257 Notice of Rule Change--180 day extension: Prior authorization for psychiatric partial hospitalization services

Notice of Rule Change--180 Day Extension; Prior Authorization for Psychiatric Partial Hospitalization Services

[26 Pa.B. 806]

   On January 28, 1995, the Department published a Notice of Rule Change (NORC) (14-NRC-55) at 25 Pa.B. 347 relating to Prior Authorization for Psychiatric Partial Hospitalization Services under Joint Committee on Documents Resolution 1994-1 (JCD Resolution). The Rule Change will be adopted by final rulemaking to 55 Pa. Code Chapter 1153.53(1).

   The Notice announced that effective January 28, 1995 the Department will require prior authorization for psychiatric partial hospitalization services that exceed the limit of 240 three hour sessions (720 total hours) of psychiatric partial hospitalization in a 365 consecutive day period for recipients under 21 years of age. Federal law requires states, with respect to Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) coverage under the Medical Assistance Program, to cover services or treatment which are medically necessary to correct or lessen health problems of these persons. Although a state may not place an absolute limit on a medically necessary service, it may require that the service be prior authorized (42 U.S.C.A. § 1396d(r)(5)), (42 C.F.R. 440.230(d)). The limitation of 720 total hours remains in effect for recipients age 21 and over. The regulation is currently under development in the Department.

   This Notice, under section 2(d)(iii) of the JCD Resolution, announces that the original NORC (14-NRC-55) shall remain in effect for an additional 180 days or until final regulations are adopted, whichever is sooner, This  
Rule Change was initially extended by publication of a 180 Day Extension at 25 Pa.B. 3920 on September 16, 1995.

   Under section 4 of the JCD Resolution, copies of this Notice have been forwarded to the Senate Public Health and Welfare Committee and the House Health and Human Services Committee.

FEATHER O. HOUSTOUN,   
Secretary

[Pa.B. Doc. No. 96-257. Filed for public inspection February 23, 1996, 9:00 a.m.]