55 Pa. Code § 1223.41 - Participation requirements
In addition to the participation requirements established
in Chapter 1101 (relating to general provisions), drug/alcohol
(1) Be fully or provisionally
licensed/approved as an outpatient drug/alcohol facility by the Department of
Health. To remain eligible for Medical Assistance reimbursement, a facility
shall be fully or provisionally licensed/approved at all times as an outpatient
drug/alcohol clinic.
(2) Have
medical personnel currently licensed or registered in accordance with the laws
of the Commonwealth.
(3) Have a
written patient referral plan that provides for inpatient hospital care and
other follow-up treatment.
(4) Post
a current, written fee schedule for billing third party and private
payors.
(5) Appoint an
administrator or director responsible for the internal operation of the clinic
in accordance with established policies. Appoint a physician responsible for
the supervision and direction of services rendered to eligible
recipients.
(6) Notify immediately
the Department 's Office of Medical Assistance Programs, in writing, of any
facility name, address and service changes prior to the effective date of
change. Failure to do so may result in payment interruptions or termination of
the provider agreement.
(7) Enter
into a written provider agreement with the Department .
(8) Forward copies of items required by
subparagraphs (i)-(v) to the Office of Medical Assistance Programs. It is the
clinic director's responsibility to notify the Office of Medical Assistance
Programs, in writing, of changes in the clinic's full compliance with licensure
standards and changes in the following items required by subparagraphs (i)-(v)
within 30 days following a change. If the clinic is relicensed by the
Department of Health, the clinic director shall also forward a copy of the
current license to the Office of Medical Assistance Programs within 30 days of
relicensure:
(i) A current Department of
Health license showing effective dates of licensure and activities
licensed.
(ii) A written
description of referral services utilized.
(iii) A written description of clinic
services provided on the clinic premises.
(iv) The current fee schedule for billing
third party and private payors.
(v)
The names and business addresses of physicians providing treatment or
supervision for MA recipients on a full-time or part-time basis in the
clinic.
(9) Have each
branch location or satellite of an approved clinic also licensed by the
Department of Health as an outpatient clinic and be approved by the Office of
Medical Assistance Programs before reimbursement can be made for services
rendered at the branch or satellite. Approval of the parent organization does
not constitute approval for any branches or satellites of the same
organization.
(10) Be approved by
the Office of Medical Assistance Programs.
(11) Ensure that a DAAP performs a level of
care assessment for each patient prior to admission to the clinic and the
provision of treatment.
Notes
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