1608 Medical Assistance Program fee increases for complete early and periodic screening, diagnosis and treatment (EPSDT) screens

Medical Assistance Program Fee Increases for Complete Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Screens

[38 Pa.B. 4838]
[Saturday, August 30, 2008]

Purpose of Notice

   The Department of Public Welfare (Department) announces that it will increase the fees paid by the Medical Assistance (MA) Program for complete EPSDT screens for MA recipients under 21 years of age, effective with dates of service on and after September 1, 2008. The Department consulted with the Pennsylvania Chapter of the American Academy of Pediatrics, the Pennsylvania Medical Society, the Medical Assistance Advisory Committee, medical providers and other key stakeholders in developing the fee increases for complete EPSDT screens. Complete EPSDT screens are those that include all of the screening components listed on the Department's EPSDT Periodicity Schedule. To encourage providers to perform a complete EPSDT screen at each interval on the EPSDT Periodicity Schedule, the fees for the complete EPSDT screens are higher than the combined fees for each component of each periodic screen.

   The Department is increasing the fees for complete EPSDT screens which include all of the components and at intervals listed on the EPSDT Periodicity Schedule as follows:

Screening Period	Description*	Current Fee For Complete Screen	Fee For Complete Screen Effective September 1, 2008
Newborn	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
by 1 month of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
2-3 months of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
4-5 months of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
6-8 months of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
9-11 months of age	Office visit, developmental screen, psychosocial/behavioral assessment, lead screen, anemia screen, oral health	$65.00	$105.00
12 months of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
15 months of age	Office Visit, developmental surveillance, psychosocial/behavioral assessment, oral health	$65.00	$80.00
18 months of age	Office visit, developmental screen, autism screen, psychosocial/behavioral assessment, lead screen, oral health	$65.00	$125.00
24 months of age	Office Visit, autism screen, developmental surveillance, psychosocial/behavioral assessment, lead screen, oral health	$65.00	$105.00
30 months of age	Office Visit, developmental screen, psychosocial/behavioral assessment, lead screen, oral health	$65.00	$105.00
3 years of age and older	Office visit, oral health, age appropriate screens/surveillance	$65.00	$90.00
*Descriptions do not include all activities associated with each periodic EPSDT screen. A complete listing of all activities is included on the Department's EPSDT Periodicity Schedule.

   The Department has issued an MA Bulletin to affected providers with the new EPSDT Periodicity Schedule, which describes each component of each periodic screen in more detail, and instructions explaining how to bill the increased fees.

Fiscal Impact

   The fee increases are estimated to result in increased costs of $2.068 million ($0.941 million in State funds) in the Medical Assistance Outpatient Program in Fiscal Year (FY) 2008-2009 and annualized costs of $3.102 million ($1.409 million in State funds) in FY 2009-2010.

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, Attention: c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions to the MA Program fees for complete EPSDT screens.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at [phone] (TDD users) or [phone] (voice users).

ESTELLE B. RICHMAN,   
Secretary

   Fiscal Note: 14-NOT-567. (1) General Fund; (2) Implementing Year 2008-09 is $0.941 million; (3) 1st Succeeding Year 2009-10 is $1.409 million; 2nd Succeeding Year 2010-11 is $1.409 million; 3rd Succeeding Year 2011-12 is $1.409 million; 4th Succeeding Year is 2012-13 is $1.409 million; 5th Succeeding Year is $1.409 million; (4) 2007-08 Program $593.992 million; 2006-07 Program $671.472 million; 2005-06 Program $945.950 million; (7) Medical Assistance--Outpatient; (8) recommends adoption.

[Pa.B. Doc. No. 08-1608. Filed for public inspection August 29, 2008, 9:00 a.m.]