Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter B - HOSPITALS AND HOSPITAL UNITS UNDER COST REIMBURSEMENT PRINCIPLES
PAYMENT FOR COST REIMBURSED HOSPITAL SERVICES
Section 1163.454 - Limitations on payment
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Payment for blood will be limited to the first three pints of whole blood provided during a period of hospitalization. An exception to this limit is made only if the patient has hemophilia, in which case payment is made for the amount of whole blood or blood products the patient requires.
(b) Payment for cost reimbursed drug and alcohol detoxification-rehabilitation services in a general hospital will be limited to days certified under § 1163.471 (relating to scope of claims review process) during which the inidividual with a drug or alcohol diagnosis is a patient in a drug and alcohol detoxification rehabilitation unit approved by the Department of Health.
(c) A recipient is limited to two periods of therapeutic leave per calendar month. Neither of these periods of therapeutic leave may exceed 12 hours in a calendar day.
The provisions of this §1163.454 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1)).
This section cited in 55 Pa. Code § 1163.451 (relating to general payment policy); 55 Pa. Code § 1163.455 (relating to noncompensable services and items); and 55 Pa. Code § 1163.457 (relating to payment policies relating to out-of-State hospitals).
