NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Fee Increase for Select Obstetrical/Gynecological Services
[34 Pa.B. 4779] The Department of Public Welfare (Department) announces that fees on the Medical Assistance (MA) Program Fee Schedule for deliveries and associated services performed by obstetricians/gynecologists (OB/GYN) will be increased, effective with dates of service on and after January 1, 2004.
This Commonwealth is currently experiencing a medical malpractice crisis that is creating a serious shortage of physicians. Obstetrics is one of the high-risk specialties most affected by the crisis. Obstetricians pay some of the highest malpractice insurance premiums in this Commonwealth. For example, in 2002 an obstetrician in Philadelphia insured with a major liability insurer would have paid approximately $105,000 for primary and excess liability coverage of $1.2 million. In 2004, that same physician paid approximately $110,000 just for primary coverage. Obstetricians throughout this Commonwealth have experienced similar premium increases.
As a result of the significant increases in insurance premiums, many OB/GYNs have been unable to afford private insurance coverage. Some obstetricians have restricted their practices to gynecology while others have left this Commonwealth to practice elsewhere or ceased practicing medicine altogether. The decrease in the number of physicians and available services has a dramatic impact on MA patients. The MA Program pays for approximately 28% of all births in this Commonwealth.
As one of several initiatives that the Commonwealth has undertaken to address the medical malpractice crisis, to assure continued access to OB/GYN services, the Department will increase the MA fee for the following procedure codes on the MA Program Fee Schedule:
Procedure Code Description of Service Current Fee Increased Fee 59410 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care $800 $1,200 59515 Cesarean delivery only; including postpartum care $800 $1,200 59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care, after previous
cesarean delivery$1,000 $1,500 59612 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps) $1,000 $1,500 59614 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care $1,000 $1,500 59618 Routine obstetric care including antepartum care, cesarean delivery and postpartum care, following attempted vaginal delivery after previous cesarean delivery $1,000 $1,500 59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery $1,000 $1,500 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care $1,000 $1,500 W5953 Third trimester basic maternity care package $1,386 $1,786 W5956 Third trimester high risk maternity care package $1,576 $2,076 W5985 Second Trimester high risk maternity care package with delivery $1,525 $2,025 W9969 Third trimester early delivery $1,550 $2,050 Fiscal Impact
The estimated cost relating to Fiscal Year 2003-2004 is $9.549 million ($4.318 million in State funds). Of this amount, $1.586 million ($0.716 million in State funds) relates to the Outpatient Program while $7.963 million ($3.602 million in State funds) is for MA-Capitation services.
The estimated cost for Fiscal Year 2004-2005 is $20.684 million ($9.495 million in State funds). Of this amount, $4.758 million ($2.180 million in State funds) relates to the Outpatient Program while $15.926 million ($7.315 million in State funds) is for MA-Capitation services.
Public Comment
Interested persons are invited to submit written comments to this notice within 30 days of this publication to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy's Secretary Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments will be considered in future revisions to the MA Program Fee Schedule. Persons with a disability may use the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-397. (1) General Fund;
Outpatient Capitation (2) Implementing Year 2003-04 is $716,000 $3,602,000 (3) 1st Succeeding Year 2004-05 is $2,180,000 $7,315,000 2nd Succeeding Year 2005-06 is $2,191,000 $7,351,000 3rd Succeeding Year 2006-07 is $2,191,000 $7,351,000 4th Succeeding Year 2007-08 is $2,191,000 $7,351,000 5th Succeeding Year 2008-09 is $2,191,000 $7,351,000 Outpatient Capitation (4) 2002-03 Program-- $666,832,000 $1,863,772,000 2001-02 Program-- $705,750,000 $1,711,084,000 2000-01 Program-- $668,586,000 $1,487,944,000
(7) Medical Assistance--Outpatient and Capitation; (8) recommends adoption. Costs for Fiscal Year 2003-04 have been included in Act 9-A of 2003, The First Supplemental General Appropriation Act of 2003. Costs for 2004-05 have been included in Act 7-A of 2004, the General Appropriation Act of 2004.
[Pa.B. Doc. No. 04-1611. Filed for public inspection August 27, 2004, 9:00 a.m.]
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