Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1221 - CLINIC AND EMERGENCY ROOM SERVICES
PROVIDER PARTICIPATION
Section 1221.41 - Participation requirements

Universal Citation: 55 PA Code ยง 1221.41

Current through Register Vol. 53, No. 52, December 30, 2023

(a) In addition to the participation requirements established in Chapter 1101 (relating to general provisions) clinics and hospital emergency rooms shall:

(1) Have an established fee schedule for billing third parties and private payors.

(2) Have a patient referral process that ensures follow up treatment by other physicians or appropriate specialists.

(3) Abide by applicable Federal and State statutes and regulations, including but not limited to Title XIX of the Social Security Act (42 U.S.C.A. §§ 1396-1396p), the Public Welfare Code (62 P. S. § 443.1 et seq.) and applicable licensing statutes.

(b) In addition to the participation requirements set forth in subsection (a) hospital clinics, medical school clinics and independent medical clinics shall:

(1) Not be enrolled in the MA Program as a Rural Health Clinic.

(2) Be licensed/approved by the Department of Health if abortions are performed in the facility.

The provisions of this § 1221.41 adopted December 5, 1980, effective 12/1/1980, 10 Pa.B. 4599; amended December 23, 1983, effective 1/1/1983, 13 Pa.B. 3932.

This section cited in 55 Pa. Code § 1221.42 (relating to additional participation requirements for hospital clinics and emergency rooms); 55 Pa. Code § 1221.44 (relating to additional participation requirements for independent clinics); and 55 Pa. Code § 1221.45 (relating to additional participation requirements for medical school clinics).

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