NOTICES
Medical Assistance Program Fee Schedule Revision
[33 Pa.B. 2020] The Department of Public Welfare (Department) will revise payment rates for select procedure codes for oxygen and oxygen-related equipment effective May 1, 2003.
Background
The Pennsylvania Medicaid State Plan (State Plan) specifies that maximum payment fees for services covered under the Medical Assistance (MA) Program are to be determined on the basis of the following: fees will not exceed the Medicare upper limit when applicable; will be consistent with efficiency, economy and quality of care; and will be sufficient to assure the availability of services to clients. In section 4552(a) of the Balanced Budget Act of 1997 (Pub. L. No. 105-33), Congress reduced payment levels for certain Medicare items, including oxygen and oxygen-related equipment (42 U.S.C.A. § 1395m(a)(9)(B)(v) and (vi)). The Department made no corresponding adjustment to the MA Program Fee Schedule for the same items.
In 2002, the Office of the Inspector General of the Department of Health and Human Services (HHS) audited the Department's payments for oxygen and oxygen-related equipment for the period January 1, 1998, through December 31, 2000. HHS concluded that the Department's payment rates were higher than the amount necessary to enlist the participation of an adequate number of providers. Following the audit, HHS recommended that the Department refund the Medicaid Program for excessive payments made to providers and limit the maximum allowable fee for oxygen and oxygen-related equipment to an amount equal to or less than the Medicare approved amount for the same item.
As recommended by HHS, the Department is adjusting the MA Program Fee Schedule payment rates for oxygen and oxygen-related equipment to equal the Medicare approved amount. Revision of these fees is necessary to comply with the State Plan and to avoid additional Federal disallowances.
The fees are revised as follows.
Revised Fee Procedure Current (Effective Code Description Fee 5/1/03) A4621 Tracheotomy mask or collar $6.05 $1.39 E0424 Stationary compressed gaseous oxygen system, rental; includes contents (per unit), regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing; 1 unit = 50 cubic ft. $288.20 $228.80 E0439 Stationary liquid oxygen system, rental; includes use of reservoir, contents (per unit), regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing; 1 unit = 10 lbs. $301.18 $228.80 E0441 Oxygen contents, gaseous, per unit (for use with owned gaseous stationary systems or when both a stationary and portable gaseous system are owned; 1 unit = 50 cubic ft.) $186.45 $161.76 E0442 Oxygen contents, liquid, per unit (for use with owned liquid stationary systems or when both a stationary and portable liquid system are owned; 1 unit = 10 lbs.) $186.45 $161.76 E0443 Portable oxygen contents, gaseous, per unit (for use only with portable gaseous systems when no stationary gas or liquid system is used; 1 unit = 5 cubic ft.) $24.62 $21.34 E0444 Portable oxygen contents, liquid, per unit (for use only with portable liquid systems when no stationary gas or liquid system is used; 1 unit = 1 lb.) $24.62 $21.34 E1390 Oxygen concentrator, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate $231.04 $228.80 E1404 Oxygen concentrator, manufacturer specified maximum flow rate greater than 5 liters per minute, at 85% or greater concentration $299.15 $228.80 E1405 Oxygen and water vapor enriching system with heated delivery $299.15 $263.87 E1406 Oxygen and water vapor enriching system without heated delivery $299.15 $248.53
Fiscal Note
It is anticipated that this revision will result in a savings of $0.042 million ($0.019 million in State funds) for Fiscal Year 2003-04.
Public Comment
Interested persons are invited to submit written comments to this notice within 30 days of this publication. Comments should be sent to the 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. Comments received will be considered in subsequent revisions to the fee schedule.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-355. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 03-718. Filed for public inspection April 18, 2003, 9:00 a.m.]
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