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​DHS COVID-19 PROVIDER RESOURCES // OMAP

Medical Assistance Bulletin 99-20-07:
"Payment in Full" and Personal Protective Equipment

Issued: June 12, 2020

Important Reminder: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every five years. Providers should log into PROMISe™ to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Enrollment (revalidation) applications may be found at https://www.dhs.pa.gov/providers/Providers/Pages/PROMISeEnrollment.aspx. 

Purpose

 The purpose of this bulletin is to advise providers that Medical Assistance (MA) beneficiaries may not be charged for Personal Protective Equipment (PPE) used in connection with medical or dental services. 

Scope

 This bulletin applies to all providers who render services to MA beneficiaries. 

Background

 On March 6, 2020, Governor Tom Wolf issued a public health emergency declaration in response to the presence of COVID-19 in Pennsylvania. On March 13, 2020, COVID-19 was declared a nationwide emergency under the Stafford Act retroactive to March 1, 2020. 

PPE is used, consistent with guidance by the Centers for Disease Control and Prevention, as part of efforts to mitigate the spread of COVID-19. The Department of Human Services has received inquiries from providers as to whether they may charge MA beneficiaries for the PPE used in connection with medical or dental services during the COVID-19 emergency. 

Discussion

The Human Services Code, 62 P.S. § 1406(a), and MA regulations at 55 Pa. Code § 1101.63, provide that all payments to providers in the MA Program, plus any copayment, constitute full payment for covered service. Providers are to accept the MA fee, and any required copayment, as payment in full and may not seek or accept supplementary payment for a covered service. A provider who seeks or accepts supplementary payment of another kind for a covered service or item is required to return the supplementary payment. See 55 Pa. Code § 1101.63a 

PPE is a supply and is part of the provider's overhead and cost of doing business. As such, providers may not charge MA beneficiaries for any PPE that is used in connection with a medical or dental service. 

Procedure

Providers may not charge MA beneficiaries for PPE used during the delivery of a Medicaid-covered service. The MA fee for the service plus any required copayment is considered to be payment in full. Providers are prohibited from seeking or receiving any additional payment. 

Any provider who may have charged MA beneficiaries for PPE must refund or credit the payment to the beneficiary. 

Information on MA Program coverage related to COVID-19 can be found on the Department of Human Services website here. 

The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides regular updates. Click here for the most up to date information regarding COVID-19. 

Comments and Questions

 The appropriate toll-free number for your provider type. Visit the Office of Medical Assistance Programs website at https://www.dhs.pa.gov/providers/Providers/Pages/Health%20Care%