Medical Assistance Program Fee Schedule Revision
[36 Pa.B. 2866]
[Saturday, June 10, 2006]
The Department of Public Welfare (Department) will revise fees on the Medical Assistance (MA) Program Fee Schedule for select procedure codes for oxygen and oxygen-related equipment effective June 12, 2006.
Fee Schedule Revisions
The Pennsylvania Medicaid State Plan (State Plan) specifies that maximum fees for services covered under the MA Program are to be determined on the basis of the following: fees may not exceed the Medicare upper limit when applicable; fees must be consistent with efficiency, economy and quality of care; and fees must be sufficient to assure the availability of services to recipients.
In section 4552(a) of the Balanced Budget Act of 1997 ((42 U.S.C.A. § 1395m(a)(9)(B)(v) and (vi)), regarding special payment rules for particular items and services, Congress reduced payment levels for certain Medicare items, including oxygen and oxygen-related equipment. As a result, the Department revised the MA Program Fee Schedule rates for these services in 2003.
Medicare reviews and revises its payment rates at least annually. As a result of rate revisions since 2003, the Department has determined that MA payment rates for several oxygen and oxygen-related equipment procedure codes are above the Medicare-approved amount for the same procedure codes. The Department is adjusting the MA Program Fee Schedule payment rates for oxygen and oxygen-related procedure codes to equal the Medicare-approved amount. Revision of these fees is necessary to comply with the State Plan and to avoid a Federal disallowance.
The Department will revise the payment rates for the following procedure codes, which must be billed with modifier RR, effective June 12, 2006:
Oxygen Procedure Codes with Fees Exceeding
Code Description Fee
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing $200.41 E0431 Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing $32.07 E0434 Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing $32.07 E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing $200.41 E1390 Oxygen concentrator, single delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate $200.41 E1405 Oxygen and water vapor enriching system with heated delivery $235.48 E1406 Oxygen and water vapor enriching system without heated delivery $216.51
It is anticipated that these revisions will result in savings of $0.743 million ($0.344 million in State funds) in the Medical Assistance--Outpatient Program in Fiscal Year (FY) 2006-2007 and annualized savings of $0.892 million ($0.414 million in State funds) in FY 2007-2008.
Interested persons are invited to submit written comments regarding this notice 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. Comments received will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
Fiscal Note: 14-NOT-478. No fiscal impact; (8) recommends adoption. Savings as a result of this action are estimated at $344,000 for Fiscal Year 2006-2007 and $414,000 for Fiscal Year 2007-2008.
[Pa.B. Doc. No. 06-1030. Filed for public inspection June 9, 2006, 9:00 a.m.]
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