PROVIDER PARTICIPATION
§ 1163.441. General participation requirements.
(a) In addition to the participation requirements established in Chapter 1101 (relating to general provisions), a cost reimbursed provider shall:
(1) Be licensed by the Department of Health.
(2) Have in effect a utilization review plan approved by Medicare or, for providers not participating in Medicare, a utilization review plan approved by the Office of Medical Assistance Programs. For a utilization review plan to be approved by the Office of Medical Assistance Programs, it shall meet the requirements in § 1163.473 (relating to hospital utilization review plan).
(b) Out-of-State rehabilitation hospitals furnishing inpatient hospital care to Commonwealth recipients shall:
(1) Be Medicare certified, or certified by the appropriate agency of the state in which the hospital is located as meeting standards comparable to Medicare or be certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Osteopathic Association (AOA) or the Commission on Accreditation of Rehabilitation Facilities (CARF).
(2) Be currently participating in the Medicaid Program of the state in which the hospital is located.
(3) Formally enroll in the MA Program and sign a provider agreement.
(c) The Department reserves the right to refuse to enter into a provider agreement with a licensed hospital or a distinct part thereof if it determines that it is in the Department’s best interests to do so.
Authority The provisions of this § 1163.441 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1).)
Source The provisions of this § 1163.441 adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185; amended November 7, 1986, effective July 1, 1986, 16 Pa.B. 4384; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial page (181861).
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