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PA Bulletin, Doc. No. 03-787



Designated Exceptional Durable Medical Equipment

[33 Pa.B. 2133]

   The Department of Public Welfare (Department) pays for nursing facility services under 55 Pa. Code Chapter 1187 (relating to nursing facility services). That chapter provides that a nursing facility enrolled in the Medical Assistance (MA) Program as a provider of nursing facility services may obtain ''additional payment'' for nursing facility services that are provided to a specific resident and that involve the use of durable medical equipment (DME) that meets the Department's definition of ''exceptional DME.'' See 55 Pa. Code § 1187.151 (relating to definitions).

   ''Exceptional DME'' is defined as ''DME that has a minimum acquisition cost that is equal to or greater than an amount specified by the Department by notice in the Pennsylvania Bulletin and is either specially adapted DME or other DME that is designated as exceptional DME by the Department by notice in the Pennsylvania Bulletin.'' See 55 Pa. Code § 1187.2 (relating to definitions). The Department publishes these notices on an annual basis. See 32 Pa.B. 734, 740 (February 9, 2002).

   The most recent list of exceptional DME was published by the Department at 32 Pa.B. 3267 (July 6, 2002). Among other things, that notice provides that ventilators and related supplies qualify as exceptional DME only if ''[u]sed by residents 21 years of age and older who require full ventilator support for a minimum of 8 hours per day to sustain life.'' By way of this notice, the Department is amending this provision to remove the limitation that the resident be 21 years of age or older. Thus, as amended, ventilators and related supplies are exceptional DME if ''[u]sed by residents who require full ventilator support for a minimum of 8 hours per day to sustain life.'' No other change is made or intended by this notice.

Effective Date

   This change will be effective upon publication in the Pennsylvania Bulletin.

Fiscal Impact

   The estimated increase in annual aggregate expenditures for Medical Assistance nursing facility services for Fiscal Year 2003-2004 will be $0.316 million ($0.143 million in State funds). No fiscal impact is anticipated during Fiscal Year 2002-2003.

Contact Person

   Interested persons are invited to submit written comments within 30 days of this publication to Gail Weidman, Long Term Care Policy Section, Department of Public Welfare, Division of Long Term Care Client Services, P. O. Box 2675, Harrisburg, PA 17105.

   Persons with a disability should use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note:  14-NOT-357; (1) General Fund; (2) Implementing Year 2002-03 is $0; (3) 1st Succeeding Year 2003-04 is $143,000; 2nd Succeeding Year 2004-05 is $156,000; 3rd Succeeding Year 2005-06 is $156,000; 4th Succeeding Year 2006-07 is $156,000; 5th Succeeding Year 2007-08 is $156,000; (4) 2001-02 Program--$761,877,000; 2000-01 Program--$722,565,000; 1999-00 Program--$693,625,000; (7) Medical Assistance--Long Term Care; (8) recommends adoption. Funding for this change is included in the 2003-04 budget.

[Pa.B. Doc. No. 03-787. Filed for public inspection April 25, 2003, 9:00 a.m.]


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