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PA Bulletin, Doc. No. 08-1905



Increase to Maximum Payment to Practitioners for Services Provided During One Period of Hospitalization

[38 Pa.B. 5816]
[Saturday, October 18, 2008]

Purpose of Notice

   The purpose of this notice is to announce that effective October 18, 2008, the Department of Public Welfare (Department) is increasing the maximum Medical Assistance (MA) payment limit for services provided by a practitioner to an MA recipient during any one period of hospitalization.

   Section 2 of Act 2008-44 amended the act of June 13, 1967 (P. L. 31, No. 21), known as the Public Welfare Code, to add section 443.10. Section 443.10(3) authorizes the Department to establish the maximum payment limit to a practitioner for services provided to an MA recipient during a period of inpatient hospitalization by publication of Notice in the Pennsylvania Bulletin.

   The current maximum payment to a practitioner for services provided during a single hospitalization is the lowest of the practitioner's usual and customary charge to the general public for the same service; the MA maximum allowable fee; or the maximum payment limit of $1,000. See 55 Pa. Code § 1150.51(e) (relating to general payment policies). Effective with hospital discharges on and after October 18, 2008, the maximum payment limit is $1,250 unless a service or procedure provided during the hospitalization has a fee which exceeds $1,250. If the fee for a service or procedure exceeds $1,250, that fee is the maximum payment limit for the period of hospitalization.

Fiscal Impact

   The cost of implementing this change is estimated at $0.866 ($0.439 million in State funds) in Fiscal Year (FY) 2008-2009 and $1.484 million ($0.751 million in State funds) in FY 2009-2010.

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 30 days will be reviewed and considered for any subsequent revision to the maximum payment for services provided during a period of hospitalization.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note: 14-NOT-571. (1) General Fund; (2) Implementing Year 2008-09 is $439,000; (3) 1st Succeeding Year 2009-10 is $751,000; 2nd Succeeding Year 2010-11 is $751,000; 3rd Succeeding Year 2011-12 is $751,000; 4th Succeeding Year 2012-13 is $751,000; 5th Succeeding Year 2013-14 is $751,000; (4) 2007-08 Program--$593.992M; 2006-07 Program--$671.472M; 2005-06 Program--$945.950M; (7) Medical Assistance--Outpatient; (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 08-1905. Filed for public inspection October 17, 2008, 9:00 a.m.]

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