Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part I - General Health
Chapter 9 - MANAGED CARE ORGANIZATIONS
Subchapter K - CREs
CERTIFICATION
Section 9.748 - Maintenance and renewal of CRE certification

Universal Citation: 28 PA Code ยง 9.748

Current through Register Vol. 54, No. 44, November 2, 2024

(a) Maintenance. A CRE shall continue to comply with the requirements of Act 68 and this subchapter to maintain its certification. To determine whether a CRE is complying with Act 68 and this subchapter, and is qualified to maintain its certification during the 3-year certification period, the Department may do one or more of the following:

(1) Perform periodic onsite inspections.

(2) Require proof of the CRE's continuing accreditation by a Nationally recognized accrediting body whose standards meet or exceed the standards of Act 68 and this subchapter.

(3) Require an onsite inspection as set forth in § 9.747 (relating to Department review and approval of a certification request).

(b) Renewal.

(1) A CRE shall submit an application for renewal of certification to the Department along with the appropriate renewal fee at least 60 days prior to the expiration of the 3-year certification period.

(2) The renewal application shall include the following:
(i) Evidence of the CRE's continued accreditation by a Nationally recognized accrediting body whose standards meet or exceed the standards of Act 68 and this subchapter.

(ii) A certification that the CRE has complied with and will continue to comply with Act 68 and this subchapter.

(iii) An updating of the CRE's originally filed list of conflicts of interest and CRE contracts with plans.

(iv) A reaffirmation of certifications included in the CRE's original application.

(3) The Department may perform an onsite inspection at the CRE before approving renewal of certification, or may require an onsite inspection set forth in § 9.747.

(c) The Department will have access to the books, records, staff, facilities and other information, including UR decisions, it finds necessary to determine whether a CRE is qualified to maintain its certification in accordance with Act 68 and this chapter.

This section cited in 28 Pa. Code § 9.741 (relating to applicability).

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