Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart D - Determination of Need and Amount of Assistance › Chapter 175 - ALLOWANCES AND BENEFITS › MA ALLOWANCES AND BENEFITS PROVISIONS FOR THE CATEGORICALLY NEEDY AND SCHOOL CHILDREN WHO ARE ONLY MEDICALLY NEEDY › Section 175.71 - Policy

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department
					 of Human Services will pay for those types of medical and allied services given
					 in the home, office, clinic or hospital that are generally recognized as
					 necessary treatment of illnesses.
(b) It will be the intention of the
					 Department of Human Services to pay for adequate medical care, in accordance
					 with accepted standards of good medical practice, to achieve the purposes set
					 forth in this chapter.
(c) There
					 will be no intention to pay for extravagant or superfluous medical care, or
					 care that would be beyond the means of the average family of moderate income.
					 Nor will the Department of Human Services pay for new and expensive medication
					 or treatment that is still in the experimental stage.
(d) The Department of Human Services will
					 expect that the professional participants, in giving services and prescribing
					 supplies within the scope of the program, may not exceed in an individual
					 instance what is essential for adequate medical care for that
					 individual.
(e) The fees paid by
					 the Department of Human Services will be in full payment of services given. A
					 practitioner who seeks or accepts additional remuneration of any kind from the
					 patient, or another person, shall be considered as violating the regulations of
					 the medical care program and will be subject to disciplinary action.
(f) The program of medical care will include
					 physicians', clinic, and dental services, medications, medical goods and
					 supplies, ambulance service, inpatient hospital care, hospital-home care,
					 nursing care in the home, public nursing home care, private nursing home care,
					 care in a mental institution and medical-social services, in accordance with
					 the regulations and fees established by the Department.
(g) The program of medical care will be
					 supplemental to other existing resources for medical services or supplies, and
					 presupposes full use of other tax-supported or voluntary agencies or facilities
					 for meeting medical needs.
(h) It
					 will be the responsibility of a County Assistance Office to be aware of the
					 resources in the area and to see that these are fully used in meeting the
					 medical needs of assistance recipients and others who apply for medical
					 assistance.
(i) The Department
					 should be charged only for services that are not available through another
					 existing tax-supported or voluntary facility. It is recognized that the
					 services of many facilities are limited in scope and availability. However,
					 some are available throughout the Commonwealth. The Department will not pay for
					 or duplicate services that are available from these statewide facilities and
					 agencies. They include treatment for rabies, which is available through County
					 Authorities, vaccinations, which is available through local school districts or
					 facilities of the State Department of Health or local boards of health,
					 physicians' services to assistance recipients in hospitals, medical care for
					 recipients certified for medical services under the Workmen's Compensation Act
					 (77
					 P. S. §§
												1-1031) or the
					 Occupational Disease Act (77 P. S. §§
												1201-1603), services for handicapped
					 children, which are provided by the State Department of Health, treatment for
					 tuberculosis or venereal diseases, which is the responsibility of State Health
					 Clinics. Since the diagnosis of tuberculosis and venereal disease may not be
					 known to the patient when he first seeks medical care, the Department will pay
					 for the initial visit to a private physician or a hospital clinic when
					 necessary to establish a diagnosis. This will not be paid for a school child
					 who is only medically needy, since diagnostic service is provided in the course
					 of the school health examination.
(j) The program of medical care as defined in
					 regulations is designed to provide treatment for the usual medical needs
					 arising from illness, disability or infirmity, and for certain needs associated
					 with restoration to self-support. Specific situations may arise in which
					 adequate medical care requires unusual or exceptional types of treatment,
					 medication or supplies that are not specified in the public assistance
					 regulations and are not available from any other source. In these cases, at the
					 request of the practitioner, transmitted through the County Assistance Office,
					 the State Office of Public Assistance will review the circumstances and approve
					 and preauthorize the service when it is deemed necessary to meet adequately the
					 needs of the eligible patient.