STATEMENTS OF POLICY
Title 55--PUBLIC WELFARE
DEPARTMENT OF PUBLIC WELFARE
[ 55 PA. CODE CH. 1223 ]
Requirements for Clinic Supervisory Physician Reviews and Reevaluations of Diagnoses, Treatment Plans and Updates
[39 Pa.B. 1991]
[Saturday, April 18, 2009]Scope
This Statement of Policy (SOP) applies to outpatient drug and alcohol services clinics enrolled in the Medical Assistance (MA) Program to provide services in either the Fee-for-Service or the Managed Care delivery systems.
Purpose
The purpose of this SOP is to clarify the requirement in § 1223.52(a)(6)(iii) and (7)(ii) (relating to payment conditions for various services) that the clinic supervisory physician review and reevaluate diagnoses, treatment plans and updates shall be done in the outpatient drug and alcohol clinic.
Discussion
Providers of outpatient drug and alcohol clinic services have requested that the Department clarify the requirement that the clinic supervisory physician reviews and reevaluates diagnoses, treatment plans and updates be completed in the clinic. Specifically, they requested clarification of the boundaries for a physician to be ''in the clinic.''
Although the Department of Health licenses each outpatient drug and alcohol clinic site separately, these facilities are recognized as part of one ''project'' if they are operated by the same legal entity or governing body. See 28 Pa. Code § 701.1 (relating to general definitions). Therefore, the Department will consider a physician to be ''in the clinic'' under § 1223.52(a)(6)(iii) and (7)(ii) when the physician is physically present in a licensed site of the same ''project.''
Regulation Interpretation
The regulation interpretation is contained in Annex A.
Effective Date
This SOP is effective immediately upon publication in the Pennsylvania Bulletin.
Contact Person
Richard J. Novak, Bureau of Policy and Program Development, Office of Mental Health and Substance Abuse Services, (717) 772-7860 or rinovak@state.pa.us.
ESTELLE B. RICHMAN,
Secretary(Editor's Note: Title 55 of the Pennsylvania Code is amended by adding a statement of policy in § 1223.52a to read as set forth in Annex A.)
Fiscal Note: 14-083. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 55. PUBLIC WELFARE
PART III. MEDICAL ASSISTANCE MANUAL
CHAPTER 1223. OUTPATIENT DRUG AND ALCOHOL CLINIC SERVICES
PAYMENT FOR OUTPATIENT DRUG/ALCOHOL CLINIC SERVICES § 1223.52a. Requirements for clinic supervisory physician reviews and reevaluations of diagnoses, treatment plans and updates--statement of policy.
The Department will consider a physician to be ''in the clinic'' under § 1223.52(a)(6)(iii) and (7)(ii) (relating to payment conditions for various services) when the physician is physically present in a licensed site of the same ''project'' as defined in 28 Pa. Code § 701.1 (relating to general definitions).
[Pa.B. Doc. No. 09-698. Filed for public inspection April 17, 2009, 9:00 a.m.]
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