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PA Bulletin, Doc. No. 96-1442



Change in Payment Method for Certain Out-of-State Hospitals

[26 Pa.B. 4288]

   The purpose of this announcement is to provide advance public notice as required by 42 CFR 447.205 of the Department's intent to change the payment method for inpatient hospital services in certain out-of-State hospitals.

   The Department is making this change to promote access to medical care for Pennsylvania's Medical Assistance recipients under 21 years of age. The Department is committed to meeting the needs of Pennsylvania's most vulnerable citizens, including children, and this change in payment method will result in the enhanced health and well-being of children in the Commonwealth.

   This change will affect hospitals which meet all of the following criteria:

   1)  The hospital must be located in a state contiguous to Pennsylvania.

   2)  The hospital must be licensed as a hospital in the state in which it is located.

   3)  The hospital must be enrolled as a provider in the Medicaid program in the state in which it is located.

   4)  The hospital must be enrolled as a provider type 11 in Pennsylvania's Medical Assistance Program.

   5)  The hospital must be routinely used as a provider of care by Pennsylvania Medical Assistance recipients in a particular locality.

   6)  For Fiscal Years 1992-93, 1993-94 and 1994-95, the hospital must meet the following conditions:

   a)  The hospital must have at least 100 inpatient admissions of Pennsylvania Medical Assistance recipients.

   b)  A minimum of 95% of the total inpatient admissions of Pennsylvania Medical Assistance recipients must be recipients under 21 years of age.

   In addition to existing state plan amendment provisions for out-of-state hospitals, hospitals qualifying under these criteria will be treated as in-state hospitals for payment purposes.

Fiscal Impact


   It is anticipated that an increase of $0.498 million ($.0235 million in State funds) in inpatient expenditures will occur for Fiscal Year 1996-97 as a result of treating qualifying out-of-state hospitals as in-state hospitals. For Fiscal Year 1997-98, the annualized cost is estimated at $0.680 million ($0.321 million in State funds).

Contact Person

   A copy of this notice is available for review at local County Assistance Offices. Interested persons are invited to submit written comments to this notice within 30 days of this publication. These 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.


   Fiscal Note: 14-NOT-128. (1)  General Fund; (2)  Implementing Year 1996-97 is $235,000; (3)  1st Succeeding Year 1997-98 is $321,000; 2nd Succeeding Year 1998-99 is $337,000; 3rd Succeeding Year 1999-00 is $354,000; 4th Succeeding Year 2000-01 is $372,000; 5th Succeeding Year 2001-02 is $391,000; (4)  FY 1994-95 $550,452,000; FY 1993-94 $681,793,000; FY 1992-93 $540,078,000; (7)  Medical Assistance-Inpatient; (8)  recommends adoption. This announcement notifies the public that the Department of Public Welfare intends to treat certain out-of-State hospitals as in-state hospitals for inpatient Medical Assistance payment purposes. The cost figure above for 1996-97 is being included in the Budget process.

[Pa.B. Doc. No. 96-1442. Filed for public inspection August 30, 1996, 9:00 a.m.]

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