RCPA - Rehabilitation and Community Providers Association
 
 

Archives

MA Copayment Bulletin Issued

The Office of Medical Assistance Programs (OMAP) issued Medical Assistance Bulletin 99-12-03, Updates to Medical Assistance Copayment Policy, effective May 15. This bulletin is applicable to all providers enrolled in the Fee-for-Service (FFS) delivery system, including Access Plus. It is not applicable to managed care.

The bulletin updates sliding scale co-payment amounts as indicated in final-omitted regulations published in the April 14 Pennsylvania Bulletin under expedited rulemaking authority of Act 22 of 2011. The final rule does not address copayment issues related to services for children with disabilities whose family income exceeds 200 percent of the Federal Poverty Income Guidelines. Those will be addressed in a separate bulletin. After consideration of comments, OMAP did not include requirements for the imposition of a $2 per trip copayment for non-emergency medical transportation paratransit services in the final regulation. OMAP eliminated provisions for reimbursement of copayments for MA and General Assistance.

OMAP can update the sliding scale copayment amounts to meet future increases in the medical care component of the Consumer Price Index for all Urban Consumers (CPI-U) through notice in the Pennsylvania Bulletin. Copayment rates are as follows:

Medical Assistance Other than General Assistance

MA FFS
Current Copayment
Copayment May 15
$2 - 10
$.50

$.65

$10.01 - 25
$1.00
$1.30
$25.01 - 50
$2.00
$2.55
$50.01
$3.00
$3.80

General Assistance

MA FFS
Current Copayment
Copayment May 15
$2 - 10
$1.00

$1.30

$10.01 - 25
$2.00
$2.60
$25.01 - 50
$4.00
$5.10
$50.01
$6.00
$7.60

Some recipients and services are excluded from copayment requirements. (See 55 Pa. Code 1101.63(b)). The Copayment Desk Reference that summarizes exclusions, fixed, and sliding scale amounts is available. Address questions about this Info to Betty Simmonds (betty@paproviders.org).

< Back