Current through Register Vol. 54, No. 44, November 2, 2024
(a) Coverage for abortions funded under the
Medical Assistance Program will be available only under the following
circumstances:
(1) Where a physician has
certified in writing and documented in the patient's record that the life of
the woman would be endangered if the pregnancy were allowed to progress to
term. The decision as to whether the woman's life is endangered is a medical
judgment to be made by the woman's physician.
(i) Payment will be made only if a licensed
physician submits a signed "Physician Certification for An Abortion" form, as
set forth in Appendix B, with the Medical Services Invoice.
(ii) A second physician's opinion regarding
endangerment of the woman's life is optional and is not a prerequisite to
payment for a covered abortion. However, the person or the attending physician,
with the consent of the person, may obtain a second physician's
opinion.
(2) Where the
recipient was the victim of rape or incest and the incident was reported to a
law enforcement agency or to a public health service within 72 hours of its
occurrence in the case of rape and within 72 hours of the time the physician
notified the patient that she was pregnant in the case of incest. A law
enforcement agency means an agency or part of an agency that is responsible for
the enforcement of the criminal laws, such as a local police department or
sheriff's office. A public health service means an agency of the Federal,
State, or local government or a facility certified by the Federal government as
a Rural Health Clinic that provides health or medical services except for those
agencies whose principal function is the performance of abortions.
(i) Payment will be made only if a licensed
physician submits a signed "Physician Certification for an Abortion" form, as
set forth in Appendix B, with the Medical Services Invoice along with
documentation signed by an official of the law enforcement agency or public
health service to which the rape or incest was reported. The documentation
shall include the following:
(A) All of the
information specified in subparagraph (ii).
(B) A statement that the report was signed by
the person making the report.
(ii) The report of the rape or incest need
not be made by the victim herself but can be reported by another person. The
report need not be made in person but may be made by mail. The report itself
must be signed by the person who reports the rape or incest and shall include
the following information:
(A) The name and
address of the victim.
(B) The name
and address of the person who made the report-if different from the
victim.
(C) The date of the
incident if it was rape.
(D) The
date the report was made.
(b) Insofar as required by the Department of
Health regulations, during the first 12 weeks of pregnancy payment will only be
made under the Medical Assistance Program for an abortion performed in a
licensed physician's office, a clinic or a hospital facility, that has been
licensed/approved by the Department of Health for that purpose.
(c) Insofar as required by the Department of
Health regulations, after the first 12 weeks of pregnancy, payment will only be
made under the Medical Assistance Program for abortions performed in a hospital
which has been licensed/approved by the Department of Health.
The provisions of this §1141.57 issued under the Public
Welfare Code (62 P. S. §
453).
This section cited in 55 Pa. Code §
1126.51 (relating to general
payment policy); 55 Pa. Code §
1141.51 (relating to general
payment policy); 55 Pa. Code §
1141.52 (relating to payment
conditions for various services); 55 Pa. Code §
1141.53 (relating to payment
conditions for outpatient services); and 55 Pa. Code §
1141.54 (relating to payment
conditions for inpatient services).
