NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Fee Schedule Update

[52 Pa.B. 7217]
[Saturday, November 19, 2022]

 In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces that it will increase fees in the Medical Assistance (MA) Program for certain ambulance transportation services in both the fee-for service (FFS) and managed care delivery systems, effective with dates of service on and after January 1, 2023.

Discussion

 Act 54 of 2022 (P.L. 540, No. 54) (Act 54), enacted July 11, 2022, authorizes increased MA fees for ambulance transportation services in both the FFS and managed care delivery systems. Specifically, Act 54 authorizes the following fees: not less than $325 for basic life support ambulance transportation services; not less than $400 for advanced life support ambulance transportation services; and a fee of not less than $4 per loaded mile for each loaded mile beyond 20 loaded miles for ground ambulance transportation.

 As a result, the Department is revising the fees on the MA Program Fee Schedule for the following procedure codes, effective with dates of service on and after January 1, 2023.

Procedure Code	Procedure Code Definition	Pricing Modifier	Current MA Fee	MA Fee Effective January 1, 2023
A0425	Ground mileage, per statute mile	U8	$2 per mile for each loaded mile beyond 20 loaded miles of a trip	$4 per mile for each loaded mile beyond 20 loaded miles of a trip
A0426	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)		$300	$400
A0427	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1—emergency)		$300	$400
A0428	Ambulance service, basic life support, nonemergency transport (BLS)		$180	$325
A0429	Ambulance service, basic life support, emergency transport (BLS, emergency)		$180	$325

Fiscal Impact

 The estimated fiscal impact for Fiscal Year (FY) 2022-2023 is $0.943 million in total funds for FFS, $19.123 million in total funds for Capitation and $3.947 million in total funds for Community HealthChoices (CHC). The FY 2023-2024 fiscal impact is an annualized amount of $1.885 million in total funds for FFS, $38.246 million in total funds for Capitation and $9.474 million in total funds for CHC.

Public Comment

 Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision of the MA Program Fee Schedule.

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

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1547. (1) General Fund;

 (7) MA—FFS; (2) Implementing Year 2022-23 is $259,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $517,000; (4) 2021-22 Program—$644,059,000; 2020-21 Program—$808,350,000; 2019-20 Program—$344,107,000;

 (7) MA—Capitation; (2) Implementing Year 2022-23 is $6,345,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $12,392,000; (4) 2021-22 Program—$4,557,000,000; 2020-21 Program—$3,060,000,000; 2019-20 Program—$2,508,000,000;

 (7) MA—CHC; (2) Implementing Year 2022-23 is $1,797,000; (3) 1st Succeeding Year 2023-24 through 5th Succeeding Year 2027-28 are $4,450,000; (4) 2021-22 Program—$4,252,000,000; 2020-21 Program—$3,166,000,000; 2019-20 Program—$2,329,000,000;

 (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 22-1794. Filed for public inspection November 18, 2022, 9:00 a.m.]

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