Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1221 - CLINIC AND EMERGENCY ROOM SERVICES
PROVIDER PARTICIPATION
Section 1221.43 - Participation requirements for hospital clinics and emergency rooms for higher reimbursement rate
Current through Register Vol. 54, No. 44, November 2, 2024
To be eligible to bill for the higher MA fee identified in Chapter 1150 (relating to MA Program payment policies) and the MA Program fee schedule outpatient hospital clinics and emergency rooms shall:
(1) Provide comprehensive medical services for a minimum of 40 hours per week. Outpatient hospital clinics meet this requirement if the outpatient department of the hospital is open and provides some clinic service 40 hours per week.
(2) Have a licensed physician present in the clinic or emergency room at all times during scheduled hours of operation to perform medical services. A physician shall be responsible for the overall management of patient care.
(3) Be approved by the Department for higher reimbursement rate.
The provisions of this §1221.43 issued under section 443.3(1) of the Public Welfare Code (62 P. S. § 443.3(1)).
This section cited in 55 Pa. Code § 1221.45 (relating to additional participation requirements for medical school clinics).
