PROVIDER PARTICIPATION
§ 1153.41. Participation requirements.
In addition to the participation requirements established in Chapter 1101 (relating to general provisions), psychiatric outpatient clinics and partial hospitalization outpatient facilities shall meet the following participation requirements:
(1) Have current licensure as a psychiatric outpatient clinic or partial hospitalization outpatient facility by the Department’s Office of Mental Health and Substance Abuse Services. To remain eligible for MA reimbursement, a psychiatric outpatient clinic or partial hospitalization outpatient facility shall be licensed at all times as a psychiatric outpatient clinic or partial hospitalization outpatient facility.
(2) Have medical personnel currently licensed, certified or registered in accordance with laws of the Commonwealth.
(3) Have a written referral plan for individuals receiving services that provides for inpatient hospital care and 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 psychiatric outpatient clinic or partial hospitalization outpatient facility. Appoint a psychiatrist or psychiatrists responsible for the supervision and direction of services rendered to eligible individuals.
(6) Notify immediately the Department, Office of Medical Assistance Programs, Bureau of Fee-for-Services, in the manner prescribed by the Department, of facility or clinic name, address and service changes prior to the effective date of change. Failure to do so may result in payment interruption or termination of the provider agreement.
(7) Enter into a written provider agreement with the Department.
(8) Have each branch location or satellite of a licensed psychiatric outpatient clinic or partial hospitalization outpatient facility also licensed by the Office of Mental Health and Substance Abuse Services as a psychiatric outpatient clinic site or psychiatric hospitalization outpatient facility, whichever is applicable, and enrolled by the Office of Medical Assistance Programs before reimbursement can be made for services rendered at the branch or satellite. Licensure and enrollment of the parent organization does not constitute licensure and enrollment for any branches or satellites of the same organization.
(9) Be enrolled as a provider in the Medical Assistance Program.
(10) Have medications prescribed by a licensed psychiatrist, physician, certified registered nurse practitioner or physician assistant within the practitioner’s scope of practice.
(11) Psychiatric outpatient clinics providing MMHT services shall have a service description approved by the Department under the conditions specified in § 5200.51 (relating to provider service description).
Authority The provisions of this § 1153.41 amended under section 201(2) of the Human Services Code (62 P.S. § 201(2)).
Source The provisions of this § 1153.41 adopted January 25, 1980, effective February 1, 1980, 10 Pa.B. 267; amended November 13, 1981, effective November 15, 1981, 11 Pa.B. 4046; amended October 11, 2019, effective October 12, 2019, 49 Pa.B. 5943. Immediately preceding text appears at serial pages (278532) and (348909).
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