dating of Keratomileusis 03/27/09 99-09-04
Ch. 1149 Implementation of the Pediatric Dental Periodicity Schedule 04/24/09 27-09-02
Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update 06/05/09 01-09-06
09-09-07
27-09-04
02-09-03
11-09-03
30-09-03
03-09-03
14-09-08
31-09-08
08-09-07
24-09-06
32-09-03
Ch. 1150 Revisions to Medical Assistance Program Fee Schedule Rates for Select Services 06/15/09 99-09-05
Ch. 1150 2008 HCPCS Updates and Other Procedure Code and Procedure Code/ Modifier Combination Changes 07/06/09 99-09-06
Ch. 1105
Ch. 1150 		Revised Medical Assessment Form (PA 635) 8/10/09 31-09-38
19-09-01
09-09-34
Ch. 1101
Ch. 1150 		Changes to Procedure Codes for the Administration Fees for Kinrix® (DTaP-IPV) and Rotarix® (Rotavirus Vaccines 08/13/09 01-09-38
08-09-39
09-09-40
31-09-41
33-09-03
Ch. 1101
Ch. 1150
Ch. 1141
Ch. 1221 		SelectPlan for Women Program Forumulary09/01/09 01-09-39
08-09-40
09-09-41
24-09-38
28-09-04
31-09-42
33-09-04
Ch. 1101
Ch. 1150
Ch. 1141
Ch. 1221 		SelectPlan for Women Program—Addition of Covered Services09/08/09 01-09-40
08-09-41
09-09-42
24-09-39
28-09-05
31-09-43
33-09-05
Ch. 1150
Ch. 1241 		Structured Screening for Developmental Delays and Autism Spectrum Disorders 09/08/09 99-09-07
Ch. 1150 Billing for the Administration of the Influenza A (H1N1) 2009 Monovalent Vaccine 10-9-09 99-09-10
Ch. 1101
Ch. 1141
Ch. 1142
Ch. 1143
Ch. 1144
Ch. 1145
Ch. 1147
Ch. 1149
Revision of the PROMISe(r) Individual Practitioner Enrollment Application and Implementation of Credentialing for Certain Providers Types 10/16/09 99-09-08
Ch. 1121 Fall 2009 Preferred Drug List (PDL) and Quantity Limits Update—Pharmacy Services 11/02/09 01-09-43
09-09-45
27-09-36
02-09-35
11-09-35
30-09-35
03-09-35
14-09-35
31-09-46
08-09-44
24-09-41
32-09-35
Ch. 1141
Ch. 1145 		Recipient Access to Chiropractic Services 11/30/09 99-09-11
Ch. 1101
Ch. 1150
Ch. 1241 		Hiberix®, Haemophilus Influenzae Type b (Hib) Vaccine12/31/09 01-09-62
08-09-61
09-09-62
31-09-64
33-09-07
2010 Ch. 1150 Health Care Benefit Package 12 Updated Employability Assessment Procedure Code List2-5-10 01-10-02
08-10-03
09-10-03
18-10-01
28-10-01
29-10-01
31-10-03
Ch. 1150 Medical Assistance Program Fee Schedule Revisions 02/19/10 99-10-01
Ch. 1101
Ch. 1150
Ch. 1241 		2010 Recommended Childhood and Adolescent Immunization Schedules03/15/10 01-10-06
08-10-07
09-10-07
31-10-09
33-10-01
Ch. 1141
Ch. 1144 		Application of Topical Fluoride Varnish by Physicians and CRNPs 03/15/10 09-10-08
31-10-08
Ch. 1121 Spring 2010 Preferred Drug List (PDL) Quantity Limits Update—Pharmacy Services05/03/10 01-10-08
09-10-10
27-10-06
02-10-06
11-10-06
30-10-06
03-10-06
14-10-06
31-10-11
08-10-09
24-10-07
32-10-06
Ch. 1150
Ch. 1121 		Updated Recommendations for Gardasil® Quadrivalent Human Papillomavirus (HPV) Vaccine05/03/10 01-10-14
08-10-15
09-10-16
31-10-17
33-10-02
Ch. 1101
Ch. 1150 		Announcing the Federally Mandated Change to Electronic Healthcare Transactions for Healthcare and Pharmacy Transactions 06/08/10 99-10-07
Ch. 1101
Ch. 1150
Ch. 1241 		Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program
Periodicity Schedule 		06/14/10 99-10-06
Ch. 1150 2009 HCPCS Updates and Other Procedure Code and Procedure Code/ Modifier Combination Changes 06/14/10 99-10-05
Ch. 1150 Health Care Benefit Package 12 Updated Employability Assessment Procedure Code List07/09/10 01-10-20
08-10-21
09-10-22
18-10-03
28-10-02
29-10-02
31-10-23
Ch. 1101
1102
1121
1123
1149
1151
1163
1181
1187
1230
1243
Policy Clarification Regarding Written Prescriptions—Statement of Policy 07/17/10 99-10-03
1101-10-01
1102-10-01
1121-10-01
1123-10-01
1149-10-01
1151-10-01
1163-10-01
1181-10-01
1187-10-01
1230-10-01
1243-10-01
Ch. 1101 SelectPlan For Women—Update to Covered Services07/30/10 01-10-22
08-10-24
09-10-21
24-10-19
28-10-03
31-10-26
33-10-03
Ch. 1225 Changes to the Provision of Hemoglobin Laboratory Services by Family Planning Clinics 07/30/10 08-10-23
Ch. 1101
1150
1241
Updates to the Medical Assistance Program Fee Schedule for the Administration of the Vaccines Prevnar 13®, Cervarix®, Twinrix®, 31-10-30 Recombivax HB®, and Menveo® 08/30/10 01-10-27
08-10-28
09-10-29
33-10-05
Ch. 1163 Hospital Uncompensated Care Program and Charity Care Plan 08/30/10 01-10-24
Ch. 1150 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 08/30/10 99-10-09
Ch. 1145 Recipient Access to Chiropractic Services 10/08/10 99-10-12
Ch. 1101
Ch. 1121 		Requirement for Prescribing Provider National Provider Identifier (NPI) Number on Outpatient Pharmacy Claims—Pharmacy Services 11/12/10 99-10-13
Ch. 1129 Dental Encounter payment for Dental Services Rendered by Rural Health Clinics and Federally Qualified Health Centers 11/15/10 08-10-50
Ch. 1245
1181 		Payment for Non-Emergency Transportation Services 11/24/10 03-10-43
26-10-01
Ch. 1101 Missed Appointments 12/01/10 99-10-14
Ch. 1101
1150
1241
Medical Assistance Program Coverage of the 2010-2011 Influenza Vaccines 12/01/10 99-10-16
2011 Ch. 1150 2010 HCPCS Updates and Other Procedure Code and Procedure Code/ Modifier Combination Changes 01/03/11 99-11-01
Ch. 1123 Change in Billing of Repairs and Replacements for Durable Medical Equipment 01/14/11 24-11-01
Ch. 1150 Health Care Benefit Package 12 Updated Employability Assessment Procedure Code List04/13/11 01-11-02
08-11-04
09-11-03
18-11-02
28-11-01
29-11-01
31-11-03
Ch. 1101 SelectPlan for Women Program—Update to Covered Services04/13/11 01-11-03
08-11-05
09-11-04
24-11-04
28-11-02
31-11-04
33-11-03
Ch. 1150 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 05/30/11 99-11-02
Ch. 1101
1150
1241
2011 Recommended Childhood and Adolescent Immunization Schedules03/18/11 01-11-04 08-11-06
09-11-05
31-11-05
33-11-04
Ch. 1123 MA Program Outpatient Fee Schedule Decrease for Select Incontinence Products 04/05/11 24-11-02
Ch. 1150 2011 HCPCS Updates and Other Procedure Code Changes 08/08/11 00-11-04
Ch. 1101 Provider Screening of Employees and Contractors for Exclusion From Participation in Federal Health Care Programs and the Effect of Exclusion on Participation 8/15/11 99-11-05
Ch. 1149 Medical Assistance Dental Benefit Changes9/26/11 27-11-47
08-11-51
Ch. 1163 Revised Payment Policy for Hospital Readmissions 10/3/11 01-11-44
Ch. 1150 Announcing the Federally Mandated Implementation of the National Correct Coding Initiative (NCCI) in the Pennsylvania Department of Public Welfare's Medical Assistance Program 11/10/11 99-11-10
Ch. 1150 ClaimCheck® Claims Criteria—Update 11/23/11 99-11-11
Ch. 1121 Medical Assistance Pharmacy Benefit Package Change 12/30/11 99-11-58
14-11-52
18-11-03
24-11-58
27-11-56
31-11-57
33-11-20
2012 Ch. 1128 Processing of Medicare Renal Dialysis Services Crossover Claims for Procedure Code 90999 2/21/12 30-12-22
Ch. 1101
1150
1241
2012 Recommended Childhood and Adolescent Immunization Schedules 03/08/12 01-12-23
08-12-24
09-12-24
31-12-24
33-12-24
Ch. 1101
Ch. 1150
Ch. 1241
Updates to the Medical Assistance Program Fee Schedule for the Administration of Prevnar 13® Vaccine04/06/12 01-12-25
08-12-26
09-12-26
31-12-26
33-12-26
Ch. 1101 Updates to Medical Assistance Copayment Policy 04/16/12 99-12-03
Ch. 1121 Changes to the Drug Cost Component of Payment for Brand Name and Generic Drugs—Pharmacy Services05/01/12 01-12-28
09-12-29
27-12-26
33-12-28
02-12-25
11-12-25
30-12-26
03-12-25
14-12-25
31-12-29
08-12-28
24-12-26
32-12-25
Ch. 1121 Changes to the Dispensing Fee Component of Payment for Brand Name and Generic Drugs—Pharmacy Services05/01/12 01-12-27
09-12-28
27-12-25
33-12-27
02-12-24
11-12-24
30-12-25
03-12-24
14-12-24
31-12-24
08-12-27
24-12-25
32-12-24
Ch. 1149 Revision of Online Training Module for the Application of Topical Fluoride Varnish 5/1/12 09-12-27
31-12-27
Ch. 1163 Newborn Payment Policy for Acute Care General Hospitals 5/4/12 01-12-26
Ch. 1150 Consultations Performed Using Telemedicine5/23/12 09-12-31 31-12-31
33-12-30
Ch. 1229 HealthChoices Physical Health Managed Care Expansion 5/25/12 99-12-05
Ch. 1150 2012 HCPCS Updates and Other Procedure Code Changes 06/25/12 99-12-06
Ch. 1229 HealthChoices Physical Health Managed Care New West Zone Expansion 08/08/12 99-12-08
Ch. 1101
Ch. 1150
Medical Assistance Program Fee Schedule Revisions 08/31/12 99-12-10
Ch. 1150 Information Regarding Peritoneal Dialysis Treatment 09/13/12 01-12-50 30-12-43
31-12-49
Ch. 1101
Ch. 1150 		Medical Assistance Program Fee Schedule Changes for Renal Dialysis Services 09/13/12 30-12-39
13-12-45
Ch. 1150 New Procedure Codes for Tobacco Cessation Counseling Services 10/03/12 99-12-09
Ch. 1101 Delaying Alternative Cost Sharing for Families of Children with Disabilities with Incomes Over 200% of the Federal Poverty Income Guidelines 10/15/12 99-12-15
Ch. 1150 Federally Mandated Implementation: Updates to National Correct Coding Initiative (NCCI) 10/26/12 99-12-12
Ch. 1101
Ch. 1150
Medical Assistance Program Fee Schedule Revisions 12/10/12 99-12-13
Ch. 1101
Ch. 1150
Ch. 1149 		Addition to the Medical Assistance Program Fee Schedule for Administration of Flu Vaccine for Intradermal Use: Fluzone Intradermal® 12/13/12 01-12-64
08-12-59
09-12-60
31-12-62
33-12-58
Ch. 1150 NPI Requirements on All Claim Submission Media 12/19/12 99-12-14
Ch. 1121 Anticoagulants—New Quantity Limit for Low Molecular Weight Heparins and Arixtra (Fondaparinux)—Pharmacy Services 12/21/12 01-12-63
09-12-59
27-12-55
33-12-57
02-12-53
11-12-52
30-12-55
03-12-53
14-12-53
31-12-61
08-12-58
24-12-54
32-12-53
Ch. 1150 Clinical Laboratory Improvement Amendments Requirements 12/28/12 01-12-67
08-12-62
09-12-63
28-12-01
31-13-65
33-13-61
2013 Ch. 1121 Prior Authorization of Antipsoriatics Topical—Pharmacy Services 1/7/13 01-13-01
09-13-01
27-13-01
33-13-01
02-13-01
11-13-01
30-13-01
03-13-01
14-13-01
31-13-01
08-13-01
24-13-01
32-13-01
Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 1/7/13 01-13-02
09-13-02
27-13-02
33-13-02
02-13-02
11-13-02
30-13-02
03-13-02
14-13-02
31-13-02
08-13-02
24-13-02
32-13-02
Ch. 1121 Prior Authorization of Diabetic Strips—Pharmacy Services 1/7/13 01-13-03
09-13-03
27-13-03
33-13-03
02-13-03
11-13-03
30-13-03
03-13-03
14-13-03
31-13-03
08-13-03
24-13-03
32-13-03
Ch. 1121 Prior Authorization of Glucocorticoids Oral—Pharmacy Services 1/7/13 01-13-04
09-13-04
27-13-04
33-13-04
02-13-04
11-13-04
30-13-04
03-13-04
14-13-04
31-13-04
08-13-04
24-13-04
32-13-04
Ch. 1121 Prior Authorization of Leukotriene Modifiers—Pharmacy Services 1/7/13 01-13-05
09-13-05
27-13-05
33-13-05
02-13-05
11-13-05
30-13-05
03-13-05
14-13-05
31-13-05
08-13-05
24-13-05
32-13-05
Ch. 1121 Prior Authorization of Neuropathic Pain Agents (Formerly Myalgia and Neuropathy Agents)—Pharmacy Services 1/7/13 01-13-06
09-13-06
27-13-06
33-13-06
02-13-06
11-13-06
30-13-06
03-13-06
14-13-06
31-13-06
08-13-06
24-13-06
32-13-06
Ch. 1121 Prior Authorization of Oncology Agents Breast Cancer—Pharmacy Services 1/7/13 01-13-07
08-13-07
14-13-07
32-13-07
02-13-07
09-13-07
24-13-07
30-13-07
03-13-07
11-13-07
27-13-07
31-13-07
33-13-07
Ch. 1121 Prior Authorization of Smoking Cessation Products—Pharmacy Services 1/7/13 01-13-08
09-13-08
27-13-08
33-13-08
02-13-08
11-13-08
30-13-08
03-13-08
14-13-08
31-13-08
08-13-08
24-13-08
32-13-08
Ch. 1121 Prior Authorization of Diabetic Meters—Pharmacy Services 1/7/13 01-13-09
09-13-09
27-13-09
33-13-09
02-13-09
11-13-09
30-13-09
03-13-09
14-13-09
31-13-09
08-13-09
24-13-09
32-13-09
Ch. 1229 HealthChoices Physical Health Managed Care New East Zone Expansion 01/18/13 99-13-02
Ch. 1121 Preferred Drug List (PDL) Update January 15, 2013—Pharmacy Services 01/22/13 01-13-11
09-13-11
27-13-11
33-13-11
02-13-10
11-13-10
30-13-10
03-13-10
14-13-10
31-13-12
08-13-11
24-13-11
32-13-10
Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 1/25/13 01-13-12
08-13-12
14-13-11
30-13-11
33-13-12
02-13-11
09-13-12
24-13-12
31-13-13
03-13-11
11-13-11
27-13-12
32-13-11
Ch. 1150 Medical Assistance Program Fee Increase for Select Primary Care Services and Physician Attestation Form 01/22/13 31-13-11
Ch. 1101
Ch. 1150
Medical Assistance Electronic Health Record (EHR)Incentive Program Year 2013 for Eligible Professionals (EP) 2/1/13 08-13-10
09-13-10
27-13-10
31-13-10
33-13-10
Ch. 1101
Ch. 1150 		Medical Assistance Electronic Health Record (EHR)Incentive Program Year 2013 for Eligible Hospitals (EH) 2/1/13 01-13-10
Ch. 1101 Updated Procedures for Submitting the Deficit Reduction Act of 2005 Attestation Form 02/14/13 99-13-04
Ch. 1229 Continued Existence of the Fee-For-Service Delivery System in HealthChoices Zones and Enrollment of Breast and Cervical Cancer Prevention and Treatment (BCCPT) Recipients in HealthChoices 02/22/13 99-13-05
Ch. 1121 Prior Authorization of Analgesics Narcotic Short Acting—Pharmacy Services 3/29/13 01-13-16
08-13-16
14-13-15
30-13-15
33-13-17
02-13-15
09-13-17
24-13-16
31-13-18
03-13-15
11-13-15
27-13-16
32-13-15
Ch. 1121 Prior Authorization of Bladder Relaxant Preparations—Pharmacy Services 3/29/13 01-13-14
09-13-15
27-13-14
33-13-15
02-13-13
11-13-13
30-13-13
03-13-13
14-13-13
31-13-16
08-13-14
24-13-14
32-13-13
Ch. 1121 Prior Authorization of Bronchodilators Beta Agonists Short Acting Agents—Pharmacy Services 3/29/13 01-13-17
08-13-17
14-13-16
30-13-16
33-13-18
02-13-16
09-13-18
24-13-17
31-13-19
03-13-16
11-13-16
27-13-17
32-13-16
Ch. 1121 Prior Authorization of Antipsychotics—Pharmacy Services 3/29/13 01-13-13
08-13-13
14-13-12
30-13-12
33-13-14
02-13-12
09-13-14
24-13-13
31-13-15
03-13-12
11-13-12
27-13-13
32-13-12
Ch. 1121 Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents—Pharmacy Services 3/29/13 01-13-15
09-13-16
27-13-15
33-13-16
02-13-14
11-13-14
30-13-14
03-13-14
14-13-14
31-13-17
08-13-15
24-13-15
32-13-14
Ch. 1101
Ch. 1150 		Medical Assistance Program Fee Schedule Revisions for Procedure Code K0606 04/01/13 24-13-10
25-13-01
Ch. 1101
Ch. 1150 		Medical Assistance Program Fee Schedule Revisions 04/15/13 99-13-03
Ch. 1121 Medical Assistance Pharmacy Benefit Package Update04/22/13 99-13-20
14-13-17
18-13-01
24-13-18
17-13-18
31-13-21
33-13-20
Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 5/3/13 01-13-19
09-13-21
27-13-19
33-13-21
02-13-17
11-13-17
30-13-17
03-13-17
14-13-18
31-13-22
08-13-19
24-13-19
32-13-17
Ch. 1101 Revised Physician Attestation Form for Primary Care Services 5/3/13 31-13-32
Ch. 1121 Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents Oral and Inhaled—Pharmacy Services 5/3/13 01-13-23
09-13-25
27-13-23
33-13-25
02-13-21
11-13-21
30-13-21
03-13-21
14-13-22
31-13-26
08-13-23
24-13-23
32-13-21
Ch. 1121 Prior Authorization of Lyrica (pregabalin) Neuropathic Pain Agents and Oral Anticonvulsants—Pharmacy Services 5/3/13 01-13-25
09-13-27
27-13-25
33-13-27
02-13-23
11-13-23
30-13-23
03-13-23
14-13-24
31-13-28
08-13-25
24-13-25
32-13-23
Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—Pharmacy Services 5/3/13 01-13-20
09-13-22
27-13-20
33-13-22
02-13-18
11-13-18
30-13-18
03-13-18
14-13-19
31-13-23
08-13-20
24-13-20
32-13-18
Ch. 1121 Prior Authorization of Botulinum Toxins (Type A and Type B)—Pharmacy Services 5/3/13 01-13-21
09-13-23
27-13-21
33-13-23
02-13-19
11-13-19
30-13-19
03-13-19
14-13-20
31-13-24
08-13-21
24-13-21
32-13-19
Ch. 1121 Prior Authorization of Benzodiazepines; Analgesics Narcotic Long Acting; and Analgesics Narcotic Short Acting—Pharmacy Services 5/3/13 01-13-26
09-13-28
27-13-26
33-13-28
02-13-24
11-13-24
30-13-24
03-13-24
14-13-25
31-13-29
08-13-26
24-13-26
32-13-24
Ch. 1121 Medicare Part D Coverage of Barbiturates and Benzodiazepines—Pharmacy Services 5/3/13 01-13-28
08-13-28
14-13-27
30-13-26
33-13-30
02-13-26
09-13-30
24-13-28
31-13-31
03-13-26
11-13-26
27-13-28
32-13-26
Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 5/3/13 01-13-27
09-13-29
27-13-27
33-13-29
02-13-25
11-13-25
30-13-25
03-13-25
14-13-26
31-13-30
08-13-27
24-13-27
32-13-25

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