NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Amendment of Copayment Regulation in 55 Pa. Code § 1101.63
[42 Pa.B. 1001]
[Saturday, February 18, 2012]The Department of Public Welfare (Department) is announcing its intent to amend the Commonwealth's Medicaid State Plan and current Medical Assistance (MA) regulations in 55 Pa. Code § 1101.63(b) (relating to payment in full), which set forth MA Program copayment requirements for covered services.
On July 1, 2011, the General Assembly enacted the act of June 30, 2011 (P. L. 89, No. 22) (Act 22), which amended the Public Welfare Code (code) (62 P. S. §§ 101—1503). Act 22 added several provisions to the code, including section 403.1 (62 P. S. § 403.1). Section 403.1(a)(1) and (3), (c) and (d) of the code authorizes the Department to promulgate final-omitted regulations under section 204(1)(iv) of the Commonwealth Documents Law (CDL)1 to establish rules, regulations, procedures and standards for the nature and extent of assistance and to modify existing benefits. In addition, to ensure that the Department's expenditures for State Fiscal Year (FY) 2011-2012 do not exceed the aggregate amount appropriated by the General Assembly, section 403.1 of the code expressly exempts these regulations from the Regulatory Review Act (71 P. S. §§ 745.1—745.12), section 205 of the CDL (45 P. S. § 1205) and section 204(b) of the Commonwealth Attorneys Act (71 P. S. § 732-204(b)).
Under section 403.1 of the code, the Department intends to submit a State Plan Amendment and promulgate final-omitted regulations amending the MA Program copayment regulations at 55 Pa. Code § 1101.63(b) as follows:
• Eliminate the copayment reimbursement provision which requires the Department to reimburse General Assistance (GA) MA recipients for copayments paid in excess of $180 in a 6-month period and all other categories of MA recipients for copayments paid in excess of $90 in a 6-month period.
• Update the MA sliding scale copayment amounts for MA recipients other than GA recipients to reflect the current medical care component of the Consumer Price Index for All Urban Consumers (CPI-U) and codify the Department's ability to make updates to the sliding scale copayment amounts on a recurring basis to account for future CPI-U adjustments as permitted by the Deficit Reduction Act of 2005 (DRA) (Pub. L. No. 109-171) and implementing regulations, through publication of a notice in the Pennsylvania Bulletin. The Department will also update the sliding scale copayment amounts for GA recipients, which will continue to be twice the amounts applied to non-GA recipients, consistent with current MA copayment policy.
• Establish a nominal fixed copayment of $2 for a one way trip and $4 for a round trip for non-emergency medical paratransit transportation services for certain MA and GA recipients.
• Make technical corrections to codify and clarify existing copayment exclusions that have been in effect in the MA Program.
The Department intends to make these changes effective April 1, 2012.
Fiscal Impact
The FY 2011-2012 fiscal impact, as a result of amending the copayment regulations is a savings of $0.733 million ($0.344 million in State funds and $0.389 million in Federal funds).
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 15 days will be reviewed and considered in the development of the State Plan Amendment and regulations.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
SecretaryFiscal Note: 14-NOT-741. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 12-299. Filed for public inspection February 17, 2012, 9:00 a.m.] _______
1 The act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. § 1204(1)(iv)). Section 204(1)(iv) of the CDL authorizes an agency to omit or modify notice of proposed rulemaking when a regulation relates to Commonwealth grants or benefits. The MA Program is a Commonwealth grant program through which eligible recipients receive coverage of certain health care benefits.
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