385 Notice of rule change--drug and alcohol clinics with provisional licenses

DEPARTMENT OF PUBLIC WELFARE

Notice of Rule Change--Drug and Alcohol Clinics with Provisional Licenses

[28 Pa.B. 1281]

   The Department of Public Welfare (Department) announces that effective March 1, 1998, enrolled outpatient drug and alcohol clinic providers that are issued provisional licenses from the Department of Health, Division of Drug and Alcohol Program Licensing, may participate in the Medical Assistance Program.

   This Rule Change will be adopted by final rulemaking to 55 Pa. Code, Chapter 1223 (relating to outpatient drug and alcohol services). Failure to implement this rule change may result in undue hardship for eligible Medical Assistance recipients who may not have access to adequate drug and alcohol services.

   This Rule Change has been reviewed by the Office of General Counsel and the Office of Attorney General.

   This Rule Change is made under the Joint Committee on Documents Resolution 1994-1 (3), 24 Pa.B. 2348, and will be in effect for 180 days pending adoption of rulemaking by the Department.

Contact Person

   Interested persons are invited to submit written comments to this notice within 30 days of this publication. Comments should be sent to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Suzanne Love, Room 515 Health and Welfare Building, Harrisburg, PA 17120.

   Persons with a disability may use the AT&T Relay Service by calling [phone] (TDD users) or [phone] (voice users). If another alternative is required, contact Thomas Vracarich at [phone].

Purpose

   The purpose of this bulletin is to revise the medical assistance (MA) enrollment policy for outpatient drug and alcohol clinics.

Scope

   This bulletin applies to outpatient drug and alcohol clinics enrolled or considering enrollment in the MA Program under the Fee-For-Service delivery system and managed care organizations under contract with the Department.

Background

   MA regulation at 55 Pa. Code, § 1223.41 states:

''§ 1223.41.  Participation requirements.

   In addition to the participation requirements established in Chapter 1101 of this title (relating to general provisions), drug/alcohol clinics must meet the following participation requirements:

   (1)  Have current full licensure as a drug/alcohol outpatient facility by the Governor's Council on Drug and Alcohol Abuse. To remain eligible for medical assistance reimbursement, a facility must be fully licensed at all times as a drug/alcohol outpatient clinic. Any conditional or provisional licensure or approval, or substandard compliance with full licensure will render the facility ineligible to receive medical assistance reimbursement for the conditional/provisional period.''

Discussion

   Since responsibility for licensing drug and alcohol clinics rests with the Department of Health (DOH), Division of Drug and Alcohol Program Licensing, the Office of Medical Assistance Programs is revising its regulations to delete references to the Governor's Council on Drug and Alcohol Abuse.

   To be consistent with DOH, Drug and Alcohol Program licensing, MA is revising its regulations to allow a clinic with a provisional license to bill for covered services rendered to eligible recipients.

   Under the DOH regulations, a provisional license does not prohibit a clinic from treating patients. New clinics are issued provisional licenses for a 6-month period following an initial Drug and Alcohol Program Licensing site inspection. Within the 6-month period the clinic must demonstrate that it can provide the services required by regulation. If the clinic meets these regulations, the DOH, Division of Drug and Alcohol Program Licensing will issue the clinic a full license. If the clinic does not meet the licensing regulations within the 6-month period, the clinic may receive another provisional license.

   A fully licensed facility may receive a full or provisional license after its yearly inspection. If the clinic receives a provisional license, the clinic has 6 months to meet regulations. If the clinic does not meet Drug and Alcohol Program licensing regulations within the 6-month period, the clinic may receive another provisional license.

   This change does not affect the participation requirement set forth at § 1223.41(8) which states: ''. . . It is the clinic director's responsibility to notify the Office of Medical Assistance Programs, in writing, of any changes in the clinic's full compliance with licensure standards ...within 30 days following any change. . .'' (emphasis added). For example, if a fully licensed clinic is issued a provisional license, the clinic director must notify MA in writing of the change in status. Conversely, when a clinic with a provisional license is granted a full license, the clinic director must also notify MA of the change.

Policy

   Effective March 1, 1998, 55 Pa. Code, § 1223.41 will read as follows:

§ 1223.41.  Participation requirements.

   In addition to the participation requirements established in Chapter 1101 of this title (relating to general provisions), drug/alcohol outpatient clinics must meet the following participation requirements:

   (1)  Must be fully or provisionally licensed/approved as an outpatient drug/alcohol facility by the Department of Health. To remain eligible for Medical Assistance reimbursement, an enrolled facility must be fully or provisionally licensed/approved at all times as an outpatient drug and alcohol clinic.

Procedure

   To enroll in the MA Program or to notify MA of any changes in licensing status, forward the appropriate information to: Office of Medical Assistance Programs, Provider Enrollment Unit, P. O. Box 8045, Harrisburg, PA 17105.

FEATHER O. HOUSTOUN,   
Secretary

   Fiscal Note:  14-NRC-72. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 98-385. Filed for public inspection March 6, 1998, 9:00 a.m.]