Section 1141.57. Payment conditions for necessary abortions

(a) Coverage for abortions funded under the Medical Assistance Program will be available only under the following circumstances:

(1) Where a physician has certified in writing and documented in the patient’s record that the life of the woman would be endangered if the pregnancy were allowed to progress to term. The decision as to whether the woman’s life is endangered is a medical judgment to be made by the woman’s physician.

(i) Payment will be made only if a licensed physician submits a signed ‘‘Physician Certification for An Abortion’’ form, as set forth in Appendix B, with the Medical Services Invoice.

(ii) A second physician’s opinion regarding endangerment of the woman’s life is optional and is not a prerequisite to payment for a covered abortion. However, the person or the attending physician, with the consent of the person, may obtain a second physician’s opinion.

(2) Where the recipient was the victim of rape or incest and the incident was reported to a law enforcement agency or to a public health service within 72 hours of its occurrence in the case of rape and within 72 hours of the time the physician notified the patient that she was pregnant in the case of incest. A law enforcement agency means an agency or part of an agency that is responsible for the enforcement of the criminal laws, such as a local police department or sheriff’s office. A public health service means an agency of the Federal, State, or local government or a facility certified by the Federal government as a Rural Health Clinic that provides health or medical services except for those agencies whose principal function is the performance of abortions.

(i) Payment will be made only if a licensed physician submits a signed ‘‘Physician Certification for an Abortion’’ form, as set forth in Appendix B, with the Medical Services Invoice along with documentation signed by an official of the law enforcement agency or public health service to which the rape or incest was reported. The documentation shall include the following:

(A) All of the information specified in subparagraph (ii).

(B) A statement that the report was signed by the person making the report.

(ii) The report of the rape or incest need not be made by the victim herself but can be reported by another person. The report need not be made in person but may be made by mail. The report itself must be signed by the person who reports the rape or incest and shall include the following information:

(A) The name and address of the victim.

(B) The name and address of the person who made the report—if different from the victim.

(C) The date of the incident if it was rape.

(D) The date the report was made.

(b) Insofar as required by the Department of Health regulations, during the first 12 weeks of pregnancy payment will only be made under the Medical Assistance Program for an abortion performed in a licensed physician’s office, a clinic or a hospital facility, that has been licensed/approved by the Department of Health for that purpose.

(c) Insofar as required by the Department of Health regulations, after the first 12 weeks of pregnancy, payment will only be made under the Medical Assistance Program for abortions performed in a hospital which has been licensed/approved by the Department of Health.

The provisions of this § 1141.57 adopted August 15, 1980, effective September 1, 1980, 10 Pa.B. 3386; amended February 13, 1981, effective February 15, 1981, 11 Pa.B. 657; amended August 7, 1981, effective August 8, 1981, 11 Pa.B. 2770. Immediately preceding text appears at serial pages (60742) and (60743).

Notation

Authority

The provisions of this § 1141.57 issued under the Public Welfare Code (62 P. S. § 453).

Notes of Decisions

The Department of Public Welfare’s regulations which require that a victim of a rape report its occurrence within 72 hours to a law enforcement agency or a public health service or that a victim of incest report to either a public authority or a public health service within 72 hours from the time the victim is advised of her pregnancy in order to qualify for state funding of an abortion were held to be an unconstitutional intrusion upon the right of privacy guaranteed under Article I, Section 1 of the Pennsylvania Constitution. Fischer v. Dept. of Public Welfare, 482 A.2d 1148, 1153 (1984); affirmed 502 A.2d 114 (Pa. 1985); motion denied 543 A.2d 177 (Pa. 1988).

Cross References

This section cited in 55 Pa. Code § 1126.51 (relating to general payment policy); 55 Pa. Code § 1141.51 (relating to general payment policy); 55 Pa. Code § 1141.52 (relating to payment conditions for various services); 55 Pa. Code § 1141.53 (relating to payment conditions for outpatient services); and 55 Pa. Code § 1141.54 (relating to payment conditions for inpatient services).