Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 52 Pa.B. 8372 (December 31, 2022).

28 Pa. Code § 4.13. Payment for HIP services.

§ 4.13. Payment for HIP services.

 (a)  Written authorization. The Division will provide written authorization, to the client and to the provider, as to HIP services for which the client is eligible and the maximum available funding and time limits for those services.

 (b)  Client responsibility for payment. If the Division determines that a client is responsible to pay for any part of HIP services, the client will be informed of that fact, and of the amount for which the client is responsible, as follows:

   (1)  The client shall be assessed a share of the cost of HIP based upon alternative financial resources between 185% and 300% of the Federal Poverty Income Guidelines. The patient’s share of the cost shall be determined using the Patient Share of Cost Table in Appendix A, as periodically updated and published in the Pennsylvania Bulletin.

   (2)  The client will be responsible to pay for HIP services up to the amount of alternative financial resources which exceed 300% of the Federal Poverty Income Guidelines.

 (c)  Notification of discontinuance of HIP funding. The Division will notify a client in writing of any discontinuance of funding. The notice will include the reason for the discontinuance and advise of appeal rights.

 (d)  Duty to update financial information. A client shall immediately report to the Division all changes in availability of alternative financial resources.

 (e)  Preexisting conditions. HIP will not pay for services to address conditions existing prior to the TBI.

 (f)  Services funded through other benefit programs. HIP will not pay for services available through other publicly funded programs. The provider will coordinate HIP with other public and private programs to assist clients to access benefits for which they may be eligible.

 (g)  Reimbursement. The Department may seek reimbursement for payments made with HIP funds on behalf of a client from an insurer that provides coverage to the client or from the proceeds of any litigation arising out of the injury which led to eligibility for enrollment in HIP.

Cross References

   This section cited in 28 Pa. Code §  4.12 (relating to funding limits).

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