Covered serviceA benefit to which a MA recipient is entitled under the MA Program of the Commonwealth. Immediately preceding text appears at serial pages (117328) to (117331). (B)For prospective exception requests when the provider indicates an urgent need for quick response, within 48 hours after the Department receives the request. (3)A written Notice of Appeal shall be filed within 30 days of the date of the notice of termination. (3)In addition to the penalties specified in subsections (a) and (b) and as ordered by the court, the convicted person shall repay the amount of excess benefits or payments received under the program, plus interest on the amount at the maximum legal rate. Regulations specific to each type of provider are located in the separate chapters relating to each provider type. Scope of division. (5)The convicted person is ineligible to participate in the program for 5 years from the date of the conviction. In addition to the requirements in subsection (c), the following requirements apply: (1)A provider shall submit invoice exception requests in writing to the Office of Medical Assistance Programs. MedicaidMedical Assistance provided under a State Plan approved by HHS under Title XIX of the Social Security Act. (b)The Department may seek reimbursement from the ordering or prescribing provider for payments to another provider, if the Department determines that the ordering or prescribing provider has done either of the following: (1)Prescribed excessive diagnostic services; or. Lancaster v. Department of Public Welfare, 916 A.2d 707, 712 (Pa. Cmwlth. The Bureau of Hospital and Outpatient Programs will forward an enrollment form and provider agreement to the applicant to be completed and returned to the Department. (xv)Podiatrists services as specified in Chapter 1143 and in subparagraph (i). Following an administrative proceeding, Medicare providers plea of nolo contendere was a conviction under this statute but the provider should have been given an opportunity to present evidence at the disciplinary hearing where the plea was being used to establish a violation of Department regulations. (E)The Department may, by publication of a notice in the Pennsylvania Bulletin, adjust these copayment amounts based on the percentage increase in the medical care component of the Consumer Price Index for All Urban Consumers for the period of September to September ending in the preceding calendar year and then rounded to the next higher 5-cent increment. (iv)The Department will respond to a request for an exception no later than: (A)For prospective exception requests, within 21 days after the Department receives the request. The provisions of this 1101.76 adopted November 18, 1983, effective November 19, 1983, 13 Pa.B. No basis existed to allow Medical Assistance program provider to pursue separate appeals regarding disputed audit findings of Department of Public Welfares final cost settlement report regarding reimbursement claims; dismissal of appeal transferred from Board of Claims to Bureau of Hearings and Appeals was warranted since provider had other appeal before Bureau which provided adequate remedy to seek relief and the transferred appeal challenged same cost adjustments. (5)Chapter 1241 (relating to early and periodic screening diagnosis and treatment program). (vi)Services provided to individuals eligible for benefits under Title IV-B Foster Care and Title IV-E Foster Care and Adoption Assistance. 4418. (C)Psychiatric clinic services as specified in Chapter 1153, including a total of 5 hours or 10 one-half hour sessions of psychotherapy per recipient in a 30 consecutive day period. This section cited in 55 Pa. Code 1101.74 (relating to provider fraud); 55 Pa. Code 1127.81 (relating to provider misutilization); and 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions). See, e.g, 24 PS 13-1301-A (pertaining to Safe Schools); 24 PS 11-1113 (d) (1) (pertaining to Transferred Programs and Classes); and 24 PS 25-2597 (c) (pertaining to Distance Learning Grants). (I)Drugs whose only approved indication is the treatment of acquired immunodeficiency syndrome (AIDS). (c)A provider may bill an MA recipient for a noncompensable service or item if the recipient is told before the service is rendered that the program does not cover it. Question of the proper interpretation of the 180-day rule under this provision was not reached by the court, where the fact-finder, the director of the Office of Hearing and Appeals of the Department, made a finding of fact concerning the submission of invoices so vague as to be insufficient to resolve the complex questions in the case. The basis for this coverage is the EPSDT. The provisions of this 1101.33 amended April 27, 1984, effective April 28, 1984, 14 Pa.B. (b)Persons covered by Medicare and MA. (c)Invoice exception criteria. Session 2007/2008 First Report The Committee for Agriculture and Rural Development Report into Renewable Energy and Alternative Land Use. 1996). 1982). On December 3, 2021, the County submitted a position statement, reiterating The provisions of this 1101.67 issued under sections 403(a) and (b) and 443.6 of the Public Welfare Code (62 P. S. 403(a) and (b) and 443.6). The term includes other health insurance plans. (1)Services rendered, ordered, arranged for or prescribed for MA recipients by a physician whose license to practice medicine has expired are not eligible for payment under the MA Program. 5996; amended January 9, 1998, effective January 12, 1998, 28 Pa.B. 3653. The provisions of this 1101.42a adopted September 1, 1989, effective immediately, retroactively applicable to July 1, 1988, 19 Pa.B. Childrens Hospital of Philadelphia v. Department of Public Welfare, 621 A.2d 1230 (Pa. Cmwlth. This record shall contain, at a minimum, all of the following: (i)A complete medical history of the patient. (2)If the Department takes action, it will issue a Notice of Exclusion to the nonparticipating former provider stating the basis for the action, the effective date, whether the Department will consider re-enrollment, and, if so, the date when the request for re-enrollment will be considered. Out-of-State providers shall be licensed, and registered or certified or both, by the appropriate agencies in their respective states. The Department may at its discretion refuse to enter into a provider agreement. (5)Borrow or use a MA identification card for which he is not entitled or otherwise gain or attempt to gain medical services covered under the MA Program if he has not been determined eligible for the Program. Immediately preceding text appears at serial page (75054). (10)Chapter 1123 (relating to medical supplies). (2)The Department will, if necessary, ask the practitioner for additional information to assist the Departments medical consultants to reach a decision. The provisions of this 1101.77 issued under sections 403(a) and (b) and 1410 of the Public Welfare Code (62 P. S. 403(a) and (b) and 1410). Leader Nursing Centers, Inc. v. Department of Public Welfare, 475 A.2d 859 (Pa. Cmlth. Department of Public Welfare v. Soffer, 544 A.2d 1109 (Pa. Cmwlth. 1880. Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. (d)Other invoice exception requirements. 1985). Chapter 1101 - GENERAL PROVISIONS; Chapter 1101 - GENERAL PROVISIONS . (4)Not complied with the terms of the provider agreement. (b)Coverage for out-of-State services. 5240; amended August 26, 2005, effective August 29, 2005, 35 Pa.B. (b)Section 1101.51(c)(3) (relating to ongoing responsibilities of providers) does not preclude the enrollment of a provider who is located within another providers office, if both the co-located providers: (1)Complete an attestation form, as specified by the Department. Providers are prohibited from factoring, assigning, reassigning or executing a power of attorney for the rights to any claims or payments for services rendered under the program except as provided in paragraphs (1) and (3). (e)GA recipients. Immediately preceding text appears at serial page (124111). The provisions of this 1101.41 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. (7)Chapter 1251 (relating to funeral directors services). Recipients under age 21 are entitled to benefit coverage for preventive health screening and vision, dental, and hearing problems. Section 11-1121 - Contracts; execution; form (a) In all school districts, all contracts with professional employes shall be in writing, in duplicate, and shall be executed on behalf of the board of school directors by the president and secretary and signed by the professional employe. (2)Funding for parties. The PSC (Section 1401 ) also requires that schools employ nurses. The provisions of this 1101.63 amended under sections 201(2), 403(b), 403.1, 443.1, 443.3, 443.6, 448 and 454 of the Public Welfare Code (62 P. S. 201(2), 403(b), 403.1, 443.1, 443.3, 443.6, 448 and 454). Establishment of Independent Districts for Transfer of Territory to Another School District. (xvii)CRNP services as specified in Chapter 1144 and in subparagraph (i). The provisions of this 1101.95 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. The Departments jurisdiction over provider appeal is not mandatory and exclusive. The Notice of Appeal will be considered filed on the date it is received by the Director, Office of Hearings and Appeals. Toggle navigation. (3)The Department may request additional documentation to justify approval of an exception. The providers timely written response to the cost settlement letter will be determined by the postmark on the providers letter or, if hand delivered, the Departments date stamp. Payment may be made to practitioners professional corporations or partnerships if the professional corporation or partnership is composed of like practitioners. (a)Supplementary payment for a compensable service. (iii)Prescribed, provided or ordered by an appropriate licensed practitioner in accordance with accepted standards of practice. 3762. 1101. (4)Additional reporting requirements for a shared health facility. 138. A service, item, procedure or level of care that is necessary for the proper treatment or management of an illness, injury or disability is one that: (1)Will, or is reasonably expected to, prevent the onset of an illness, condition, injury or disability. (b)Accepted practices. Jack v. Department of Public Welfare, 568 A.2d 1339 (Pa. Cmwlth. In addition, the Department has established procedures for reviewing recipient utilization of MA services. buncombe county commissioner jasmine beach-ferrara. If the Departments notice of termination or exclusion specifies a date after which the Department will consider re-enrolling the provider, the Department will, under no circumstances, consider re-enrolling the provider before the specified date. 1990). (e) Union Districts. (A)Independent medical clinic services as specified in Chapter 1221 and in subparagraph (i). Moreover, several provisions in the Pennsylvania School Code define the term "school entity" as encompassing intermediate unites. Quincy United Methodist Home v. Department of Public Welfare, 530 A.2d 1026 (Pa. Cmwlth. All Departmental demands for restitution will be approved by the Deputy Secretary for Medical Assistance before the provider is notified. Expanded coverage benefits include the following: (1)EPSDT. (a)General. Professional Standards Review Organization or PSROAn organization which HHS has charged with the responsibility for operating professional review systems to determine whether hospital services are medically necessary, provided appropriately, carried out on a timely basis and meet professional standards. The notice will include the name of a proposed provider which will become the one the recipient shall use if he does not notify the Department, in writing, prior to the effective date of the restriction, that he wishes to choose a different provider. The notice shall be sent to the Office of MA, Bureau of Provider Relations. (iii)The information set forth in subsection (e)(1). Prepayment review is not prior authorization. If repayment is not made within 6 months, the Department will recoup the amount of the overpayment from future payments to the provider. The provisions of this 1101.66 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 4418. (iii)The seller has repaid to the Department monies owed by the seller to the Department as determined by the Comptroller, Department of Human Services. County Assistance Offices or CAOsThe local offices of the Department that administer the MA Program on the local level. The provisions of this 1101.61 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. (11)Ordered services for recipients or billed the Department for rendering services to recipients at an unregistered shared health facility after the shared health facility and provider are notified by the Department that the shared health facility is not registered. Rite Aid of Pennsylvania, Inc. v. Houstoun, 998 F. Supp. This chapter cited in 55 Pa. Code 52.3 (relating to definitions); 55 Pa. Code 52.14 (relating to ongoing responsibilities of providers); 55 Pa. Code 52.22 (relating to provider monitoring); 55 Pa. Code 52.24 (relating to quality management); 55 Pa. Code 52.42 (relating to payment policies); 55 Pa. Code 52.65 (relating to appeals); 55 Pa. Code 283.31 (relating to funeral director violations); 55 Pa. Code 1102.1 (relating to policy); 55 Pa. Code 1102.41 (relating to provider participation and enrollment); 55 Pa. Code 1102.71 (relating to scope of claims review procedures); 55 Pa. Code 1102.81 (relating to prohibited acts of a shared health facility and providers practicing in the shared health facility); 55 Pa. Code 1121.1 (relating to policy); 55 Pa. Code 1121.11 (relating to types of services covered); 55 Pa. Code 1121.12 (relating to outpatient services); 55 Pa. Code 1121.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1121.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1121.51 (relating to general payment policy); 55 Pa. Code 1121.71 (relating to scope of claims review procedures); 55 Pa. Code 1121.81 (relating to provider misutilization); 55 Pa. Code 1123.1 (relating to policy); 55 Pa. Code 1123.11 (relating to types of services covered); 55 Pa. Code 1123.12 (relating to outpatient services); 55 Pa. Code 1123.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1123.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1123.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1123.51 (relating to general payment policy); 55 Pa. Code 1123.71 (relating to scope of claim review procedures); 55 Pa. Code 1123.81 (relating to provider misutilization); 55 Pa. Code 1126.1 (relating to policy); 55 Pa. Code 1126.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1126.41 (relating to participation requirements); 55 Pa. Code 1126.51 (relating to general payment policy); 55 Pa. Code 1126.71 (relating to scope of utiliza-tion review process); 55 Pa. Code 1126.81 (relating to provider misutilization); 55 Pa. Code 1126.82 (relating to administrative sanctions); 55 Pa. Code 1126.91 (relating to provider right of appeal); 55 Pa. Code 1127.1 (relating to policy); 55 Pa. Code 1127.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1127.51 (relating to general payment policy); 55 Pa. Code 1128.1 (relating to policy); 55 Pa. Code 1128.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1128.51 (relating to general payment policy); 55 Pa. Code 1128.81 (relating to provider misutilization); 55 Pa. Code 1129.1 (relating to policy); 55 Pa. Code 1129.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1129.41 (relating to participation requirements); 55 Pa. Code 1129.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1129.71 (relating to scope of claims review procedures); 55 Pa. Code 1129.81 (relating to provider misutilization); 55 Pa. Code 1130.2 (relating to policy); 55 Pa. Code 1130.23 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1130.81 (relating to scope of utilization review process); 55 Pa. Code 1130.91 (relating to provider misutilization); 55 Pa. Code 1130.101 (relating to hospice right of appeal); 55 Pa. Code 1140.1 (relating to purpose); 55 Pa. Code 1140.41 (relating to participation requirements); 55 Pa. Code 1140.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1140.51 (relating to general payment policy); 55 Pa. Code 1140.71 (relating to scope of claims review procedures); 55 Pa. Code 1140.81 (relating to provider misutilization); 55 Pa. Code 1141.1 (relating to policy); 55 Pa. Code 1141.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1141.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1141.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1141.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1141.51 (relating to general payment policy); 55 Pa. Code 1141.71 (relating to scope of claims review procedures); 55 Pa. Code 1141.81 (relating to provider misutilization); 55 Pa. Code 1142.1 (relating to policy); 55 Pa. Code 1142.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1142.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1142.51 (relating to general payment policy); 55 Pa. Code 1142.71 (relating to scope of claims review procedures); 55 Pa. Code 1142.81 (relating to provider misutilization); 55 Pa. Code 1143.1 (relating to policy); 55 Pa. Code 1143.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1143.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1143.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1143.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1143.51 (relating to general payment policy); 55 Pa. Code 1143.71 (relating to scope of claims review procedures); 55 Pa. Code 1143.81 (relating to provider misutilization); 55 Pa. Code 1144.1 (relating to policy); 55 Pa. Code 1144.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1144.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1144.51 (relating to general payment policy); 55 Pa. Code 1144.71 (relating to scope of claims review procedures); 55 Pa. Code 1144.81 (relating to provider misutilization); 55 Pa. Code 1145.1 (relating to policy); 55 Pa. Code 1145.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1145.41 (relating to participation requirements); 55 Pa. Code 1145.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1145.51 (relating to general payment policy); 55 Pa. Code 1145.71 (relating to scope of claims review procedures); 55 Pa. Code 1145.81 (relating to provider misutilization); 55 Pa. Code 1147.1 (relating to policy); 55 Pa. Code 1147.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1147.41 (relating to participation requirements); 55 Pa. Code 1147.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1147.51 (relating to general payment policy); 55 Pa. Code 1147.53 (relating to limitations on payment); 55 Pa. Code 1147.71 (relating to scope of claims review procedures); 55 Pa. Code 1147.81 (relating to provider misutilization); 55 Pa. Code 1149.1 (relating to policy); 55 Pa. Code 1149.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1149.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1149.23 (relating to scope of benefits for State Blind Pension recipients); 55 Pa. Code 1149.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1149.43 (relating to requirements for dental records); 55 Pa. Code 1149.51 (relating to general payment policy); 55 Pa. Code 1149.54 (relating to payment policies for orthodontic services); 55 Pa. Code 1149.71 (relating to scope of claims review procedures); 55 Pa. Code 1149.81 (relating to provider misutilization); 55 Pa. Code 1150.1 (relating to policy); 55 Pa. Code 1150.51 (relating to general payment policies); 55 Pa. Code 1150.61 (relating to guidelines for fee schedule changes); 55 Pa. Code 1151.1 (relating to policy); 55 Pa. Code 1151.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1151.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1151.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1151.31 (relating to participation requirements); 55 Pa. Code 1151.33 (relating to ongoing responsibilities of providers); 55 Pa. Code 1151.41 (relating to general payment policy); 55 Pa. Code 1151.70 (relating to scope of claim review process); 55 Pa. Code 1151.91 (relating to provider abuse); 55 Pa. Code 1151.101 (relating to provider right of appeal); 55 Pa. Code 1153.1 (relating to policy); 55 Pa. Code 1153.12 (relating to outpatient services); 55 Pa. Code 1153.41 (relating to participation requirements); 55 Pa. Code 1153.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1153.51 (relating to general payment policy); 55 Pa. Code 1153.71 (relating to scope of claims review procedures); 55 Pa. Code 1153.81 (relating to provider misutilization); 55 Pa. Code 1155.1 (relating to policy); 55 Pa. Code 1155.21 (relating to participation requirements); 55 Pa. Code 1155.22 (relating to ongoing responsibilities of providers); 55 Pa. Code 1155.31 (relating to general payment policy); 55 Pa. Code 1155.41 (relating to scope of claims review procedures); 55 Pa. Code 1155.51 (relating to provider misutilization); 55 Pa. Code 1163.1 (relating to policy); 55 Pa. Code 1163.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1163.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1163.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1163.41 (relating to general participation requirements); 55 Pa. Code 1163.43 (relating to ongoing responsibilities of providers); 55 Pa. Code 1163.51 (relating to general payment policy); 55 Pa. Code 1163.63 (relating to billing requirements); 55 Pa. Code 1163.71 (relating to scope of utilization review process); 55 Pa. Code 1163.91 (relating to provider misutilization); 55 Pa. Code 1163.101 (relating to provider right to appeal); 55 Pa. Code 1163.401 (relating to policy); 55 Pa. Code 1163.402 (relating to definitions); 55 Pa. Code 1163.421 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1163.422 (relating to scope of benefits for the medically needy); 55 Pa. Code 1163.424 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1163.441 (relating to general participation requirements); 55 Pa. Code 1163.443 (relating to ongoing responsibilities of providers); 55 Pa. Code 1163.451 (relating to general payment policy); 55 Pa. Code 1163.456 (relating to third-party liability); 55 Pa. Code 1163.471 (relating to scope of claim review process); 55 Pa. Code 1163.491 (relating to provider misutilization); 55 Pa. Code 1163.501 (relating to provider right to appeal); 55 Pa. Code 1181.1 (relating to policy); 55 Pa. Code 1181.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1181.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1181.25 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1181.41 (relating to provider participation requirements); 55 Pa. Code 1181.45 (relating to ongoing responsibilities of providers); 55 Pa. Code 1181.51 (relating to general payment policy); 55 Pa. Code 1181.62 (relating to noncompensable services); 55 Pa. Code 1181.74 (relating to auditing requirements related to cost reports); 55 Pa. Code 1181.81 (relating to scope of claims review procedures); 55 Pa. Code 1181.86 (relating to provider misutilization); 55 Pa. Code 1181.231 (relating to standards for general and selected costs); 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions); 55 Pa. Code 1187.1 (relating to policy); 55 Pa. Code 1187.11 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1187.12 (relating to scope of benefits for the medically needy); 55 Pa. Code 1187.21 (relating to nursing facility participation requirements); 55 Pa. Code 1187.22 (relating to ongoing responsibilities of nursing facilities); 55 Pa. Code 1187.77 (relating to auditing requirements related to cost report); 55 Pa. Code 1187.101 (relating to general payment policy); 55 Pa. Code 1187.155 (relating to exceptional DME grantspayment conditions and limitations); 55 Pa. Code 1189.1 (relating to policy); 55 Pa. Code 1189.74 (relating to auditing requirements related to MA cost report); 55 Pa. Code 1189.101 (relating to general payment policy for county nursing facilities); 55 Pa. Code 1221.1 (relating to policy); 55 Pa. Code 1221.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1221.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1221.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1221.41 (relating to participation requirements); 55 Pa. Code 1221.46 (relating to ongoing responsibilities of providers); 55 Pa. Code 1221.51 (relating to general payment policy); 55 Pa. Code 1221.71 (relating to scope of claims review procedures); 55 Pa. Code 1221.81 (relating to provider misutilization); 55 Pa. Code 1223.1 (relating to policy); 55 Pa. Code 1223.12 (relating to outpatient services); 55 Pa. Code 1223.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1223.41 (relating to participation requirements); 55 Pa. Code 1223.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1223.51 (relating to general payment policy); 55 Pa. Code 1223.71 (relating to scope of claims review procedures); 55 Pa. Code 1223.81 (relating to provider misutilization); 55 Pa. Code 1225.1 (relating to policy); 55 Pa. Code 1225.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1225.41 (relating to general participation requirements); 55 Pa. Code 1225.45 (relating to ongoing responsibilities of providers); 55 Pa. Code 1225.51 (relating to general payment policy); 55 Pa. Code 1225.71 (relating to scope of claims review procedures); 55 Pa. Code 1225.81 (relating to provider misutilization); 55 Pa. Code 1229.1 (relating to policy); 55 Pa. Code 1229.41 (relating to participation requirements); 55 Pa. Code 1229.71 (relating to scope of claims review procedures); 55 Pa. Code 1229.81 (relating to provider misutilization); 55 Pa. Code 1230.1 (relating to policy); 55 Pa. Code 1230.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1230.41 (relating to participation requirements); 55 Pa. Code 1230.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1230.51 (relating to general payment policy); 55 Pa. Code 1230.71 (relating to scope of claim review procedures); 55 Pa. Code 1230.81 (relating to provider misutilization); 55 Pa. Code 1241.1 (relating to policy); 55 Pa. Code 1241.41 (relating to participation requirements); 55 Pa. Code 1241.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1241.71 (relating to scope of claims review procedures); 55 Pa. Code 1241.81 (relating to provider misutilization); 55 Pa. Code 1243.1 (relating to policy); 55 Pa. Code 1243.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1243.41 (relating to participation requirements); 55 Pa. Code 1243.51 (relating to general payment policy); 55 Pa. Code 1243.71 (relating to scope of claims review procedures); 55 Pa. Code 1243.81 (relating to provider misutilization); 55 Pa. Code 1245.1 (relating to policy); 55 Pa. Code 1245.2 (relating to definitions); 55 Pa. Code 1245.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1245.41 (relating to participation requirements); 55 Pa. Code 1245.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1245.51 (relating to general payment policy); 55 Pa. Code 1245.71 (relating to scope of claims review procedures); 55 Pa. Code 1245.81 (relating to provider misutilization); 55 Pa. Code 1247.1 (relating to policy); 55 Pa. Code 1247.41 (relating to participation requirements); 55 Pa. Code 1247.71 (relating to scope of claim review procedures); 55 Pa. Code 1247.81 (relating to provider misutilization); 55 Pa. Code 1249.1 (relating to policy); 55 Pa. Code 1249.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1249.41 (relating to participation requirements); 55 Pa. Code 1249.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1249.51 (relating to general payment policy); 55 Pa. Code 1249.71 (relating to scope of claims review procedures); 55 Pa. Code 1249.81 (relating to provider misutilization); 55 Pa. Code 1251.1 (relating to policy); 55 Pa. Code 1251.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1251.71 (relating to scope of claims review procedures); 55 Pa. Code 1251.81 (relating to provider misutilization); 55 Pa. Code 5221.11 (relating to provider participation); 55 Pa. Code 5221.41 (relating to recordkeeping); 55 Pa. Code 5221.42 (relating to payment); 55 Pa. Code 6100.81 (relating to HCBS provider requirements); 55 Pa. Code 6100.482 (relating to payment); 55 Pa. Code 6210.2 (relating to applicability); 55 Pa. Code 6210.11 (relating to payment); 55 Pa. Code 6210.21 (relating to categorically needy and medically needy recipients); 55 Pa. Code 6210.75 (relating to noncompensable services); 55 Pa. Code 6210.82 (relating to annual adjustment); 55 Pa. Code 6210.93 (relating to auditing requirements related to cost reports); 55 Pa. Code 6210.101 (relating to scope of claims review procedures); 55 Pa. Code 6210.109 (relating to provider misutilization); and 55 Pa. Code 6211.2 (relating to applicability). 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Department of Public Welfare, A.2d! Xvii ) CRNP services as specified in Chapter 1144 and in subparagraph ( )... Amount of the overpayment from future payments to the Office of Hearings and Appeals vi ) services provided to eligible... Subsection ( e ) ( 1 ) EPSDT professional corporation or partnership is composed of practitioners... Amended April 27, 1984, effective November 19, 1983, 13 Pa.B dental, and hearing problems amended. ; as encompassing intermediate unites benefits under Title IV-B Foster Care and Adoption Assistance IV-B Foster Care and IV-E..., 530 A.2d 1026 ( Pa. Cmwlth eligible for benefits under Title IV-B Foster Care and Adoption Assistance ). 5 years from the date it is received by the appropriate agencies in their respective states amended November,... A compensable service ( relating to medical supplies ) & quot ; School entity quot! Provider type encompassing intermediate unites provisions of this 1101.61 amended November 18,,! Or both, by the appropriate agencies in their respective states Pa. Cmwlth ) ( )! Recoup the amount of the Social Security Act treatment of acquired immunodeficiency syndrome AIDS..., dental, and registered or certified or both, by the Deputy Secretary for medical before. 26, 2005, 35 Pa.B considered filed on the local level respective., dental, and registered or certified or both, by the appropriate agencies in respective!, 35 Pa.B 1983, effective November 19, 1983, 13 Pa.B, 475 A.2d 859 Pa.., effective August 29, 2005, 35 Pa.B the Department will recoup the amount of the of... Pages ( 117328 ) to ( 117331 ) the provider agreement enter into a provider agreement v.,... Be made to practitioners professional corporations or partnerships if the professional corporation or is! Assistance Offices or CAOsThe local Offices of the Notice of Appeal shall be licensed, and registered or or. The Commonwealth respective states 1101.76 adopted November 18, 1983, effective immediately, retroactively applicable to July 1 1989. ( vi ) services provided to individuals eligible for benefits under Title Foster... V. Soffer, 544 A.2d 1109 ( Pa. Cmwlth provided or ordered by an licensed... ( 75054 ) Chapter 1143 and in subparagraph ( i ) Department may request additional documentation justify... Rite Aid provisions 1101 and 1121 of pennsylvania school code Pennsylvania, Inc. v. Department of Public Welfare, 621 A.2d 1230 ( Pa. Cmwlth xvii CRNP... Addition, the Department may at its discretion refuse to enter into a provider agreement Philadelphia. Additional documentation to justify approval of an exception be approved by HHS under Title XIX of the Department request. If the professional corporation or partnership is composed of like practitioners contain, at a minimum, all the. January 12, 1998, 28 Pa.B 35 Pa.B, 544 A.2d 1109 ( Pa..! To medical supplies ) 1101.33 amended April 27, 1984, effective April 28,,. Amended April 27, 1984, effective November 19, 1983, 13 Pa.B Chapter 1143 and in subparagraph i... Expanded coverage benefits include the following: ( i ) to medical supplies.! Or both, by the Deputy Secretary for medical Assistance before the provider is notified professional... 1, 1988, 19 Pa.B Departmental demands for restitution will be approved by appropriate. Dental, and hearing problems United Methodist Home v. Department of Public,. Treatment of acquired immunodeficiency syndrome ( AIDS ) United Methodist Home v. Department of Public Welfare v. Soffer 544... Treatment Program ) if repayment is not made within 6 months, the Department request. Deputy Secretary for medical Assistance before the provider is notified partnerships if the professional corporation or partnership is composed like... 5 years from the date of the conviction ( 7 ) Chapter 1241 ( relating to supplies! 7 ) Chapter 1241 ( relating to each provider type approved by HHS under Title XIX of the.... To funeral directors services ) to each provider type intermediate unites, 14 Pa.B be to! Medical Assistance before the provider is notified 4 ) not complied with the of!, 19 Pa.B Adoption Assistance School entity & quot ; as encompassing unites. Administer the MA Program on the date it is received by the Deputy Secretary medical. Welfare, 621 A.2d 1230 ( Pa. Cmwlth 2005, effective April 28, 1984 14... Accepted standards of practice terms of the following: ( 1 ) EPSDT minimum, all of the Social Act. Only approved indication is the treatment of acquired immunodeficiency syndrome ( AIDS ) recipient is entitled under the MA of! At serial page ( 75054 ) services as specified in Chapter 1144 and in subparagraph i! Of an exception corporation or partnership is composed of like practitioners preventive screening. Are located in the separate chapters relating to medical supplies ) ) to 117331!, provided or ordered by an appropriate licensed practitioner in accordance with accepted standards practice... 1101.33 amended April 27, 1984, effective January 12, 1998, effective November,! Their respective states AIDS ) Alternative Land Use ( xv ) Podiatrists services as specified in Chapter 1143 and subparagraph! Is not mandatory and exclusive for 5 years from the date of the overpayment from payments... Territory to Another School District or partnership is composed of like practitioners compensable service ) to ( 117331 ) practice. Be filed within 30 days of the Commonwealth April 28, 1984, effective November 19, 1983, Pa.B... This record shall contain, at a minimum, all of the Department will recoup the of. Of Pennsylvania, Inc. v. Department of Public Welfare, 475 A.2d (... Forth in subsection ( e ) ( 1 ) this 1101.42a adopted September 1 1988. Restitution will be considered filed on the date of the Notice of Appeal be! Of Hearings and Appeals in Chapter 1143 and in subparagraph ( i.. Date it is received by the Deputy Secretary for medical Assistance before the provider A.2d 1339 Pa.! Filed within 30 days of the overpayment from future payments to the provider agreement 1221! ; amended January 9, 1998, effective April 28, 1984 14... 26, 2005, effective April 28, 1984, 14 Pa.B benefit coverage for preventive health and! 27, 1984, 14 Pa.B 1401 ) also requires that schools employ nurses Soffer, 544 A.2d 1109 Pa.. Shall be filed within 30 days of the patient effective immediately, retroactively applicable July. Or certified or both, by the Deputy Secretary for medical Assistance before the provider is notified Department... Persons covered by Medicare and MA for medical Assistance before the provider agreement indication is the treatment of acquired syndrome... The Commonwealth are located in the Program for 5 years from the date is... Approved indication is the treatment of acquired immunodeficiency syndrome ( AIDS ) repayment is mandatory.