Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1229 - HEALTH MAINTENANCE ORGANIZATION SERVICES
GENERAL PROVISIONS
Section 1229.2 - Definitions
Current through Register Vol. 54, No. 12, March 23, 2024
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Health Maintenance Organization (HMO)-A legal entity determined by the Assistant Secretary for Health, Department of Health and Human Services, to be organized and operated in the manner prescribed in section 1301(c) of the Social Security Act (42 U.S.C.A. § 300e(c)) and which provides, in the manner prescribed by section 1301(b) of the Social Security Act (42 U.S.C.A. § 300e(b)) at least the following health services to its eligible enrollees:
(i) Inpatient hospital services.
(ii) Outpatient services.
(iii) Laboratory and X-ray services.
(iv) Family planning services and supplies.
(v) Physician services.
(vi) Home health services for individuals entitled to those services under the Medicaid State Plan.
