55 Pa. Code § 1229.41 - Participation requirements
In addition to the participation requirements established in Chapter 1101 (relating to general provisions), Health Maintenance Organizations (HMOs) shall meet the following participation requirements:
(1) Have signed a contract with the
Office of Medical Assistance for provision of HMO services to Medical
Assistance eligibles.
(2) Comply
with applicable Federal and State laws and regulations including but not
limited to, Title XIX of the Social Security Act (42 U.S.C.A. §§
1396-1396k); Article IV of the Public
Welfare Code (62 P. S. §§
401-489), and, when applicable,
the Voluntary Nonprofit Health Service Act of 1972 (40 P. S. §§
1551-1557).
(3) Have arrangements with other providers
for referring recipients for services for which they are eligible under the
Medical Assistance Program but which are not provided by the
HMO.
Notes
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