Current through Register Vol. 54, No. 49, December 7, 2024
Section 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: (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.The provisions of this § 175.74 adopted August 4, 1977, effective 8/5/1977, 7 Pa.B. 2180; amended July 28, 1978, effective 8/28/1978, 8 Pa.B. 2104. This section cited in 55 Pa. Code § 175.23 (relating to requirements).