Medical Assistance Program Fee Schedule; Decrease for Select Incontinence Products [41 Pa.B. 1267]
[Saturday, March 5, 2011]The Department of Public Welfare (Department) announces that it will decrease the fees on the Medical Assistance (MA) Program Fee Schedule for four select incontinence products effective with dates of service on and after March 7, 2011.
Fee Schedule Revisions
The Commonwealth's Medicaid State Plan specifies that maximum fees for services covered under the MA Program must be consistent with efficiency, economy and quality of care.
The Department surveyed all 50 state Medicaid programs for incontinence product fees by Healthcare Common Procedure Coding System procedure codes. The Department received responses from 33 state Medicaid programs for those products that the state had an established fee. The Department averaged the responding Medicaid programs' fees by procedure code for the incontinence products, and found that the majority of the Commonwealth MA Program incontinence product fees were similar to or less than the fees paid by the responding Medicaid programs. The Department identified four incontinence product procedure codes, T4533, T4535, T4536 and T4543, for which its fees are higher than the average incontinence product fee paid by the responding Medicaid programs. To meet efficiency and economy requirements, the Department is decreasing the MA Program Fee Schedule fees for procedure codes T4533, T4535, T4536 and T4543 as follows:
CPT
CodeProcedure Code Definition
Current
MA FeeMA Fee
Effective
March 7, 2011T4533 Youth sized disposable incontinence product, brief/diaper, each $ 0.76 $0.65 T4535 Disposable liner, shield, guard, pad, undergarment for incontinence, each $ 0.76 $0.40 T4536 Incontinence product, protective underwear, pull-on, reusable, any size, each $13.00 $7.20 T4543 Disposable incontinence product, brief, diaper, bariatric, each $ 2.03 $1.62 Fiscal Impact
The estimated savings from this fee decrease for these select incontinence products is $0.549 million ($0.211 million in State funds) in Fiscal Year (FY) 2010-2011. The projected fiscal impact for FY 2011-2012 is estimated at $3.293 million ($1.485 million in State funds).
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 in any subsequent revisions to the MA Program Outpatient Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
GARY D. ALEXANDER,
Acting SecretaryFiscal Note: 14-NOT-682. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 11-394. Filed for public inspection March 4, 2011, 9:00 a.m.]
