Current through Register Vol. 54, No. 12, March 23, 2024
(a) Coverage for abortions funded under the
MA 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. Payment will be made only if a "Physician
Certification for an Abortion" form, signed by a licensed physician, is
submitted with the Medical Services Invoice. A sample of the required
"Physician Certification for an Abortion" form appears in the provider handbook
with instructions for its completion.
(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 if a "Physician Certification for an Abortion" form is submitted
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 must include the following:
(A) 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
shall 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 MA 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 MA Program for abortions performed in a hospital which has been
licensed/approved by the Department of Health.
The provisions of this §
1221.57 issued under the Public
Welfare Code (62 P. S. §
453).
This section cited in 55 Pa. Code §
1221.51 (relating to general
payment policy).
