Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PROVIDER PARTICIPATION
Section 1163.43 - Ongoing responsibilities of providers
Current through Register Vol. 54, No. 12, March 23, 2024
In addition to the ongoing responsibilities established in Chapter 1101 (relating to general provisions), and as a condition of continued participation in the MA Program, general hospitals shall comply with the following:
(1) Maintain transfer agreements with skilled nursing and intermediate care facilities, private psychiatric hospitals and rehabilitation hospitals, for the prompt and appropriate transfer of patients who no longer need acute inpatient hospital care.
(2) For services provided to MA recipients, keep separate patient statistics and fiscal records on the cost of, and charges for, those services provided in:
(3) Retain complete, accurate and auditable medical and fiscal records for 4 years for MA patients under Chapter 1101.
(4) Furnish to the Department or its agents, Federal and State auditors, auditable copies of patient records and fiscal records upon request under Chapter 1101.
(5) For those hospitals not participating in Medicare, submit to the Office of MA for review and approval, details of changes to the hospital's utilization review system, including revisions to the utilization review plan, within 30 days of the date of the change.
The provisions of this § 1163.43 amended under section 443.1(1) of the Public Welfare Code (62 P. S. § 443.1(1)).
