Pennsylvania Code
Title 55 - HUMAN SERVICES
Part VIII - Intellectual Disability and Autism Manual
Subpart C - Administration and Fiscal Management
Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM
SPECIAL PROGRAMS
Section 6100.803 - Organized health care delivery system
Universal Citation: 55 PA Code ยง 6100.803
Current through Register Vol. 54, No. 52, December 28, 2024
(a) OHCDS is an organized health care delivery system. An OHCDS is an arrangement in which a provider that renders an HCBS chooses to offer a different vendor of an HCBS through a subcontract to facilitate the delivery of vendor goods or services to an individual.
(b) The following requirements of this chapter do not apply to an OHCDS:
(1)
Sections 6100.47-6100.49 (relating to criminal
history checks; funding, hiring, retention and utilization; and child abuse
history certification) for public transportation and indirect services and
supplies.
(2) Training as specified
in §§
6100.141-6100.143 (relating to
training).
(3) Section
6100.405 (relating to incident
analysis).
(4) Medication
administration as specified in §§
6100.461-6100.469.
(5) Section
6100.571 (relating to fee schedule
rates).
(6) Sections
6100.641-6100.672, 6100.681-6100.694 and 6100.711.
(7) Section
6100.805 (relating to vendor goods
and services).
(c) In addition to this chapter, the following requirements apply to OHCDS.
(1) An OHCDS shall:
(i) Be an enrolled Medical Assistance waiver
provider.
(ii) Be enrolled in the
Medicaid management information system.
(iii) Provide at least one Medical Assistance
service.
(iv) Agree to provide the
identified vendor goods or services to individuals.
(v) Bill the Medicaid management information
system for the amount of the vendor goods or services.
(vi) Pay the vendor that provided the vendor
goods or services the amount billed for in the Medicaid management information
system.
(2) An OHCDS may
bill a separate administrative fee in accordance with the following:
(i) The administrative fee may not exceed the
limit set by Federal requirements.
(ii) The administrative activities must be
required to deliver the vendor good or HCBS to an individual and must be
documented to justify the separate administrative fee.
(3) An OHCDS shall ensure that each vendor
with which it contracts meets the applicable provisions of this
chapter.
(4) Only vendor goods and
services may be subcontracted through the OHCDS. A provider that subcontracts
shall have written agreements specifying the duties, responsibilities and
compensation of the subcontractor.
(5) An OHCDS shall provide the Department
with an attestation that the cost of the good or service is the same as or less
than the cost charged to the general public.
Disclaimer: These regulations may not be the most recent version. Pennsylvania may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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