Section 454 - Medical assistance benefit packages; coverage, copayments, premiums and rates(a) Notwithstanding any other provision of law to the contrary, the department shall promulgate regulations as provided in subsection (b) to establish provider payment rates; the benefit packages and any copayments for adults eligible for medical assistance under Title XIX of the Social Security Act (49 Stat 620, 42 U.S.C. § 1396 et seq.) and adults eligible for medical assistance in general assistance-related categories; and the premium or copayment requirements for disabled children whose family income is above two hundred percent of the Federal poverty income limit. Subject to such Federal approval as may be necessary, the regulations shall authorize and describe the available benefit packages and any copayments and premiums, except that the department shall set forth the copayment and premium schedule for disabled children whose family income is above two hundred percent of the Federal poverty income limit by publishing a notice in the Pennsylvania Bulletin. The department may adjust such copayments and premiums for disabled children by notice published in the Pennsylvania Bulletin. The regulations shall also specify the effective date for provider payment rates.(b) For purposes of implementing this section, and notwithstanding any other provision of law, including section 814-A of this act, the secretary shall promulgate regulations pursuant tosection 204(1)(iv) of the act of July 31, 1968 (P.L. 769, No. 240), referred to as the Commonwealth Documents Law, which shall, until December 31, 2005, be exempt from all of the following acts:(1)Section 205 of the Commonwealth Documents Law.(2) Section 204(b) of the act of October 15, 1980 (P.L. 950, No. 164), known as the "Commonwealth Attorneys Act."(3) The act of June 25, 1982 (P.L. 633, No. 181), known as the "Regulatory Review Act."(c) The department is authorized to grant exceptions to any limits specified in the benefit packages adopted under this section or when any of the following circumstances applies: (1) The department determines the recipient has a serious chronic systemic illness or other serious health condition and denial of the exception will jeopardize the life of or result in the rapid, serious deterioration of the health of the recipient.(2) The department determines that granting a specific exception to a limit is a cost-effective alternative for the medical assistance program.(3) The department determines that granting an exception to a limit is necessary in order to comply with Federal law.(d) As used in this section: "Adult" means recipients twenty-one years of age or older, except when in relation to copayments, for which the term means recipients eighteen years of age or older.
"Benefit packages" means the list of items and services covered by medical assistance, including any limitations on covered items and services.
Amended by P.L. 369 2013 No. 55, § 2, eff. 7/9/2013.1967, June 13, P.L. 31, No. 21, art. 4, § 454, added 2005, July 7, P.L. 177, No. 42, § 6, imd. effective. Amended 2011, June 30, P.L. 89, No. 22, § 7, effective July 1, 2011.