55 Pa. Code § 6100.803 - Organized health care delivery system
(a) OHCDS is an organized health care
delivery system. An OHCDS is an arrangement in which a provider that renders an
HCBS chooses to offer a different vendor of an HCBS through a subcontract to
facilitate the delivery of vendor goods or services to an individual.
(b) The following requirements of this
chapter do not apply to an OHCDS:
(1)
Sections 6100.47-6100.49 (relating to criminal
history checks; funding, hiring, retention and utilization; and child abuse
history certification) for public transportation and indirect services and
supplies.
(3) Section
6100.405 (relating to incident
analysis).
(5) Section
6100.571 (relating to fee schedule
rates).
(7) Section
6100.805 (relating to vendor goods
and services).
(c) In
addition to this chapter, the following requirements apply to OHCDS.
(1) An OHCDS shall:
(i) Be an enrolled Medical Assistance waiver
provider.
(ii) Be enrolled in the
Medicaid management information system.
(iii) Provide at least one Medical Assistance
service.
(iv) Agree to provide the
identified vendor goods or services to individuals.
(v) Bill the Medicaid management information
system for the amount of the vendor goods or services.
(vi) Pay the vendor that provided the vendor
goods or services the amount billed for in the Medicaid management information
system.
(2) An OHCDS may
bill a separate administrative fee in accordance with the following:
(i) The administrative fee may not exceed the
limit set by Federal requirements.
(ii) The administrative activities must be
required to deliver the vendor good or HCBS to an individual and must be
documented to justify the separate administrative fee.
(3) An OHCDS shall ensure that each vendor
with which it contracts meets the applicable provisions of this
chapter.
(4) Only vendor goods and
services may be subcontracted through the OHCDS. A provider that subcontracts
shall have written agreements specifying the duties, responsibilities and
compensation of the subcontractor.
(5) An OHCDS shall provide the Department
with an attestation that the cost of the good or service is the same as or less
than the cost charged to the general public.
Notes
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