PROVIDER PARTICIPATION
§ 1223.41. Participation requirements.
In addition to the participation requirements established in Chapter 1101 (relating to general provisions), drug/alcohol outpatient clinics shall meet the following participation requirements:
(1) Be fully or provisionally licensed/approved as an outpatient drug/alcohol facility by the Department of Health. To remain eligible for Medical Assistance reimbursement, a facility shall be fully or provisionally licensed/approved at all times as an outpatient drug/alcohol clinic.
(2) Have medical personnel currently licensed or registered in accordance with the laws of the Commonwealth.
(3) Have a written patient referral plan that provides for inpatient hospital care and other 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 clinic in accordance with established policies. Appoint a physician responsible for the supervision and direction of services rendered to eligible recipients.
(6) Notify immediately the Department’s Office of Medical Assistance Programs, in writing, of any facility name, address and service changes prior to the effective date of change. Failure to do so may result in payment interruptions or termination of the provider agreement.
(7) Enter into a written provider agreement with the Department.
(8) Forward copies of items required by subparagraphs (i)—(v) to the Office of Medical Assistance Programs. It is the clinic director’s responsibility to notify the Office of Medical Assistance Programs, in writing, of changes in the clinic’s full compliance with licensure standards and changes in the following items required by subparagraphs (i)—(v) within 30 days following a change. If the clinic is relicensed by the Department of Health, the clinic director shall also forward a copy of the current license to the Office of Medical Assistance Programs within 30 days of relicensure:
(i) A current Department of Health license showing effective dates of licensure and activities licensed.
(ii) A written description of referral services utilized.
(iii) A written description of clinic services provided on the clinic premises.
(iv) The current fee schedule for billing third party and private payors.
(v) The names and business addresses of physicians providing treatment or supervision for MA recipients on a full-time or part-time basis in the clinic.
(9) Have each branch location or satellite of an approved clinic also licensed by the Department of Health as an outpatient clinic and be approved by the Office of Medical Assistance Programs before reimbursement can be made for services rendered at the branch or satellite. Approval of the parent organization does not constitute approval for any branches or satellites of the same organization.
(10) Be approved by the Office of Medical Assistance Programs.
(11) Ensure that a DAAP performs a level of care assessment for each patient prior to admission to the clinic and the provision of treatment.
Authority The provisions of this § 1223.41 amended under section 443.3(1) of the Public Welfare Code (62 P. S. § 443.4(1)).
Source The provisions of this § 1223.41 amended November 9, 2001, effective November 10, 2001, and apply retroactively to March 1, 1998, 31 Pa.B. 6153; amended November 8, 2002, effective November 9, 2002, 32 Pa.B. 5513. Immediately preceding text appears at serial pages (285061) to (285062).
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