PRIOR PRINTER'S NOS. 418, 1070 PRINTER'S NO. 1360
No. 396 Session of 1979
INTRODUCED BY MESSRS. TADDONIO, ZORD, DiCARLO, POTT, MRKONIC AND
KNEPPER, FEBRUARY 20, 1979
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES,
MAY 8, 1979
AN ACT
1 Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
2 act to consolidate, editorially revise, and codify the public
3 welfare laws of the Commonwealth," providing for prior
4 authorization for certain medical assistance services.
5 The General Assembly of the Commonwealth of Pennsylvania
6 hereby enacts as follows:
7 Section 1. The act of June 13, 1967 (P.L.31, No.21), known <--
8 as the "Public Welfare Code," is amended by adding a section to
9 read:
10 Section 443.7. Prior Authorization.--The department may
11 develop regulations requiring prior authorization of medical
12 equipment, prescription drugs, oxygen, supportive braces,
13 specific dental services and orthopedic shoes, but not limited
14 thereto. Such regulations may establish procedures for issuing
15 prior authorization at whatever administrative level the
16 department through the secretary deems appropriate.
17 Appropriateness shall be determined by the secretary after
18 hearings have been held and public imput is received.
1 SECTION 1. SUBSECTION (E) OF SECTION 443.6, ACT OF JUNE 13, <--
2 1967 (P.L.31, NO.21) KNOWN AS THE "PUBLIC WELFARE CODE," ADDED
3 SEPTEMBER 26, 1978 (P.L.769, NO.146), IS AMENDED TO READ:
4 SECTION 443.6. REIMBURSEMENT FOR CERTAIN MEDICAL ASSISTANCE
5 ITEMS AND SERVICES.--
6 * * *
7 (E) THE DEPARTMENT SHALL PROMULGATE REGULATIONS TO IMPLEMENT
8 THIS SECTION AND SHALL ESTABLISH A PROCEDURE FOR PRIOR
9 AUTHORIZATION. SUCH REGULATIONS MAY ESTABLISH PROCEDURES FOR
10 ISSUING PRIOR AUTHORIZATION AT WHATEVER ADMINISTRATIVE LEVEL THE
11 DEPARTMENT THROUGH THE SECRETARY DEEMS APPROPRIATE.
12 APPROPRIATENESS SHALL BE DETERMINED BY THE SECRETARY AFTER
13 HEARINGS HAVE BEEN HELD AND PUBLIC INPUT IS RECEIVED. PROCEDURES
14 ADOPTED IN ACCORDANCE WITH THIS SECTION SHALL PROVIDE
15 AUTHORIZATION WHEN APPROPRIATE, WITHOUT UNDUE DELAY. WHEN NO
16 DECISION IS MADE ON A REQUEST TO THE DEPARTMENT FOR COVERED
17 SERVICES WITHIN TWENTY-ONE DAYS OF THE DATE THAT THE REQUEST IS
18 RECEIVED BY THE DEPARTMENT, THE AUTHORIZATION SHALL BE DEEMED
19 APPROVED. THE DEPARTMENT SHALL KEEP A RECORD OF THOSE CASES IN
20 WHICH NO DECISION IS MADE WITHIN TWENTY-ONE DAYS.
21 Section 2. This act shall take effect in 60 days.
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