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PA Bulletin, Doc. No. 08-1340


Medical Assistance Prior Authorization Requirements

[38 Pa.B. 3942]
[Saturday, July 19, 2008]

Purpose of Notice

   The purpose of this notice is to announce that the Department of Public Welfare (Department) will add nonemergency advanced radiologic imaging services to the Medical Assistance (MA) Program's list of services and items that require prior authorization, effective with dates of service on and after August 1, 2008.

   Section 443.6(b)(7) of the Public Welfare Code (62 P. S. § 443.6(b)(7)) authorizes the Department to add items and services to the list of services requiring prior authorization by publication of notice in the Pennsylvania Bulletin.

   Advanced radiologic imaging services are diagnostic studies that provide greater differentiation than X-rays between bone and soft tissue, allowing practitioners to diagnose diseases at earlier stages while avoiding more invasive and costly diagnostic procedures. The MA Program will require prior authorization for the following outpatient advanced radiologic imaging services:

   *  Magnetic Resonance Imaging (MRI)
   *  Magnetic Resonance Angiogram (MRA)
   *  Magnetic Resonance Spectroscopy (MRS)
   *  Computerized Tomography (CT)
   *  Positron Emission Tomography (PET)
   *  Single Photon Emission Computed Tomography (SPECT)
   *  Nuclear Medicine Cardiology Scans

   The Department will issue an MA Bulletin to providers enrolled in the MA Program, specifying the procedures and review guidelines for obtaining prior authorization of these services.

Fiscal Impact

   Implementing the prior authorization requirement for advanced radiologic imaging services is estimated to save $1.121 million ($0.622 million in State funds) in the Medical Assistance Outpatient Program in Fiscal Year 2008-2009, and annualized savings of $1.345 million ($0.746 million in State funds) are anticipated in Fiscal Year 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 prior authorization requirements for advanced radiologic imaging services.

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


   Fiscal Note: 14-NOT-559. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 08-1340. Filed for public inspection July 18, 2008, 9:00 a.m.]

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