PRINTER'S NO. 1634
No. 1250 Session of 2001
INTRODUCED BY ROBBINS, LAVALLE, TOMLINSON, EARLL, WAUGH, BODACK,
HOLL, KUKOVICH, LEMMOND, GERLACH, ERICKSON, RHOADES, MUSTO,
ORIE, MADIGAN, SCARNATI, SCHWARTZ, KASUNIC AND ARMSTRONG,
DECEMBER 13, 2001
REFERRED TO PUBLIC HEALTH AND WELFARE, DECEMBER 13, 2001
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," further providing for
4 certain medical assistance payments.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. Section 443.3 of the act of June 13, 1967
8 (P.L.31, No.21), known as the Public Welfare Code, amended
9 November 28, 1973 (P.L.364, No.128), is amended to read:
10 Section 443.3. Other Medical Assistance Payments.--Payments
11 on behalf of eligible persons shall be made for other services,
12 as follows:
13 (1) Rates established by the department for outpatient
14 services as specified by regulations of the department adopted
15 under Title XIX of the Federal Social Security Act consisting of
16 preventive, diagnostic, therapeutic, rehabilitative or
17 palliative services; furnished by or under the direction of a
18 physician, chiropractor or podiatrist, by a hospital or
1 outpatient clinic which qualifies to participate under Title XIX
2 of the Federal Social Security Act, to a patient to whom such
3 hospital or outpatient clinic does not furnish room, board and
4 professional services on a continuous, twenty-four hour a day
5 basis. The following shall apply:
6 (i) Except for managed care arrangements, the department
7 shall pay general acute care hospitals, psychiatric providers
8 and rehabilitation providers for outpatient services on a fee-
9 for-service basis.
10 (ii) Beginning July 1, 2002, through June 30, 2003, the
11 department shall pay each hospital, psychiatric provider and
12 rehabilitation provider an outpatient supplemental payment equal
13 to fifteen percent of the total payments made to these providers
14 for outpatient services provided during the previous twelve
15 months.
16 (iii) Beginning July 1, 2003, and thereafter, the department
17 shall establish an outpatient payment system for hospitals,
18 psychiatric providers and rehabilitation providers using
19 procedure and description codes used under the Medicare program.
20 The rates for each procedure shall not be less than those paid
21 under the Medicare program. The rates shall be adjusted annually
22 beginning July 1, 2004, and thereafter.
23 (2) Rates established by the department for (i) other
24 laboratory and X-ray services prescribed by a physician,
25 chiropractor or podiatrist and furnished by a facility other
26 than a hospital which is qualified to participate under Title
27 XIX of the Federal Social Security Act, (ii) physician's
28 services consisting of professional care by a physician,
29 chiropractor or podiatrist in his office, the patient's home, a
30 hospital, a nursing home or elsewhere, (iii) the first three
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1 pints of whole blood, (iv) remedial eye care, as provided in
2 Article VIII consisting of medical or surgical care and aids and
3 services and other vision care provided by a physician skilled
4 in diseases of the eye or by an optometrist which are not
5 otherwise available under this Article, (v) special medical
6 services for school children, as provided in the Public School
7 Code of 1949, consisting of medical, dental, vision care
8 provided by a physician skilled in diseases of the eye or by an
9 optometrist or surgical care and aids and services which are not
10 otherwise available under this article.
11 Section 2. This act shall take effect immediately.
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