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PA Bulletin, Doc. No. 18-1520k

[48 Pa.B. 5943]
[Saturday, September 22, 2018]

[Continued from previous Web Page]

Year Code Citation(s) Subject Date Issued Bulletin
Number
  Ch. 1121 Prior Authorization of Xofigo (radium Ra 223 dichloride)—Pharmacy Service 06/13/16 01-16-18 09-16-17 27-16-16 02-16-16 11-16-16 30-16-16 14-16-16 31-16-19 08-16-17 24-16-17 32-16-15 33-16-16
  Ch. 1123
Ch. 1249 		Face-to-Face Encounter Requirements for Prescribing of Home Health Services Including Durable Medical Equipment and Medical Supplies 06/27/2016 05-16-04 24-16-18 25-16-03 31-16-21
  Ch. 1101 2016 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 06/27/2016 99-16-08
  Ch. 1150 Observation Services 06/27/2016 01-16-19 14-16-17 27-16-17 31-16-20
  Ch. 1121 Prior Authorization of Hereditary Angioedema (HAE) Agents—Pharmacy Services 07/05/16 01-16-22 09-16-20 27-16-20 02-16-19 11-16-19 30-16-19 03-16-19 14-16-20 31-16-24 08-16-20 24-16-22 32-16-18 33-16-19
  Ch. 1121 Prior Authorization of Anticoagulants—Pharmacy Services 07/05/2016 01-16-20 09-16-18 27-16-18 02-16-17 11-16-17 30-16-17 03-16-18 14-16-18 31-16-22 08-16-18 24-16-20 32-16-16 33-16-17
  Ch. 1121 Prior Authorization of Cephalosporins and Related Agents—Pharmacy Services 07/05/2016 01-16-28 09-16-26 27-16-26 02-16-25 11-16-25 30-16-25 03-16-25 14-16-26 31-16-30 08-16-26 24-16-28 32-16-24 33-16-25
  Ch. 1121 Preferred Drug List (PDL) Update July 18, 2016—
Pharmacy Services 		07/05/16 01-16-26 09-16-24 27-16-24 02-16-23 11-16-23 30-16-23 03-16-23 14-16-24 31-16-28 08-16-24 24-16-26 32-16-22 33-16-23
  Ch. 1121 Prior Authorization of Antifungals, Topical—Pharmacy Services 07/05/16 01-16-21 09-16-19 27-16-19 02-16-18 11-16-18 30-16-18 03-16-18 14-16-19 31-16-23 08-16-19 24-16-21 32-16-17 33-16-18
  Ch. 1121 Prior Authorization of Tetracyclines—Pharmacy Services 07/05/16 01-16-25 09-16-23 27-16-23 02-16-22 11-16-22 30-16-22 03-16-22 14-16-23 31-16-27 08-16-23 24-16-25 32-16-21 33-16-22
  Ch. 1121 Prior Authorization of Opiate Overdose Agents—
Pharmacy Services 		07/07/16 01-16-27 09-16-25 27-16-25 02-16-24 11-16-24 30-16-24 03-16-24 14-16-25 31-16-29 08-16-25 24-16-24 32-16-23 33-16-24
  Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 07/08/16 01-16-24 02-16-21 03-16-21 08-16-22 09-16-22 11-16-21 14-16-22 24-16-24 27-16-22 30-16-21 31-16-26 32-16-20 33-16-21
  Ch. 1101 Federal Final Rule, ''Nondiscrimination in Health Programs and Activities'' and Implication for Coverage of Services Related Gender Transition 07/18/16 99-16-11
  Ch. 1121 Coverage for Mosquito Repellants 07/18/16 99-16-14
  Ch. 1101 Enrollment of Physician Assistants Who Order, Refer and Prescribe for Medical Assistance Beneficiaries 08/03/16 10-16-01
  Ch. 1101 Assignment of ACA Categorical Risk Levels and Implementation of Site Visits 08/04/16 99-16-13
  Ch. 1101 Electronic Provider Enrollment Application 08/08/16 99-16-12
  Ch. 1150 Payment of Claims for Services Provided To Children and Adolescents for the Diagnostic Assessment and Treatment of Autism Spectrum Disorder 08/17/16 99-16-15
Ch. 1150 Medical Assistance Program Fee Increases 08/26/16 05-16-05
  1249 For Private Duty/Shift Nursing Services to MA   16-16-01
    Beneficiaries Under 21 Years of Age    
  Ch. 1241 Environmental Lead Investigations 09/13/16 01-16-29 08-16-27 09-16-27 31-16-31 33-16-26 55-16-01
  Ch. 1121 Prior Authorization of Incretin Mimetic/Enhancer Hypoglycemics—Pharmacy Services 09/30/16 01-16-30 09-16-28 27-16-27 02-16-26 11-16-26 30-16-26 03-16-26 14-16-27 31-16-32 08-16-28 24-16-29 32-16-25 33-16-27
  Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Service 10/20/16 01-16-31 09-16-29 27-16-28 02-16-27 11-16-27 30-16-27 03-16-27 14-16-28 31-16-33 08-16-29 24-16-30 32-16-26 33-16-28
  Ch. 1101 Services Ordered, Referred, or Prescribed By Graduate Medical or Osteopathic Trainees 11/02/16 01-16-32 31-16-34
  Ch. 1101
1225 		MA Program Fee Schedule Updates for Certain Family Planning Services 11/26/16 01-16-33 08-16-31 09-16-30 28-16-02 31-16-35 33-16-29
  Ch. 1101
1150
1121 		Federally Qualified Health Center Alternative Payment Methodologies for Delivery Services 11/28/16 08-16-30
  Ch. 1121 Addition to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent Flu Vaccine Derived from Cell Cultures 12/23/16 01-17-01 08-17-01 09-17-01 31-17-01 33-17-01
  Ch. 1121 Prior Authorization of Opiate Dependence Treatments—Pharmacy Service 01/04/17 01-17-02 02-17-01 03-17-01 08-17-02 09-17-02 11-17-01 14-17-01 24-17-01 27-17-01 30-17-02 31-17-03 32-17-01 33-17-02
  Ch. 1101
1150 		Submission of Claims that Require the National Provider Identifier (NPI) of the Ordering, Referring or Prescribing Provider 01/30/17 99-17-02
  Ch. 1121 Prior Authorization of Anitparkinson's Agents—
Pharmacy Services 		01/30/17 01-17-06 09-17-05 27-17-04 02-17-04 11-17-04 30-17-05 03-17-04 14-17-04 31-17-06 08-17-05 24-17-04 32-17-04 33-17-05
  Ch. 1121 Prior Authorization of Botulinum Toxins—Pharmacy Services 01/30/17 01-17-09 09-17-08 27-17-07 02-17-07 11-17-07 30-17-08 03-17-07 14-17-07 31-17-09 08-17-08 24-17-07 32-17-07 33-17-08
  Ch. 1121 Prior Authorization of Bronchodilators, Beta Agonists—Pharmacy Services 01/30/17 01-17-10 09-17-09 27-17-08 02-17-08 11-17-08 30-17-09 03-17-08 14-17-08 31-17-10 08-17-09 24-17-08 32-17-08 33-17-09
  Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 01/30/17 01-17-11 02-17-09 03-17-09 08-17-10 09-17-10 11-17-09 14-17-09 24-17-09 27-17-09 30-17-10 31-17-11 32-17-09 33-17-10
  Ch. 1121 Prior Authorization of Analgesics, Narcotic Long Acting and Analgesics, Narcotic Short Acting—Pharmacy Service 01/31/17 01-17-04 09-17-03 27-17-02 02-17-02 11-17-02 30-17-03 03-17-02 14-17-02 31-17-04 08-17-03 24-17-02 32-17-02 33-17-03
  Ch. 1121 Prior Authorization of Analgesics, Non-Narcotic Barbiturate Combinations—Pharmacy Service 01/31/17 01-17-05 09-17-04 27-17-03 02-17-03 11-17-03 30-17-04 03-17-03 14-17-03 31-17-05 08-17-04 24-17-03 32-17-03 33-17-04
  Ch. 1121 Prior Authorization of Anxiolytics—Pharmacy Services 01/31/17 01-17-07 09-17-06 27-17-05 02-17-05 11-17-05 30-17-06 03-17-05 14-17-05 31-17-07 08-17-06 24-17-05 32-17-05 33-17-06
  Ch. 1121 Prior Authorization of Bile Salts—Pharmacy Service 01/31/17 01-17-08 09-17-07 27-17-06 02-17-06 11-17-06 30-17-07 03-17-06 14-17-06 31-17-08 08-17-07 24-17-06 32-17-06 33-17-07
  Ch. 1121 Prior Authorization of Nplate (romiplostim)—
Pharmacy Services 		01/31/17 01-17-12 02-17-10 03-17-10 08-17-11 09-17-11 11-17-10 14-17-10 24-17-10 27-17-10 30-17-11 31-17-12 32-17-10 33-17-11
  Ch. 1121 Prior Authorization of Pituitary Suppressive Agents, LHRH—Pharmacy Services 01/31/17 01-17-13 02-17-11 03-17-11 08-17-12 09-17-12 11-17-11 14-17-11 24-17-11 27-17-11 30-17-12 31-17-13 32-17-11 33-17-12
  Ch. 1121 Prior Authorization of Promacta (eltrombopag)—
Pharmacy Services 		01/31/17 01-17-14 02-17-12 03-17-12 08-17-13 09-17-13 11-17-12 14-17-12 24-17-12 27-17-12 30-17-13 31-17-14 32-17-12 33-17-13
  Ch. 1121 Prior Authorization of Sedative Hypnotics—Pharmacy Services 01/31/17 01-17-15 02-17-13 03-17-13 08-17-14 09-17-14 11-17-13 14-17-13 24-17-13 27-17-13 30-17-14 31-17-15 32-17-13 33-17-14
  Ch. 1121 Prior Authorization of Stimulants and Related Agents—Pharmacy Services   01/31/17 01-17-16 02-17-14 03-17-14 08-17-15 09-17-15 11-17-14 14-17-14 24-17-14 27-17-14 30-17-15 31-17-16 32-17-14 33-17-15
  Ch. 1121 Prior Authorization of Xyrem (sodium oxybate)—
Pharmacy Services 		01/31/17 01-17-17 02-17-15 03-17-15 08-17-16 09-17-16 11-17-15 14-17-15 24-17-15 27-17-15 30-17-16 31-17-17 32-17-15 33-17-16
  Ch. 1101 School-Based ACCESS Program Provider Handbook 02/28/17 35-17-01
  Ch. 1101 Implementation of Criminal Background Checks for Providers Assigned ACA Categorical Risk Level of High 03/06/17 99-17-03
  Ch. 1241 2017 Recommended Childhood and Adolescent Immunization Schedules 04/24/17 99-17-04
  Ch. 1121 Prior Authorization of Xolair (omalizumab)—Pharmacy Services 04/27/17 01-17-18 02-17-16 03-17-16 08-17-18 09-17-17 11-17-16 14-17-16 24-17-16 27-17-16 30-17-17 31-17-18 32-17-16 33-17-17
  Ch. 1121 Prior Authorization of Ophthalmic Immunomodulators—Pharmacy Services 04/27/17 01-17-19 02-17-17 03-17-17 08-17-19 09-17-18 11-17-17 14-17-17 24-17-17 27-17-17 30-17-18 31-17-19 32-17-17 33-17-18
  Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 04/27/17 01-17-21 02-17-19 03-17-19 08-17-21 09-17-20 11-17-19 14-17-19 24-17-19 27-17-19 30-17-20 31-17-21 32-17-19 33-17-20
  Ch. 1129 Opt-In Procedures for Federally Qualified Health Centers and Rural Health Clinics to Receive the Prospective Payment System Rate from Managed Care Organizations 05/30/17 07-17-01 08-17-22
  Ch. 1101 Discontinuance of Federally Qualified Health Center Alternative Payment Methodology for Delivery Services in the Federally Qualified Health Center Setting 05/30/17 08/17/17
  Ch. 1121 Prior Authorization of Analgesics, Narcotic Long Acting and Analgesics, Narcotic Short Acting—Pharmacy Services 06/07/17 01-17-22 02-17-20 03-17-20 08-17-23 09-17-21 11-17-20 14-17-20 24-17-20 27-17-20 30-17-21 31-17-22 32-17-20 33-17-21
  Ch. 1121 Prior Authorization of Cinqair (reslizumab)—Pharmacy Services 06/07/17 01-17-23 02-17-21 03-17-21 08-17-24 09-17-22 11-17-21 14-17-21 24-17-21 27-17-21 30-17-22 31-17-23 32-17-21 33-17-22
  Ch. 1121 Prior Authorization of Exondys 51 (eteplirsen)—Pharmacy Services 06/07/17 01-17-24 02-17-22 03-17-22 08-17-25 09-17-23 11-17-22 14-17-22 24-17-22 27-17-22 30-17-23 31-17-24 32-17-22 33-17-23
  Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—
Pharmacy Services 		06/07/17 01-17-25 09-17-24 27-17-23 02-17-23 11-17-23 30-17-24 03-17-23 14-17-23 31-17-25 08-17-26 24-17-23 32-17-23 33-17-24
  Ch. 1121 Prior Authorization of Oncology Agents, Breast Cancer—Pharmacy Services 06/07/17 01-17-26 02-17-24 03-17-24 08-17-27 09-17-25 11-17-24 14-17-24 24-17-24 27-17-24 30-17-25 31-17-26 32-17-24 33-17-25
  Ch. 1121 Prior Authorization of Spinraza (nusinersen)—
Pharmacy Services 		06/07/17 01-17-27 02-17-25 03-17-25 08-17-28 09-17-26 11-17-25 14-17-25 24-17-25 27-17-25 30-17-26 31-17-27 32-17-25 33-17-26
  Ch. 1101 Updates to the Medical Assistance Copayment Desk Reference 06/26/17 99-17-06
  Ch. 1121 Prior Authorization of Hepatitis C Agents—Pharmacy Services 06/28/17 01-17-30 02-17-26 03-17-26 08-17-32 09-17-28 11-17-26 14-17-26 24-17-27 27-17-27 30-17-27 31-17-30 32-17-26 33-17-29
  Ch. 1121 Payment for Covered Outpatient Drugs—Pharmacy Services 06/28/17 99-17-09
  Ch. 1121 Prior Authorization of Angiotensin Modulators—
Pharmacy Services 		07/13/17 01-17-34 09-17-32 27-17-30 02-17-29 11-17-29 30-17-30 03-17-29 14-17-29 31-17-34 08-17-35 24-17-30 32-17-29 33-17-33
  Ch. 1121 Preferred Drug List (PDL) Update July 25, 2017—
Pharmacy Services 		07/21/17 01-17-32 02-17-27 03-17-27 08-17-33 09-17-30 11-17-27 14-17-27 24-17-27 27-17-28 30-17-28 31-17-32 32-17-27 33-17-31
  Ch. 1149 Public Health Dental Hygiene Practitioner Enrollment in the Medical Assistance Program 08/01/17 08-17-31 10-17-01 27-17-26
  Ch. 1241 Revisions to the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 08/07/17 99-17-10
  Ch. 1101
1150 		2017 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 08/07/17 99-17-08
  Ch. 1101
1150 		Pasteurized Donor Human Milk 08/07/17 01-17-31 09-17-29 25-17-02 31-17-31 33-17-30
  Ch. 1101
1150
1225 		MA Program Fee Schedule Updates for Certain Family Planning Services 08/07/17 01-17-29 08-17-29 09-17-27 24-17-26 25-17-01 28-17-01 31-17-28 33-17-27
  Ch. 1101
1150 		Procedure Code Change for Tobacco Cessation Counseling Services 08/07/17 99-17-07
  Ch. 1121 Prior Authorization of Intra-Articular Hyaluronates—
Pharmacy Services 		08/08/17 01-17-33 02-17-28 03-17-28 08-17-34 09-17-31 11-17-28 14-17-28 24-17-29 27-17-29 30-17-29 31-17-33 32-17-28 33-17-32
  Ch. 1127
1143
1163 		''Newborn Add'' Feature for COMPASS 08/09/17 01-17-28 33-17-28 47-17-01
  Ch. 1101 Limited English Proficiency Requirements 08/11/17 99-17-11
  Ch. 1101 School-Based ACCESS Program Provider Handbook 11/22/17 35-17-02
  Ch. 1121 Prior Authorization of Antibiotics, GI and Related Agents—Pharmacy Services 12/14/17 01-17-35 02-17-30 03-17-30 08-17-37 09-17-34 11-17-30 14-17-31 24-17-31 27-17-32 30-17-31 31-17-36 32-17-30 33-17-35
  Ch. 1121 Prior Authorization of Analgesics, Opioid Long Acting—Pharmacy Services 12/27/17 01-17-36 02-17-31 03-17-31 08-17-37 09-17-35 11-17-31 14-17-32 24-17-32 27-17-33 30-17-32 31-17-37 32-17-31 33-17-36
  Ch. 1121 Prior Authorization of Xermelo (telotristat ethyl)—
Pharmacy Services 		12/27/17 01-17-44 02-17-39 03-17-39 08-17-46 09-17-43 11-17-39 14-17-40 24-17-40 27-17-41 30-17-40 31-17-45 32-17-39 33-17-44
  Ch. 1121 Prior Authorization of Austedo (deutetrabenazine)—
Pharmacy Services 		12/27/17 01-17-40 02-17-35 03-17-35 08-17-42 09-17-39 11-17-35 14-17-36 24-17-36 27-17-37 30-17-36 31-17-41 32-17-35 33-17-40
  Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—
Pharmacy Services 		12/27/17 01-17-38 02-17-33 03-17-33 08-17-40 09-17-37 11-17-33 14-17-34 24-17-34 27-17-35 30-17-34 31-17-39 32-17-33 33-17-38
  Ch. 1121 Prior Authorization of Ingrezza (valbenazine)—
Pharmacy Services 		12/27/17 01-17-39 02-17-34 03-17-34 08-17-41 09-17-38 11-17-34 14-17-35 24-17-35 27-17-36 30-17-35 31-17-40 32-17-34 33-17-39
  Ch. 1121 Prior Authorization of Brineura (cerliponase alfa)—
Pharmacy Services 		12/27/17 01-17-41 02-17-36 03-17-36 08-17-43 09-17-40 11-17-36 14-17-37 24-17-37 27-17-38 30-17-37 31-17-42 32-17-36 33-17-41
  Ch. 1121 Prior Authorization of Analgesics, Opioid Short Acting—Pharmacy Services 12/14/17 01-17-37 02-17-32 03-17-32 08-17-39 09-17-36 11-17-32 14-17-33 24-17-33 27-17-34 30-17-33 31-17-38 32-17-32 33-17-37
  Ch. 1163 Hospital Responsibilities Related to the Uncompensated Care Program and Charity Care Plans 12/27/17 01-17-03  
  Ch. 1121 Prior Authorization of Xenazine (tetrabenazine)—
Pharmacy Services 		12/27/17 01-17-45 02-17-40 03-17-40 08-17-47 09-17-44 11-17-40 14-17-41 24-17-41 27-17-42 30-17-41 31-17-46 32-17-40 33-17-45
  Ch. 1121 Prior Authorization of Bone Resorption Suppression and Related Agents—Pharmacy Services 12/27/17 01-17-42 02-17-37 03-17-37 08-17-44 09-17-41 11-17-37 14-17-38 24-17-38 27-17-39 30-17-38 31-17-43 32-17-37 33-17-42
  Ch. 1121 Prior Authorization of Cytokine and CAM Antagonists—Pharmacy Services 12/27/17 01-17-46 02-17-41 03-17-41 08-17-48 09-17-45 11-17-41 14-17-42 24-17-42 27-17-43 30-17-42 31-17-47 32-17-41 33-17-46
2018 Ch. 1101
1150 		Revised Health Care Benefit Packages Provider Reference Chart (MA 446) 01/02/18 99-18-01  
  Ch. 1241 Updates to the 2017 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 01/03/18 99-18-02  
  Ch. 1121 Preferred Drug List (PDL) Update January 8, 2018—
Pharmacy Services 		01/08/18 01-18-01 02-18-01 03-18-01 08-18-01 09-18-01 11-18-01 14-18-01 24-18-01 27-18-01 30-18-01 31-18-01 32-18-01 33-18-01
  Ch. 1121 Corrected—Prior Authorization of Hepatitis C Agents—Pharmacy Services 01/22/18 01-18-04 02-18-02 03-18-02 08-18-04 09-18-04 11-18-02 14-18-02 24-18-02 27-18-03 30-18-02 31-18-04 32-18-02 33-18-04
  Ch. 1101
1150 		Acupuncturist Enrollment in the Medical Assistance Program 02/21/18 08-18-05 09-18-05 10-18-01 14-18-03 27-18-04 31-18-05 33-18-05  
  Ch. 1141
1142
1149
1221
1243 		Clinical Laboratory Improvement Amendments Excluded Laboratory Services Update 02/26/18 01-18-03 08-18-03 09-18-03 27-18-02 28-18-01 31-18-03 33-18-03  
  Ch. 1221 Addition to the Medical Assistance Program Fee Schedule for Administration of Quadrivalent Flu Vaccine Derived from Cell Cultures, Preservative 03/5/18 01-18-02 08-18-02 09-18-02 31-18-02 33-18-02  
  Ch. 1101 School-Based ACCESS Program Provider Handbook 03/14/18 35-18-01  
  Ch. 1221 Prior Authorization of Opioid Dependence Treatments—Pharmacy Services 04/10/18 01-18-06 02-18-04 03-18-04 08-18-07 09-18-07 11-18-04 14-18-05 24-18-04 27-18-06 30-18-04 31-18-07 32-18-04 33-18-07
  Ch. 1101
1121
1150 		Update to Submission of Claims that Require the National Provider Identifier (NPI) of a Medical Assistance Enrolled Ordering, Referring or Prescribing Provider 04/16/18 99-18-06  
  Ch. 1121 Prior Authorization of Analgesics, Opioid Long Acting—Pharmacy Services 04/26/18 01-18-07 09-18-08 27-18-07 33-18-08 02-18-05 11-18-05 30-18-05 03-18-05 14-18-06 31-18-08 08-18-08 24-18-05 32-18-05
  Ch. 1121 Prior Authorization of Analgesics, Opioid Short Acting—Pharmacy Services 04/26/18 01-18-05 09-18-06 27-18-05 33-18-06 02-18-03 11-18-03 30-18-03 03-18-03 14-18-04 31-18-06 08-18-06 24-18-03 32-18-03
  Ch. 1241 2018 Recommended Childhood and Adolescent Immunization Schedule 04/27/18 99-18-05  
  Ch. 1101
1150 		Update to 180-Day Exception Requests and Invoice Submission Time Frames 05/25/18 99-18-08  
  Ch. 1101 Reduction of Mailed Paper Remittance Advices 06/15/18 99-18-09  
  Ch. 1101
1150 		Enrollment of Tobacco Cessation Providers 06/18/18 99-18-10  
  Ch. 1101
1150 		2018 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 07/2/18 99-18-07  
  Ch. 1149 Medical Assistance Program Dental Fee Schedule Update 07/2/18 27-18-08  
  Ch. 1127
1142
1144
1221
1252 		Updates to the Family Planning Services Program Fee Schedule 07/2/18 01-18-08 08-18-09 09-18-09 24-18-06 25-18-01 28-18-02 31-18-09 33-18-09  
  Ch. 1149
1241 		Updates to the Pediatric Dental Periodicity Schedule 07/3/18 27-18-09  
  Ch. 1141
1144
1225
1241 		Childhood Nutrition and Weight Management Services 07/3/18 01-18-09 08-18-10 09-18-10 16-18-01 23-18-01 31-18-10  
  Ch. 1121 Preferred Drug List (PDL) Update July 23, 2018—
Pharmacy Services 		07/18/18 01-18-11 02-18-06 03-18-06 08-18-13 09-18-12 11-18-06 14-18-07 24-18-07 27-18-10 30-18-06 31-18-12 32-18-06 33-18-11  
  Ch. 1121 Prior Authorization of Thalidomide and Derivatives—
Pharmacy Services 		07/23/18 01-18-23 02-18-18 03-18-18 08-18-25 09-18-24 11-18-18 14-18-19 24-18-19 27-18-22 30-18-18 31-18-24 32-18-18 33-18-23  
  Ch. 1121 Prior Authorization of VMAT2 Inhibitors—Pharmacy Services 07/23/18 01-18-17 02-18-12 03-18-12 08-18-19 09-18-18 11-18-12 14-18-13 24-18-13 27-18-16 30-18-12 31-18-18 32-18-12 33-18-17  
  Ch. 1121 Prior Authorization of Oncology Agents, Oral—
Pharmacy Services 		07/23/18 01-18-22 02-18-17 03-18-17 08-18-24 09-18-23 11-18-17 14-18-18 24-18-18 27-18-21 30-18-17 31-18-23 32-18-17 33-18-22  
  Ch. 1121 Prior Authorization of Immunomodulators, Atopic Dermatitis—Pharmacy Services 07/23/18 01-18-13 02-18-08 03-18-08 08-18-15 09-18-14 11-18-08 14-18-09 24-18-09 27-18-12 30-18-08 31-18-14 32-18-08 33-18-13  
  Ch. 1121 Prior Authorization of Enzyme Replacements, Gauchers Disease—Pharmacy Services 07/23/18 01-18-20 02-18-15 03-18-15 08-18-22 09-18-21 11-18-15 14-18-16 24-18-16 27-18-19 30-18-15 31-18-21 32-18-15 33-18-20  
  Ch. 1121 Prior Authorization of Neuropathic Pain Agents—
Pharmacy Services 		07/23/18 01-18-16 02-18-11 03-18-11 08-18-18 09-18-17 11-18-11 14-18-12 24-18-12 27-18-15 30-18-11 31-18-17 32-18-11 33-18-16  
  Ch. 1121 Prior Authorization of Lipotropics, Other—Pharmacy Services 07/23/18 01-18-14 02-18-09 03-18-09 08-18-16 09-18-15 11-18-09 14-18-10 24-18-10 27-18-13 30-18-09 31-18-15 32-18-09 33-18-14  
  Ch. 1121 Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents—Pharmacy Services 07/23/18 01-18-21 02-18-16 03-18-16 08-18-23 09-18-22 11-18-16 14-18-17 24-18-17 27-18-20 30-18-16 31-18-22 32-18-16 33-18-21  
  Ch. 1121 Prior Authorization of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)—Pharmacy Services 07/23/18 01-18-18 02-18-13 03-18-13 08-18-20 09-18-19 11-18-13 14-18-14 24-18-14 27-18-17 30-18-13 31-18-19 32-18-13 33-18-18  
  Ch. 1121 Prior Authorization of Monoclonal Antibodies—Anti-IL, Anti-IgE (MABs-Anti-IL, Anti-IgE)—Pharmacy Services 07/23/18 01-18-15 02-18-10 03-18-10 08-18-17 09-18-16 11-18-10 14-18-11 24-18-11 27-18-14 30-18-13 31-18-19 32-18-13 33-18-18  
  Ch. 1121 Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations—Pharmacy Services 07/23/18 01-18-12 02-18-07 03-18-07 08-18-14 09-18-13 11-18-07 14-18-08 24-18-08 27-18-11 30-18-07 31-18-13 32-18-07 33-18-12  
  Ch. 1121 Prior Authorization of Bone Resorption Suppression and Related Agents—Pharmacy Services 07/23/18 01-18-19 02-18-14 03-18-14 08-18-21 09-18-13 11-18-07 14-18-08 24-18-08 27-18-11 30-18-07 31-18-13 32-18-07 33-18-12  
  Ch. 1241 Updates to Pennsylvania's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule 08/01/18 99-18-13    
  Ch. 1121 Prior Authorization of Multiple Sclerosis Agents—
Pharmacy Services 		08/13/18 01-18-24

GUIDANCE MANUALS:

• Provider Handbook—Physician—updated 10/2017
• Provider Handbook—Dentist—updated 10/2017
• Provider Handbook—Podiatrist—updated 10/2017
• Provider Handbook—Medical Supplier—updated 10/2017
• Provider Handbook—Short Procedure Unit/Ambulatory Surgical Center—updated 10/2017
• Provider Handbook—Chiropractor—updated 10/2017
• Provider Handbook—Birth Centers—updated 10/2017
• Provider Handbook—Independent Medical/Surgical Clinic—updated 10/2017
• Provider Handbook—Inpatient Hospital (Encompasses provider types General Hospital, Rehabilitation Hospital, Private Mental Hospital, State Mental Hospital and Extended Acute Psychiatric Care—updated 10/2017
• Provider Handbook—Outpatient Hospital (Encompasses provider types General Hospital, and Rehabilitation Hospital)—updated 10/2017
• Provider Handbook—Optometrist—updated 10/2017
• Provider Handbook—Independent Laboratory—updated 10/2017
• Provider Handbook—Ambulance Company—updated 10/2017
• Provider Handbook—Pharmacy—updated 10/2017
• Provider Handbook—Portable X-Ray Provider—updated 10/2017
• Provider Handbook—Renal Dialysis Center—updated 10/2017
• Provider Handbook—Funeral Director—updated 10/2017
• Provider Handbook—Home Health Agency—updated 10/2017
• Provider Handbook—Rural Health Clinic—updated 10/2017
• Provider Handbook—Drug and Alcohol Clinic—updated 10/2017
• Provider Handbook—Outpatient Psychiatric Clinic—updated 10/2017
• Provider Handbook—Family Planning Clinic—updated 10/2017
• Provider Handbook—Midwives—updated 10/2017
• Provider Handbook—Psychiatric Partial Hospitalization Facility—updated 10/2017
• Provider Handbook—Hospice—updated 10/2017
• Provider Handbook—Psychologist—updated 10/2017
• Provider Handbook—Comprehensive Outpatient Rehabilitation Facility—updated 10/2017
• Provider Handbook—Physical Therapist—updated 10/2017
• Provider Handbook—Certified RN Anesthetist—updated 10/2017
• Provider Handbook—Certified RN Practitioner—updated 10/2017
• Provider Handbook—Early Periodic Screening, Diagnosis and Treatment (EPSDT) Provider updated 10/2017
• Provider Handbook—Nutritionist—updated 10/2017
• Provider Handbook—PA Department of Aging (PDA) Waiver—updated 10/2017
• Provider Handbook—COMMCARE Waiver updated 10/2017
• Medical Assistance Transportation Program—Standards and Guidelines updated 11/2016

OTHER:

• PA 67 Section 1915(b) Waiver

Office of Long-Term Living—Contact: Virginia Brown (717) 783-4510

Year Code Citation(s) Subject Date Issued Bulletin Number
1998 — Respite Care Nursing Facility Admissions 04/17/98 35-98-06
36-98-06
  — Medicare Cost-Sharing Payment for Nursing Facility Residents 07/31/98 35-98-10
36-98-10
1999 Ch. 1187 Capital Component Payments for Post-Moratorium Beds 06/28/99 1187-99-01
35-99-05
36-99-05
2007   Nursing Facility Documentation Requirements for Movable Equipment that is Rented or Leased 12/07/07 03-07-10
2008   Nursing Facility Documentation Requirements for Movable Equipment that is Rented or Leased 07/07/08 03-08-04
2009   Provider Rates for Services Funded through the OBRA, Independence and COMMCARE Waivers 06/25/09 05-09-02
17-09-02
36-09-02
41-09-02
43-09-02
55-09-02
59-09-02
2010   Office of Long Term Living Home and Community Based Program Policy Clarification Update (Omnibus Bulletin) 11/23/10 05-10-08
51-10-08
55-10-08
59-10-08
    Nursing Home Transition Outreach Form 10/08/10 05-10-05
51-10-05
52-10-05
55-10-05
59-10-05
    Standards and Reimbursement Rates for the Enhanced Older Adult Daily Living Center Program for Medicaid Aging Waiver Participants 04/20/10 03-10-02
41-10-02
55-10-02
2011   Accessibility Adaptations and Assistive Technology 10/11/11 05-11-07
51-11-07
52-11-07
54-11-07
55-11-07
59-11-07
    Community Integration Changes provided in the MA Home and Community—Based Waiver Program 09/29/11 05-11-05
51-11-05
52-11-05
55-11-05
59-11-05
    Program Fraud & Financial Abuse in Office of Long Term Living MA Home and Community Based Services (HCBS) Programs 08/08/11 05-11-04
51-11-04
52-11-04
54-11-04
55-11-04
59-11-04
    Recession of OLTL Bulletin 05-10-07, 51-10-07, 52-10-07, 5-10-075, 59-10-07 06/30/11 05-11-03
51-11-03
52-11-03
55-11-03
59-11-03
  CH 52 Procedures and Timeframes Related to Performance of Level of Care Assessments and Independent Enrollment Broker Responsibilities (This bulletin supersedes and replaces 55-12-02) 12/31/12 55-12-03
2012 CH. 1187 Nursing Facility Participation Review Process and Guidelines-statement of policy 06/30/12 42 Pa.B. 3748
  CH 52
CH 52 		OLTL Service Coordination Rate in Effect
OLTL Rate for Enrollment 		07/14/12
06/30/12 		42 Pa.B. 4545 42 Pa.B. 381
  CH 52 OLTL Fee Schedule Rates established 06/09/12 42 Pa.B. 3343
  CH 52 Hearings and Appeals 12/23/13 51-13-12
55-13-12
59-13-12
2013 CH 52 Rescission of Office of Long-Term Living HCBS Directives, Bulletins and Other Policy Documents 12/04/13 05-13-11
51-13-11
55-13-11
59-13-11
  CH 52 Statewide Waiting List Guidelines for Office of Long-Term Living Medicaid Waivers and the Act 150 Program 11/05/13 05-13-08
51-13-08
55-13-08
59-13-08
  CH 52 Clarification of type, scope, amount, duration and frequency of services 05/16/13 05-13-05
08-13-05
11-13-05
17-13-05
19-13-05
25-13-05
26-13-05
41-13-05
51-13-05
54-13-05
55-13-05
59-13-05
  CH 52 Providing for Absence Policies in the Enhanced Adult Daily Living Centers 03/22/13 03-13-03
41-13-03
55-13-03
  CH 52 Billing Instructions-Home and Community Based Waiver Provider's Billing of Procedure Codes Based on Authorized Service Plans through PROMISeTM 02/07/13 05-13-02
51-13-02
54-13-02
55-13-02
59-13-02
  CH 52
CH 52 		OLTL Enrollment Fee Increase
OLTL Service Coordination Rate Increase 		01/26/13
01/26/13 		43 Pa.B. 589 43 Pa.B. 590
  CH 52 Maintaining Waiver Eligibility While in an Institution 01/24/13 05-13-01
51-13-01
52-13-01
55-13-01
59-13-01
2014 — Preventable Serious Adverse Events 09/13/14 03-14-08
CH 52 Final Fee Schedule Rates for Personal Assistance Services (Agency)
Final Fee Schedule Rates for Personal Assistance Services (Consumer)
Final Fee Schedule Rates for Service Coordination Services
Service Coordination After-Hours Coverage 		09/13/14   09/13/14   09/13/14   06/19/14 44 Pa.B. 5935 44 Pa.B. 5935 44 Pa.B. 5935 51-14-07
55-14-07
59-14-07
    Financial Management Services Information 05/12/14 51-14-07
54-14-07
55-14-07
59-14-07
    Revised Target Resident (MI, ID, ORC) Reporting Form (MA 408) 02/12/14 03-14-12  
  CH 52 Release of OLTL Home and Community-Based Services Provider Handbook 01/30/14 03-14-02
05-14-02
08-14-02
11-14-02
17-14-02
19-14-02
23-14-02
25-14-02
26-14-02
41-14-02
51-14-02
54-14-02
55-14-02
59-14-02
    OLTL Home and Community-Based Services Service Authorization Form 01/15/14 51-14-01 55-14-01 59-14-01
  CH 52 Critical Incident Management 04/16/15 05-15-02
51-15-02
54-15-02
55-15-02
59-15-02
2015 CH 52 Rescission of HCBS Directives, Bulletins and other Policy Documents 10/27/2015 54-15-03, 59-15-03
    Revised Pennsylvania Preadmission Screening Resident Review Identification (Level I) Form
(MA 376) 		12-15-2015 01-15-04, 03-15-04, 07-15-04, 55-15-04
    Revised Pennsylvania Preadmission Screening Resident Review Evaluation (Level II) Form
(MA 376.2) 		12-15-2015 01-15-05 03-15-05
    Medical Assistance Fee Schedule; Addition of Maximum Overtime Rates for Personal Assistance Services (Consumer) and Respite (Consumer) 01/02/16 46 Pa.B. 106
2016   Medical Assistance Fee Schedule Revisions in the Aging, COMMCARE, Independence and OBRA Waivers 01/02/16 46 Pa.B. 107
    Overtime and Minimum Wage Requirements in Participant-Directed Models of Service 01/11/2016 54-16-01, 59-16-01
    Electronic Submission of Nursing Facilities' MA-11 Cost Reports, Supporting Documentation and Signed Certification Report 03-01-2016 03-16-02
    Provider Choice Protocol 03/08/2016 59-16-03  
    Act 150 Program Guidelines   05/12/2016 54-16-04, 59-16-04
    Employment and Employment Related Services 07/26/2016 59-16-07
    Individual Service Plan Development, Review, and Implementation
Nursing Home Transition Program Changes Participant Reviews
Home and Community-Based Settings Requirements 		10/14/2016 10/28/2016 12/28/2016 12/28/2016 59-16-13 59-16-09 59-16-12 59-16-14
    Medical Assistance Fee Schedule; Final Rates for Additional Services Added to the COMMCARE and Independence Waivers 11/19/16 46 Pa.B. 7398
2017   Act 150 Program Sliding Fee Scale for Calendar Year 2018 01/02/2018 54-17-02 59-17-02
2018   Standardized Participant Information Packet 01/16/2018 59-18-01
    Revised Pennsylvania Preadmission Screening Resident Review (PASRR) Level I Identification Form (MA 376) 08/01/2018 01-18-03 03-18-03 07-18-03 59-18-03
    Revised Pennsylvania Preadmission Screening Resident Review (PASRR) Level II Evaluation Form (MA 376.2) 08/01/2016 01-18-04 03-18-04

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