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• Increased outpatient substance abuse treatment from 30 days to 90 full-session visits per year, and from 120 to 360 days in a lifetime; • Increased the non-hospital residential care limit from 30 to 90 days per year and from 90 to 360 in a lifetime; • Increased the number of therapy visits for speech, occupational and physical therapy from 60 combined to 60 for each type of service annually; and • Established no maximums for chemotherapy, dialysis, respiratory and radiation therapy.

• This SPA also added two crowd-out strategies for children above 200 percent of the FPL.

Children Covered Under the Program

• The State reported that 256,627 children were ever enrolled in its program during Federal Fiscal Year 2008.

Administration

• PA CHIP is administered by the Pennsylvania Insurance Department.

Health Care Delivery System

• Managed care contracts cover most areas of the State. Less than 5 percent of enrollees in rural areas do not have access to managed care and are served through fee for service.

Benefit Package

• The benefit package is the PA CHIP benefit package that was implement prior to SCHIP. Pennsylvania is one of three states whose comprehensive benefit package was cited by Title XXI as having sufficient coverage to meet the requirements for a State Children's Health Insurance Plan. Services include: inpatient hospitalization; outpatient services; physician services; surgical services; clinic services; prescription drugs; laboratory and radiological services; inpatient and outpatient mental health services; inpatient and outpatient substance abuse services; durable medical equipment; home and community-based health care services; nursing care services; dental services; case management; physical, occupational, and speech therapy; hospice care; and ambulance services when medically necessary. Did you update in relationship to this amendment? Please make sure it’s accurate.

Cost Sharing

• There is no cost sharing for families at or below 200 of the FPL.

• There are monthly premiums to children above 200 percent and at or below 300 percent of the FPL.

• For children above 200 percent of the FPL, there are co-payments for physician visits (other than preventive and diagnostic dental services, vision services, well-baby-well-child, immunizations, or emergency care that results in admissions as follows: