§ 1163.62. Payment conditions for abortions.
(a) Coverage for abortions funded under the MA Program is available only if:
(1) A physician has certified in writing and documented in the patient’s record that the life of the woman would be endangered if the pregnancy were allowed to progress to term. The decision as to whether the woman’s life is endangered is a medical judgment to be made by the woman’s physician. Payment will be made for an inpatient hospitalization for purposes of an abortion only if a ‘‘Physician Certification for an Abortion’’ form signed by a licensed physician is submitted with the invoice for payment. A sample of the required ‘‘Physician Certification for an Abortion’’ form appears in the Provider Handbook.
(2) If the recipient was the victim of rape or incest and the incident was reported to a law enforcement agency or to a public health service within 72 hours of its occurrence in the case of rape and in the case of incest within 72 hours of the time the physician notified the patient that she was pregnant. A law enforcement agency is an agency or part of an agency which is responsible for the enforcement of the criminal laws, such as a local police department or sheriff’s office. A public health service is an agency of the Federal, State or local government or a facility certified by the Federal government as a Rural Health Clinic which provides health or medical services. Those agencies whose principal function is the performance of abortions are not considered public health agencies.
(i) Payment is made for inpatient hospitalization only if a ‘‘Physician Certification for an Abortion’’ form, signed by a licensed physician is submitted with the invoice for payment along with documentation signed by an official of the law enforcement agency or public health service to which the rape or incest was reported. The documentation must include:
(A) The information specified in subsection (a)(2)(ii).
(B) A statement that the report was signed by the person making the report.
(ii) The report of the rape or incest need not be made by the victim herself but can be reported by another person. The report need not be made in person but may be made by mail. The report itself shall be signed by the person who reports the rape or incest and must include:
(A) The name and address of the victim.
(B) The name and address of the person who made the report if different from the victim.
(C) The date of the incident if it was rape.
(D) The date the report was made.
(b) Insofar as required by 28 Pa. Code Chapter 29 Subchapter D (relating to ambulatory gynecological surgery in hospitals and clinics), during the first 12 weeks of pregnancy, payment is made under the MA Program only for an abortion performed in a licensed physician’s office, a clinic or a hospital outpatient facility which has been licensed/approved by the Department of Health for that purpose.
(c) Insofar as required by 28 Pa. Code Chapter 29 Subchapter D, after the first 12 weeks of pregnancy, payment is made under the MA Program only for abortions performed in a hospital which has been licensed/approved by the Department of Health.
Source The provisions of this § 1163.62 adopted September 23, 1983, effective September 24, 1983, 13 Pa.B. 2881; amended June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185. Immediately preceding text appears at serial pages (85052) to (85053).
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