Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1128 - RENAL DIALYSIS SERVICES
PAYMENT FOR RENAL DIALYSIS SERVICES
Section 1128.52 - Payment criteria
Universal Citation: 55 PA Code ยง 1128.52
Current through Register Vol. 54, No. 12, March 23, 2024
(a) The Department will establish maximum reimbursement fees for dialysis facilities based on the following criteria:
(1) The level
of reimbursement will be consistent with efficiency, economy and quality of
care.
(2) The level of
reimbursement will be sufficient to assure availability of services.
(3) Rate increases and decreases, and changes
in the actual methodology used in establishing the maximum fees will be
published as a notice in the Pennsylvania Bulletin.
(b) The fee for dialysis services may be decreased by the Department if:
(1)
Medicare or the Department of Health Chronic Renal Disease Program payment
rates decrease.
(2) The providers'
Statewide average usual charge decreases.
(3) Other compelling circumstances occur
under which, in the interest of the general public, the Department revises its
decisions regarding maximum payment levels.
(c) With the exception of the fee for ongoing maintenance dialysis, payment is made to participating dialysis facilities at the Department of Health, Chronic Renal Disease Program rates in effect as of July 1, 1986. Changes in payment rates will be published in the Pennsylvania Bulletin in the form of a notice.
This section cited in 55 Pa. Code § 1128.51 (relating to general payment policy).
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