1880. (7)Been convicted of a criminal offense under State or Federal laws relating to the practice of the providers profession as certified by a court. (1)Recipients receiving services under the MA Program are responsible to pay the provider the applicable copayment amounts set forth in this subsection. (10)Except in emergency situations, dispense, render or provide a service or item without a practitioners written order and the consent of the recipient or submit a claim for a service or item which was dispensed or provided without the consent of the recipient. Lancaster v. Department of Public Welfare, 916 A.2d 707, 712 (Pa. Cmwlth. 5995; amended November 24, 1995, effective November 25, 1995, and apply retroactively to November 1, 1995, 25 Pa. B. (vi)For all other services, the amount of the copayment is based on the MA fee for the service, using the following schedule: (A)If the MA fee is $2 through $10, the copayment is 65. (14)Commit a prohibited act specified in 1102.81(a) (relating to prohibited acts of a shared health facility and providers practicing in the shared health facility). (iii)Legend and nonlegend drugs as specified in Chapter 1121 not to exceed a maximum of six prescriptions and refills per month. (2)Keep the recorded prescription on file. (4)Knowingly or intentionally visit more than three practitioners or providers, who specialize in the same field, in the course of 1 month for the purpose of obtaining excessive services or benefits beyond what is reasonably needed (as determined by medical professionals engaged by the Department) for the treatment of a diagnosed condition of the recipient. (x)Family planning services and supplies. (b)The Department will consider exceptions to subsection (a) on a case-by-case basis. (2)If the Department determines that a recipient misuses or overutilizes MA benefits, the Department is authorized to restrict a recipient to a provider of his choice for each medical specialty or type of provider covered under the MA Program. (3)Outpatient hospital services as follows: (i)Short procedure unit services as specified in Chapter 1126 (relating to ambulatory surgical center services and hospital short procedure unit services). HHSThe United States Department of Health and Human Services or its successor agency, which is given responsibility for implementation of Title XIX of the Social Security Act. 1999). The provisions of this 1101.75 issued under sections 403(a) and (b), 441.1 and 1410 of the Human Services Code (62 P. S. 403(a) and (b), 441.1 and 1410). Prepayment review is not prior authorization. (2)Laboratory and X-ray services are excluded from the deductible requirement. Written notice of the Departments action to delay payment will also be sent to the PSRO, where applicable. This section cited in 55 Pa. Code 140.721 (relating to conditions of eligibility); 55 Pa. Code 1101.31 (relating to scope); 55 Pa. Code 1101.63 (relating to payment in full); 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); and 55 Pa. Code 1187.152 (relating to additional reimbursement of nursing facility services related to exceptional DME). Department of Public Welfare v. Divine Providence Hospital, 516 A.2d 82 (Pa. Cmwlth. FQHCFederally qualified health center. 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. 1984). The provisions of this 1101.77a adopted December 13, 1996, effective December 14, 1996, 26 Pa.B. (3)The Department intends to periodically monitor the expiration of medical licenses to ensure compliance with MA regulations. Immediately preceding text appears at serial page (62901). Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. Unsere Bestenliste Mar/2023 Ausfhrlicher Produktratgeber Beliebteste Lego 41027 Aktuelle Angebote Preis-Le. 2683. (2)Departmental receipt of a claim is evidenced by appearance of the claim on a remittance advice (RA). In considering the providers request for re-enrollment, the Department will take into account such factors as the severity of the offense, whether there has been any licensure action against the provider, whether the provider has been convicted in a State, Federal or local court of Medicaid offenses and whether there are any claims or penalties outstanding against the provider. This information is obtained from state personal income tax returns. 6364. 538. (3)Failed to comply with the conditions of participation listed in Articles IV or XIV of the Public Welfare Code (62 P. S. 401493 and 14011411). REVISED JUDICATURE ACT OF 1961 Act 236 of 1961 AN ACT to revise and consolidate the statutes relating to the organization and jurisdiction of the courts of this state; the powers The Department may at its discretion refuse to enter into a provider agreement. title 104 - senate of pennsylvania; title 107 - house of representatives of pennsylvania; title 201 - rules of judicial administration; title 204 - judicial system general provisions; title 207 - judicial conduct; title 210 - appellate procedure; title 225 - rules of evidence; title 231 - rules of civil procedure; title 234 - rules of criminal . (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. (e)For the purpose of subsection (d)(4)(ii)(iv) the Department will accept a volume discount as market value if it remains equal to or above the actual acquisition cost of the product. Del Borrello v. Department of Public Welfare, 508 A.2d 368 (Pa. Cmwlth. (5)Paragraphs (1)(4) do not apply if the provider is bankrupt or out-of-business and the debt is uncollectable under section 1903(d)(2)(D) of the Social Security Act (42 U.S.C.A. (4)Disallowances for services or items rendered during a period of nonenrollment or termination, except on the issue of identity. Providers are required, upon request, to furnish the Department or its designated agents, the Office of the Attorney General or the Secretary of Health and Human Services, with medical and fiscal records as specified in 1101.51(e) (relating to ongoing responsibilities of providers). A medical facility shall disclose to the Department, upon execution of a provider agreement or renewal thereof, the name and social security number of a person who has a direct or indirect ownership or control interest of 5% or more in the facility. (17)Chapter 1129 (relating to rural health clinic services). 1999). Abolition of Independent Districts (Repealed). (xi)Inpatient psychiatric care as specified in Chapter 1151, up to 30 days per fiscal year. It allows them now for 2 years to fund a combination of either economic or security improvements on the seaports. 4811; amended April 13, 2012, effective May 15, 2012, 42 Pa.B. (5)Been suspended or terminated from Medicare. The Pennsylvania Code website reflects the Pennsylvania Code Also, future invoices may be adjusted downward to correct previous overpayments discovered through postpayment invoice review. Because the Federal government has approved the Commonwealths Medical Assistance State Plan, the court is obligated to grant great deference to that plan, as well as to the Departments interpretation of its own regulations. (3)Vacation trips and professional seminars. 3653; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. The provisions of this 1101.21 amended through April 27, 1984, effective April 28, 1984, 14 Pa.B. The provisions of this 1101.69a adopted October 20, 1989, effective February 6, 1989, 19 Pa.B. This section cited in 55 Pa. Code 1130.51 (relating to provider enrollment requirements). If a third-party resource refuses payment to the provider based on coverage exclusions or other reasons, the provider may bill the Department by submitting an invoice with a copy of the third partys refusal advisory attached. 1107. 3653; amended February 5, 1988, effective February 6, 1988, 18 Pa.B. Immediately preceding text appears at serial page (233035). (d)The provider shall pay the amount of restitution owed to the Department either directly or by offset of valid invoices that have not yet been paid. (D)Rural health clinic services and FQHC services as specified in Chapter 1129 and in subparagraph (i). (2)The following services are excluded from the copayment requirement for all categories of recipients: (i)Services furnished to individuals under 18 years of age. If a prescription is telephoned to a pharmacist, the prescribers record shall have a notation to this effect. In the absence of a timely appeal, a request to reopen a cost report was discretionary. Providers are responsible for checking the recipients MSE card and other forms of notification sent to the provider by the Department, to verify that the recipient has not been restricted to obtaining the service from a single provider. The letter will request that the provider contact the Office of the Comptroller within 15 days of the date of the letter to establish a repayment schedule. (14)Chapter 1121 (relating to pharmaceutical services). 1986). (c)The amount of restitution demanded by the Department will be the amount of the overpayment received by the ordering or prescribing provider or the amount of payments to other providers for excessive or unnecessary services prescribed or ordered. The MA Program does not reimburse recipients for their expenditures. (e) Union Districts. (xxv)More than one of a series of a specific allergy test provided in a 24-hour period. (9)Submit a claim for a service or item at a fee that is greater than the providers charge to the general public. 2002); appeal denied 839 A.2d 354 (Pa. 2003). (a)Invoices. If the notice is not mailed within 18 days from the date of receipt at the address specified in the handbook, the request is automatically authorized. This section cited in 55 Pa. Code 1187.158 (relating to appeals). The Department pays for compensable services furnished out-of-State to eligible Commonwealth recipients if: (1)The recipient requires emergency medical care while temporarily away from his home. In addition, the Department has established procedures for reviewing recipient utilization of MA services. (B)Ambulatory surgical center services as specified in Chapter 1126. (21)Chapter 1181 (relating to nursing facility care). Ashton Hall, Inc. v. Department of Public Welfare, 743 A.2d 529 (Pa. Cmwlth. Immediately preceding text appears at serial page (69575). Other private or governmental health insurance benefits shall be utilized before billing the MA Program. (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. (b)Written orders and prescriptions transmitted by electronic means must be electronically encrypted or transmitted by other technological means designed to protect and prevent access, alteration, manipulation or use by any unauthorized person. (xxi)Tobacco cessation counseling services. (8)Chapter 1229 (relating to health maintenance organization services). If repayment is not made within 6 months, the Department will recoup the amount of the overpayment from future payments to the provider. (b)Criteria for provider re-enrollment. (8)Been subject to a disciplinary action taken or entered against the provider in the records of the State licensing or certifying agency. The provisions of this 1101.94 amended April 27, 1984, effective April 28, 1984, 14 Pa.B 1454. Since failure of Medical Assistance provider to submit invoices for payment within the 6-month period as required by subsection (a) was due to extreme negligence of an employe rather than the result of a technical or inadvertent omission, the equitable doctrine of substantial performance could not be invoked to require payment. (vi)Treatment or external medication carts. (7)Chapter 1251 (relating to funeral directors services). (a)The term within a providers office means the physical space where a healthcare provider performs the following on an ambulatory basis: health examinations, diagnosis, treatment of illness or injury; other services related to diagnosis or treatment of illness or injury. This is not to preclude the use of facsimile machines. (5)Consultations ordered shall be relevant to findings in the history, physical examination or laboratory studies. Immediately preceding text appears at serial page (86720). (3)A participating provider may not lease or rent space, shelves or equipment within a providers office to another provider or allowing the placement of paid or unpaid staff of another provider in a providers office. Section 252. (b) 4370, and by approval of the court of a joint motion for modification of a consent agreement dated February 11, 1985 in Turner v. Beal, et al., C.A. County Assistance Offices or CAOsThe local offices of the Department that administer the MA Program on the local level. Noncompensable itemA service or supply a provider furnishes for which there is no provision for payment under this part. (vii)The record shall contain summaries of hospitalizations and reports of operative procedures and excised tissues. (a)This section does not apply to noncompensable items or services. This section supports DPWs decision to deny reimbursement to hospital which admitted patient overnight for treatment which could have safely been rendered in Special Procedure Unit. 4418; amended August 5, 2005, effective August 10, 2005, 35 Pa.B. No part of the information on this site may be reproduced for profit or sold for profit. (e)Payment is not made for services or items rendered, prescribed or ordered by providers who have been terminated from the Medical Assistance program. (b)Categorically needy. Policy clarification regarding physician licensurestatement of policy. (Sections 1101 to 1195) Chapter 12 - Adjustment of Debts of a Family Farmer or Fisherman with Regular Annual . (ii)Specific drugs identified by the Department in the following categories: (E)Antipsychotic agents, except those that are also schedule C-IV antianxiety agents. To request re-enrollment, the provider shall send a written request to the Departments Office of Medical Assistance, Bureau of Provider Relations. (4)The solicitation or receipt or offer of a kickback, payment, gift, bribe or rebate for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, ordering or arranging for or recommending purchasing, leasing or ordering a good, facility, service or item for which payment is made under MA. (1)A $150 deductible per fiscal year shall be applied to adult GA recipients for the following MA compensable services: (i)Ambulatory surgical center services. Immediately preceding text appears at serial pages (124108) to (124110). (5)If it is found that a recipient or a member of his family or household, who would have been ineligible for MA, possessed unreported real or personal property in excess of the amount permitted by law, the amount collectible shall be limited to an amount equal to the market value of such excess property or the amount of MA granted during the period the excess property was held, whichever is less. Nursing care facilities have the right to appeal any adjustments made by the Department of Public Welfare based on audits performed after the facility filed its annual cost report. Presbyterian Medical Center of Oakmont v. Department of Public Welfare, 792 A.2d 23 (Pa. Cmwlth. (9)Optometrists services as specified in Chapter 1147 (relating to optometrists services) and in paragraph (2). If the results of the Departments review warrant it, the recipient will be placed on the restricted recipient program, which means that he will be restricted to obtaining certain services from a single provider of his choice. 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. Further, the Secretary of the DPW assured the president of the facility that payment would be received for the services provided. The school and the Roads Service should be able to work together more to manage the travel demand in a way that gives priority to walking and cycling, and . (C)Outpatient hospital clinic services as specified in Chapter 1221 and in subparagraph (i). When Established; Classification (Repealed). (xxiii)Medical examinations when requested by the Department. Presbyterian Medical Center of Oakmont v. Department of Public Welfare, 792 A.2d 23 (Pa. Cmwlth. This section cited in 55 Pa. Code 51.27 (relating to misuse and abuse of funds and damage of participants property); 55 Pa. Code 5221.43 (relating to quality assurance and utilization review); and 55 Pa. Code 6100.744 (relating to additional conditions and sanctions). If the applicant is determined to be eligible, the Department issues Medical Services Eligibility (MSE) cards that are effective from the first of the month through the last day of the month. provisions 1101 and 1121 of pennsylvania school codeheel pain in the morning due to uric acid For prospective exception requests, if the provider or recipient is not notified of the decision within 21 days of the date the request is received, the exception will be automatically granted. Claims may be resubmitted directly to the claims processing system in accordance withsubsection (b). (xvi)Chiropractic services as specified in Chapter 1145 limited to the visits specified in subparagraph (i). If, after investigation, the Department determines that a provider has submitted or has caused to be submitted claims for payments which the provider is not otherwise entitled to receive, the Department will, in addition to the administrative action described in 1101.821101.84 (relating to administrative procedures), refer the case record to the Medicaid Fraud Control Unit of the Department of Justice for further investigation and possible referral for prosecution under Federal, State and local laws. The term does not include any of the following: (3)An intermediate care facility for individuals with an intellectual disability. A provider who has been approved is eligible to be reimbursed only for those services furnished on or after the effective date on the provider agreement and only for services the provider is eligible to render subject to limitations in this chapter and the applicable provider regulations. (19)Chapter 1230 (relating to portable x-ray services). Each individual practitioner or medical facility shall have a separate provider agreement with the Department. (iii)If the Department has a basis for termination which is related to the criminal conviction (with the exception of exclusions from Medicare) the minimum period of the termination will be the longer of 5 years or the period related to the other action. 2) Follow hours and room rules established before the event begins. provisions 1101 and 1121 of pennsylvania school code. 1102. 1999). People search by name, address and phone number. The following listings, which are not all-inclusive, set forth examples of items and practices that would be considered accepted or improper under the Program. May 7, 2022 . The Department of Public Welfare acted within its discretion in denying a claimants request for a Medical Assistance regulation program exception to compensate her for the expense of a special commercially processed food, where the claimant did not present any medical evidence to show that the food was medically necessary for her physical maintenance; the Department did not refuse the claimant, the minimum necessary medical services required for the successful treatment of the particular medical condition presented, as required under Title XIX of the Social Security Act (42 U.S.C.A. The provisions of this 1101.21 amended through April 27, 1984, effective April 28, 1984, 14 Pa.B. Phone directory of Ocala, Florida. 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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