Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part I - General Health
Chapter 9 - MANAGED CARE ORGANIZATIONS
Subchapter K - CREs
CERTIFICATION
Section 9.745 - Responsible applicant
Universal Citation: 28 PA Code ยง 9.745
Current through Register Vol. 54, No. 44, November 2, 2024
(a) To be certified by the Department, an applicant for certification to perform UR shall be a responsible person.
(1) To make this
determination, the Department may review and verify the credentials of any
officer, director or member of the management staff of the applicant.
(2) The Department may consider whether any
of the officers, directors or management personnel have ever:
(i) Been involved in a bankruptcy proceeding
as an officer, director or senior manager of a corporation.
(ii) Been convicted of a state or Federal
offense related to health care.
(iii) Been listed by a state or Federal
agency as debarred, excluded or otherwise ineligible for state or Federal
program participation.
(iv) Been
convicted of a criminal offense which would call in to question the
individual's ability to operate a CRE.
(v) Had a history of malpractice or civil
suits, penalties or judgments against them.
(b) To be determined a responsible person, an applicant shall demonstrate to the Department that it has the ability to perform URs and grievance reviews based on medical necessity and appropriateness, without bias.
This section cited in 28 Pa. Code § 9.741 (relating to applicability).
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