55 Pa. Code § 1163.443 - Ongoing responsibilities of providers

In addition to the ongoing responsibilities established in Chapter 1101 (relating to general provisions), and as a condition of continued participation in the MA Program, rehabilitation hospitals and those general hospitals providing distinct part unit services that are reimbursed under this subchapter shall comply with the following:

(1) Maintain transfer agreements with skilled nursing and intermediate care facilities, private psychiatric hospitals, and rehabilitation hospitals, for the prompt and appropriate transfer of patients who no longer need acute inpatient hospital care. Rehabilitation hospitals need not maintain agreements with each other.

(2) Retain complete, accurate and auditable medical and fiscal records for 4 years for all MA patients under Chapter 1101.

(3) Furnish to the Department or its agents, Federal and State auditors, auditable copies of patient records and fiscal records upon request under Chapter 1101.

(4) For those hospitals not participating in Medicare, submit to the Office of MA for review and approval, details of any changes to the hospital's utilization review system, including revisions to the utilization review plan, within 30 days of the date of the change.

(5) Hospitals being reimbursed for distinct part unit services shall keep separate patient statistics and fiscal records on the cost of, and charges for, services provided to MA patients in each distinct part unit being reimbursed under this subchapter.

Notes

55 Pa. Code § 1163.443

The provisions of this § 1163.443 adopted June 22, 1984, effective 7/1/1984, 14 Pa.B. 2185.