55 Pa. Code § 1128.41 - Participation requirements

(a) In addition to the participation requirements established in §§ 1101.41-1101.43 (relating to participation), a renal dialysis facility shall:

(1) Have a signed contractual agreement with the Department of Health Chronic Renal Disease Program.

(2) Be enrolled in the MA Program as a renal dialysis provider.

(3) Be Medicare certified in accordance with Medicare regulations at 42 CFR 405.2100-405.2171 (relating to conditions for coverage of suppliers of End-Stage Renal Disease (ESRD) services).

(4) 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. §§ 1396-1396s), the Public Welfare Code (62 P. S. §§ 101-1411) and applicable licensing statutes.

(5) Have an established schedule of charges for billing third parties and private payors that is published and made available to the general public.

(6) If requested, furnish information to the Department necessary to establish rates as specified in § 1128.53 (relating to limitations on payment), in the form and manner the Department requires.

(b) It is the responsibility of the dialysis facility to determine that physicians associated with the facility meet the qualifications specified by the Department of Health.

(c) Out-of-State dialysis facilities providing services to Pennsylvania recipients shall, in addition to complying with the appropriate requirements of this section, either be Medicare certified or be approved or licensed by the appropriate agency of the state in which the facility is located as meeting standards comparable to Medicare.

(d) The Department reserves the right to refuse to enter into a provider agreement with a dialysis facility whenever it determines that it is in the best interest of the Program and its beneficiaries to do so.

Notes

55 Pa. Code § 1128.41