55 Pa. Code § 1155.31 - General payment policy

(a) Except as provided in subsections (b)-(d), payment is made to a licensed IBHS agency for medically necessary IBHS provided by qualified individuals under the supervision and direction of a clinical director that meets the qualifications in § 5240.12(b) or § 5240.81(b) (relating to staff qualifications; and staff qualifications for ABA services), subject to the conditions and limitations in this chapter, Chapters 1101 and 1150 (relating to general provisions; and MA Program payment policies) and the MA Program fee schedule.

(b) Payment will be made to an IBHS agency that complies with Chapter 5240 (relating to intensive behavioral health services) and holds an outpatient psychiatric clinic, a psychiatric partial hospitalization program or a family-based mental health license issued by the Department as of October 19, 2019, until the agency's license expires.

(c) Payment will be made to an unlicensed IBHS agency that complies with Chapter 5240 and is approved to provide behavioral health rehabilitation services as of October 19, 2019, for 1 year after promulgation of this chapter.

(d) Payment will be made to an unlicensed IBHS agency that complies with Chapter 5240 and is approved to provide ABA services as of October 19, 2019, for 180 days after promulgation of this chapter.

(e) Payment will not be made for a compensable IBHS if payment is available through a third party. Providers shall comply with § 1101.64 (relating to third-party medical resources (TPR)).

Notes

55 Pa. Code § 1155.31