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DPW Announces Act 22 Regulatory Agenda
February 10, 2012

The Department of Public Welfare (DPW) is moving to implement regulatory changes under the authority of Act 22 of 2011 expedited rulemaking. The February 11 Pennsylvania Bulletin (PAB) includes a regulatory agenda that identifies regulations that are projected to be published in the coming year. The section related to DPW (http://www.pabulletin.com/secure/data/vol42/42-6/262a.html) includes regulations that will be promulgated under Act 22 and also those that will undergo the regulatory review process. On February 18 DPW intends to publish notices of intent for expedited regulations that will make changes to the Medical Assistance (MA) program. PCPA members are asked to be alert to the notices and issuance of expedited regulations that will have a very short, two-week comment period. DPW has requested that Medical Assistance Advisory Committee (MAAC) members submit questions about the regulatory issuance prior to the February 23 meeting so that they may prepare responses. Members are asked to submit questions regarding the notices as soon as possible to Betty Simmonds for discussion at the MAAC and to submit comments directly to DPW. Some regulations will be implemented retroactively, some immediately, and some at a future date.

The following expedited regulatory changes were identified:

  • Office of Developmental Programs, Home and Community-Based Services (55 Pa. Code Ch. 51) – to establish payment rates, fee schedules, and payment methodology for home and community-based services. The regulations will also establish provider qualifications for providers in the Adult Autism, Consolidated, and Person/Family Directed Support waiver programs.
  • Office of Developmental Programs, ICF/MR Programs (55 Pa. Code Ch. 6211) – to revise payment methodologies, provider cost report requirements, and update definitions for private ICF/MR programs.
  • MA Co-Payment Changes (55 Pa. Code, Ch. 1101) – to eliminate excess co-payment reimbursement, to update sliding scale co-payment amounts, and to allow future adjustments to the sliding scale amounts through notice in the PAB, and to apply co-payments for nonemergency medical transportation paratransit services. The regulations will also clarify co-payment exclusions in the MA program.
  • Medical Assistance Pharmaceutical Services Payment Methodology Change (55 Pa. Code Ch. 1121) – to amend current regulations at 55 Pa. Code §§ 1121.55 – 1121.56 related to pharmacy dispensing fees, payment methodology for legend and non-legend drugs, and determination of drug cost.
  • Long-Term Living, Home and Community-Based Services (55 Pa. Code Ch. 52) – to establish provider qualifications and payment provisions for providers in the Aging, Attendant Care, COMMCARE, Independence, and OBRA waivers and the Act 150 program.
  • State Supplementary Payment (SSP) Levels (55 Pa. Code Ch. 299) - to codify the SSP levels in 55 Pa. Code 299.37 and to rescind Appendix A (relating to SSP payment levels).

Please be mindful of the notices and regulations issued by DPW and be prepared for quick review and response. Information will be distributed to members as quickly as possible when it becomes available. PCPA values member input and also encourages direct response to DPW.

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