55 Pa. Code § 175.74 - Procedures
(a)
Method
of payment. The method of payment to practitioners and vendors will be
as follows:
(1) In accordance with public
assistance regulations and fee schedules, the Department will make direct
payments to practitioners and vendors for services, medications and medical
supplies provided. This system is necessary because medical needs are extremely
varied and unpredictable, requiring an individualized and flexible way of
meeting these needs.
(2) Payment
for the health items as the usual household medicine chest supplies and items
of personal care will not be included in the system of practitioner and vendor
payments because these items constitute a common, predictable, continuing need.
Therefore, an amount of money to meet this need will be included in the money
payment to the recipient, in the determination of eligibility of the need
amount of the nonmoney payment recipient, and in the evaluation of resources of
a medically needy school child.
(b)
Responsibility of practitioner or
vendor. Since medical care is paid only for eligible persons, it will
be the responsibility of the practitioner or vendor, in order to be assured of
payment, to verify with the County Board of Assistance that the person is
eligible.
(c)
Form PA 21-P
(Authorization Sheets). Form PA 21-P will be used in accordance with
the following:
(1) The Form PA 21-P is used
for determining need for PA, PC, PD and PJ.
(2) The method for determining need will be
the same as the method used to compute the grant as outlined in §
175.24 (relating to procedures),
except that when the NMP client is a person who would be included as a member
of an existing assistance unit if he were a money payment recipient, the
following modifications will apply:
(i)
NMP. The Family Size Allowance of the NMP will be determined
as if the NMP person were included in the assistance unit.
(ii)
Category. Enter the
appropriate category symbol as determined in §
141.71 (relating to policy). For
groups containing more than one category, a separate column will be used for
each category. After the unadjusted monthly grant on the Form PA 21-P has been
computed and is in the amount of $.01 or more, medical assistance to the
categorically needy will be authorized by filling in the column opposite the
spaces below "Cash Grant" as follows:
(A)
Effective date. For openings, changes or discontinuances enter
the date the decision is made or the date the Form PA 124 is completed,
whichever is later.
(B)
Statistical code. Enter one of the action code letters listed
as follows and the appropriate reason code:
(I) Opening-A.
(II) Closing-C.
(III) Deletion of person or
persons-D.
(IV) Addition of person
or persons-E.
(V) Addition or
deletion of persons without change in total number of persons; change of
address-F.
(C)
Reference No. The letter of that section of the Form PA 21
which is affected will be entered.
(D)
Authorized By. Enter the
name or initials of the person authorizing NMP will be entered. After the form
is completed up to this point it will be checked and the NMP Authorization
Card, PA 124, or the NMP Closing Card, PA 124-C, will be typed.
(E)
Typed. The Authorization
Typist will enter initials and the date the Form PA 124 is typed. The initials
of the typist will indicate that all items indicated in the Reference No. block
have been taken care of.
(d)
Identification cards. A
paper ID card, PA 5-A for categorically needy recipients, will be issued to
certify the eligibility of a person for Medical Assistance. In addition, an
embossed plastic card may be issued as a convenience for pharmacists in
preparing invoices. The paper ID card will be the only card entitling a person
to an MA service. Embossed plastic cards will have no value without the
appropriate Medical Assistance Identification Card.
(e)
Quarterly reports.
Quarterly reports will be prepared in accordance with the following:
(1) The CAO will prepare quarterly calendar
reports by memorandum of the total number of PA 5-A and PA 5-C ID cards by
category issued in the quarter. If no cards were issued in certain categories
or if no cards were issued at all, this should be indicated.
(2) The information should be sent to the
Office of Income Maintenance, Room 415, Health and Welfare Building, the 20th
of the month following the end of the calendar quarter using an envelope with
the CAO return address.
Notes
This section cited in 55 Pa. Code § 175.23 (relating to requirements).
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