PROVIDER PARTICIPATION
§ 1247.41. Participation requirements.
(a) In addition to the participation requirements established in Chapter 1101 (relating to general provisions), each case manager shall enroll in the MA Program as a case manager.
(b) Enrollment is open to registered nurses licensed in this Commonwealth and individuals possessing, at a minimum, a bachelor’s degree in one of the social sciences.
(c) Case managers shall maintain licensure status, if required for initial enrollment, and shall have the particularized knowledge of the special needs associated with the conditions of the special target group.
(d) In addition to meeting the requirements of this section, out-of-State case managers are eligible for enrollment if one of the following occurs:
(1) An appropriate Pennsylvania-based case manager is not available within a reasonable distance to provide the targeted case management services needed by members of a target group.
(2) The recipient lives in an area where residents generally receive health care services from providers located in the area in which the case manager is situated.
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