Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1229 - HEALTH MAINTENANCE ORGANIZATION SERVICES
PROVIDER PARTICIPATION
Section 1229.41 - Participation requirements
Current through Register Vol. 54, No. 12, March 23, 2024
In addition to the participation requirements established in Chapter 1101 (relating to general provisions), Health Maintenance Organizations (HMOs) shall meet the following participation requirements:
(1) Have signed a contract with the Office of Medical Assistance for provision of HMO services to Medical Assistance eligibles.
(2) Comply with applicable Federal and State laws and regulations including but not limited to, Title XIX of the Social Security Act (42 U.S.C.A. §§ 1396-1396k); Article IV of the Public Welfare Code (62 P. S. §§ 401-489), and, when applicable, the Voluntary Nonprofit Health Service Act of 1972 (40 P. S. §§ 1551-1557).
(3) Have arrangements with other providers for referring recipients for services for which they are eligible under the Medical Assistance Program but which are not provided by the HMO.
