First, . If the provider chooses the offset method, the provider may choose to offset the overpayment in one lump sum or in a maximum of four equal installments over the repayment period. This section cited in 55 Pa. Code 1121.41 (relating to participation requirements); 55 Pa. Code 1123.41 (relating to participation requirements); 55 Pa. Code 1127.41 (relating to participation requirements); 55 Pa. Code 1128.41 (relating to participation requirements); 55 Pa. Code 1141.41 (relating to participation requirements); 55 Pa. Code 1142.41 (relating to participation requirements); 55 Pa. Code 1143.41 (relating to participation requirements); 55 Pa. Code 1144.41 (relating to participation requirements); 55 Pa. Code 1149.41 (relating to participation requirements); and 55 Pa. Code 1251.41 (relating to participation requirements). (3)Failed to comply with the conditions of participation listed in Articles IV or XIV of the Public Welfare Code (62 P. S. 401493 and 14011411). (xiv)Services furnished by a funeral director. The next three digits refer to the Julian Calendar date. 4418; amended August 5, 2005, effective August 10, 2005, 35 Pa.B. Detailed case material and findings will be made available to the agencies specified in paragraph (1). Section 251. (17)Drugs as specified in Chapter 1121 (relating to pharmaceutical services). A medical facility shall disclose to the Department, upon execution of a provider agreement or renewal thereof, the name and social security number of a person who has a direct or indirect ownership or control interest of 5% or more in the facility. When Established; Classification (Repealed). (xi)Staff to perform nursing facility functions outside the practice of pharmacy. Immediately preceding text appears at serial pages (75058) and (75059). Greensburg Nursing and Convalescent Center v. Department of Public Welfare, 633 A.2d 249 (Pa. Cmwlth. In addition, if a providers claim to the Department incurs a delay due to a third party or an eligibility determination, and the 180-day time frame has not elapsed, the provider shall still submit the claim through the normal claims processing system. It is a function of the CAO to identify recipient misutilization; abuse or possible fraud in relation to the MA Program. For the purpose of establishing the usual and customary charge to the general public, the provider shall permit the Department access to payment records of non-MA patients without disclosing the identity of the patients. . The Notice of Appeal also shall set forth in detail the reasons for the appeal. (4)This paragraph applies to overpayments relating to cost reporting periods ending prior to October 1, 1985. . Written notice of the Departments action to delay payment will also be sent to the PSRO, where applicable. The strict 6 month deadline for submission of invoices by Medical Assistance providers is not arbitrary or unreasonable since it was intended and does benefit providers by assuring prompt payment. The term includes other health insurance plans. 1102. This chapter sets forth the MA regulations and policies which apply to providers. (2)Treatment and medication forms that are already part of the pharmacys software and may be supplied to the nursing facility. The Department may not pay for a restricted service rendered by a provider other than the one to which a recipient has been restricted unless it was furnished in response to an emergency situation. (ii)Ambulatory surgical center services as specified in Chapter 1126. 5995; amended August 26, 2005, effective August 29, 2005, 35 Pa.B. (2)Chapter 1145 (relating to chiropractors services). 3653; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. (c)Invoice exception criteria. 1982). The provisions of this 1101.77a adopted December 13, 1996, effective December 14, 1996, 26 Pa.B. The provisions of this 1101.77 adopted November 18, 1983, effective November 19, 1983, 13 Pa.B. Jack v. Department of Public Welfare, 568 A.2d 1339 (Pa. Cmwlth. Professional Standards Review Organization or PSROAn organization which HHS has charged with the responsibility for operating professional review systems to determine whether hospital services are medically necessary, provided appropriately, carried out on a timely basis and meet professional standards. The provisions of this 1101.51a adopted May 27, 2016, effective May 28, 2016, 46 Pa.B. The school nurse or doctor refers the child to the provider by completing a School Medical Referral Form. (3)Outpatient hospital services as follows: (i)Short procedure unit services as specified in Chapter 1126 (relating to ambulatory surgical center services and hospital short procedure unit services). Therefore, strict compliance is mandatory and substantial compliance is insufficient. A petitioners failure to correct or respond not once, but twice, to a request regarding the lack of specificity of issues stated on the Notice of Appeal was unreasonable and justified dismissal of the appeal. (iii)For nonemergency services provided in a hospital emergency room, the copayment on the hospital support component is double the amount shown in subparagraph (vi), if an approved waiver exists from the United States Department of Health and Human Services. (12)Enter into an agreement, combination or conspiracy to obtain or aid another in obtaining payment from the Department for which the provider or other person is not entitled, that is, eligible. 336; amended April 12, 1991, effective May 1, 1991, 21 Pa.B. (a)Supplementary payment for a compensable service. Providers shall retain fiscal records relating to services they have rendered to MA recipients regardless of whether the records have been produced manually or by computer. (3)The trip back to this Commonwealth would endanger his health. 1996). If the applicant is determined to be eligible, the Department issues Medical Services Eligibility (MSE) cards that are effective from the first of the month through the last day of the month. (iii)A request for an exception may be made prospectively, before the service has been delivered, or retrospectively, after the service has been delivered. Immediately preceding text appears at serial pages (75056), (47798) to (47799) and (75057). A correctly completed invoice shall accompany the request. 1454. PractitionerA medical doctor, doctor of osteopathy, dentist, optometrist, podiatrist, chiropractor or other medical professional licensed by the Commonwealth or by another state who is authorized to participate in the MA Program as a provider. HOME; ABOUT; heavy duty lazy susan; BRANDS; CONTACT; provisions 1101 and 1121 of pennsylvania school code To be reimbursed for an item or service, the provider shall be eligible to provide it on the date it is provided, and the recipient shall be eligible to receive it on the date it is furnished unless there is specific provision for such payment in the provider regulations. 538. (3)The Department may request additional documentation to justify approval of an exception. number, and the patients or the patients employers address. (5)Chapter 1241 (relating to early and periodic screening diagnosis and treatment program). (viii)A provider may not hold a recipient liable for payment for services rendered in excess of the limits established in subsections (b) and (e) unless both of the following conditions are met: (A)The provider has requested an exception to the limit and the Department has denied the request. Immediately preceding text appears at serial pages (75054) and (75055). (3)If a provider appeals the Departments action of terminating the enrollment and participation of or suspending payments to the provider: (i)The Department will pay the provider for compensable service rendered on and after the effective date specified in the notice if the appeal of the provider is upheld. (7)An appeal by the provider of the audit disallowance does not suspend the providers obligation to repay the amount of the overpayment to the Department. It has nearly 89,000 students and over 10% international students. (5)Ordered with the recipients knowledge. The Department of Public Welfare was equitably estopped from denying the nursing care facility full Medical Assistance (MA) reimbursement for the patient care the facility provided to MA patients during its period of decertification. The adults in charge should have guidelines tohelp you. Although termination of the written provider agreement is the only sanction expressly provided for in subsection (e)(4), the Department has the right to impose a lesser included penalty of suspension of that agreement. Though its origin in Aristotle's school is beyond doubt, . (iii)Granting the exception is necessary in order to comply with Federal law. (iii)Outpatient hospital clinic services as specified in Chapter 1221 (relating to clinic and emergency room services) and in paragraph (2). Enrollment and ownership reporting requirements. Section 252. The notice will state the basis for the action, the effective date, whether the Department will consider re-enrollment and, if so, the date when re-enrollment will be considered. (2)The process for requesting an exception is as follows: (i)A recipient or a provider on behalf of a recipient may request an exception. 1999). (5)The procedures in this subsection do not apply if the provider is bankrupt or out-of-business under section 1903(d)(2)(D) of the Social Security Act (42 U.S.C.A. Founded in 1855, the university's history started with the Farmer's High School of Pennsylvania. (ii)For inpatient hospital services, provided in a general hospital, rehabilitation hospital or private psychiatric hospital, the copayment is $6 per covered day of inpatient care, not to exceed $42 per admission. ballet costumes for adults. The Department will use statistical sampling methods and, where appropriate, purchase invoices and other records for the purpose of calculating the amount of restitution due for a service, item, product or drug substitution. REVISED JUDICATURE ACT OF 1961 Act 236 of 1961 AN ACT to revise and consolidate the statutes relating to the organization and jurisdiction of the courts of this state; the powers (1)Services rendered, ordered, arranged for or prescribed for MA recipients by a physician whose license to practice medicine has expired are not eligible for payment under the MA Program. (c)Effects of termination of providers. Therefore, the provider shall not make any direct or indirect referral arrangements between practitioners and other providers of medical services or supplies but may recommend the services of another provider or practitioner; automatic referrals between providers are, however, prohibited. The denial of the claim was not an arbitrary act, but was based upon duly enacted regulations that are reasonable and provide ample time for submission of a claim. (a) Scope. provisions 1101 and 1121 of pennsylvania school codelive science subscription. An applicant may appeal under 2 Pa.C.S. Immediately preceding text appears at serial page (69575). Postpartum periodThe period beginning on the last day of the pregnancy and extending through the end of the month in which the 60-day period following termination of the pregnancy ends. Reference should be made to 1101.91(b) (relating to recipient misutilization and abuse). Immediately preceding text appears at serial pages (290141) to (290143). (6)Chapter 1225 (relating to family planning clinic services). The provisions of this 1101.43 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. This section cited in 55 Pa. Code 1187.158 (relating to appeals). Immediately preceding text appears at serial pages (117328) to (117331). For the purposes of prior authorization, emergency situations are those which meet the Federal Medicaid definition of medical emergency as it may be amended in the future. (10)Home health care as specified in Chapter 1249 (relating to home health agency services). (ii)The provider shall include in the notice of the agreement of sale the effective date of the sale and a copy of the sales agreement. The method of repayment is determined by the Department. Interest will be calculated from the date payment was made by the Department to the date full repayment is made to the Commonwealth. (7)Chapter 1251 (relating to funeral directors services). This does not include reports regarding drug usage. (4)Except for the exclusions specified in paragraphs (2) and (3), each MA service furnished by a provider to an eligible recipient is subject to copayment requirements. (a)In-state providers. Immediately preceding text appears at serial page (233035). If an approved waiver does not exist, the copayment will follow the schedule shown in subparagraph (vi). The MA Program is authorized under Article IV of the Public Welfare Code (62 P. S. 401488) and is administered in conformity with Title XIX of the Social Security Act (42 U.S.C.A. 6006; reserved February 10, 1995, effective February 11, 1995, 25 Pa.B. No statutes or acts will be found at this website. The provisions of this 1101.68 amended December 14, 1990, effective January 1, 1991, 20 Pa.B. (ii)Home health care as specified in Chapter 1249, up to a maximum of 30 visits per fiscal year. (vi)The record shall indicate the progress at each visit, change in diagnosis, change in treatment and response to treatment. A provider who seeks or accepts supplementary payment of another kind from the Department, the recipient or another person for a compensable service or item is required to return the supplementary payment. (a)Expanded coverage. State College Manor Ltd. v. Department of Public Welfare, 498 A.2d 996 (Pa. Cmwlth. The Department will pay for scheduled periodic health screening services for categorically needy and medically needy individuals. The provisions of this Ordinance are designed to achieve the following: 11.A. Categorically needyAged, blind or disabled individuals or families and children who are otherwise eligible for Medicaid and who meet the financial eligibility requirements for TANF, SSI or an optional State supplement. Prepayment review is not prior authorization. (a)To participate in the MA Program, a physician shall have and maintain a current license. Noncompensable itemA service or supply a provider furnishes for which there is no provision for payment under this part. (iii)When the total component or only the technical component of the following services are billed, the copayment is $2: (iv)For all other services, the amount of the copayment is based on the MA fee for the service, using the following schedule: (A)If the MA fee is $2 through $10, the copayment is $1.30. (5)Submit a claim for services or items which were not rendered by the provider or were not rendered to a recipient. 1101.11. 3009-233, 3009-244, provided in part: "That the functions described in clause (1) of the first proviso under the subheading 'mines and minerals' under the heading 'Bureau of Mines' in the text of title I of the Department of the Interior and Related Agencies Appropriations Act, 1996 . (d)The practitioners signature on the prescription is waived only for a telephoned drug prescription. (vii)Emergency room care as specified in Chapter 1221, limited to emergency situations as defined in 1101.21 and 1150.2 (relating to definitions; and definitions). 1396(b)(2)(D)). Sec. (7)Been convicted of a criminal offense under State or Federal laws relating to the practice of the providers profession as certified by a court. 1105. This section cited in 55 Pa. Code 1101.74 (relating to provider fraud); 55 Pa. Code 1101.75 (relating to provider prohibited acts); 55 Pa. Code 1101.77 (relating to enforcement actions by the Department); 55 Pa. Code 1127.81 (relating to provider misutilization); 55 Pa. Code 1181.542 (relating to who is required to be screened); and 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions). This may include, but is not necessarily limited to, purchase invoices, prescriptions, the pricing system used for services rendered to patients who are not on MA, either the originals or copies of Departmental invoices and records of payments made by other third party payors. (D)If the MA fee is $50.01 or more, the copayment is $7.60. 1985). AdultAn MA recipient 21 years of age or older. For the request to be considered, it should include statements from peer review bodies, probation officers where appropriate, or professional associates, giving factual evidence of why they believe the violations leading to the termination will not be repeated. Department of Public Welfare v. Soffer, 544 A.2d 1109 (Pa. Cmwlth. Out-of-State providers shall be licensed, and registered or certified or both, by the appropriate agencies in their respective states. Del Borrello v. Department of Public Welfare, 508 A.2d 368 (Pa. Cmwlth. (1)A $150 deductible per fiscal year shall be applied to adult GA recipients for the following MA compensable services: (i)Ambulatory surgical center services. In two Dutch samples, Van IJzendoorn (2001) found significant correlations between ethnocentrism and authoritarianism in both high school and university students. A notice confirming the termination will be sent to the provider. 1986). The providers timely written response to the cost settlement letter will be determined by the postmark on the providers letter or, if hand delivered, the Departments date stamp. Payment for medical and health care is made solely from Commonwealth funds since these individuals do not meet the criteria for Federal funding of their medical care under Medicaid. No part of the information on this site may be reproduced for profit or sold for profit. (3)Disallowances for untimely submission of invoices, except where it is alleged the Department has directly caused the delay. The provisions of this 1101.94 amended April 27, 1984, effective April 28, 1984, 14 Pa.B 1454. (a)Any physician, dentist, optometrist, podiatrist, chiropractor, pharmacy, laboratory, nursing facility, hospital, clinic, home health agency, ambulance service, health establishment, State Mental Retardation Center or medical supplier in this Commonwealth or another state may apply to participate in the MA Program. For prospective exception requests, if the provider or recipient is not notified of the decision within 21 days of the date the request is received, the exception will be automatically granted. The provider does not have the right to appeal the following: (1)Disallowances for services or items provided to noneligible individuals. (i)A provider is not paid for services or items rendered on and after the effective date of his termination from the program. This section cited in 55 Pa. Code 1121.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1123.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1123.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1126.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1127.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1128.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1129.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1130.23 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1141.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1142.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1143.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1144.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1145.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1147.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1151.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1151.43 (relating to limitation on payment); 55 Pa. Code 1163.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1163.424 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1181.25 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1221.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1223.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1225.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1230.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1243.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1245.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1249.24 (relating to scope of benefits for General Assistance recipients); and 55 Pa. Code 1251.24 (relating to scope of benefits for General Assistance recipients). Written requests to participate in the MA Program should be sent to the Departments Office of MA, Bureau of Hospital and Outpatient Programs. (2)A provider whose enrollment in the program has been terminated may not, during the period of termination: (i)Own, render, order or arrange for a service for a recipient. 3653. MedicaidMedical Assistance provided under a State Plan approved by HHS under Title XIX of the Social Security Act. Providers in states adjacent to this Commonwealth who regularly furnish services to Pennsylvania MA recipients shall be required to enter into a written provider agreement. This chapter cited in 55 Pa. Code 52.3 (relating to definitions); 55 Pa. Code 52.14 (relating to ongoing responsibilities of providers); 55 Pa. Code 52.22 (relating to provider monitoring); 55 Pa. Code 52.24 (relating to quality management); 55 Pa. Code 52.42 (relating to payment policies); 55 Pa. Code 52.65 (relating to appeals); 55 Pa. Code 283.31 (relating to funeral director violations); 55 Pa. Code 1102.1 (relating to policy); 55 Pa. Code 1102.41 (relating to provider participation and enrollment); 55 Pa. Code 1102.71 (relating to scope of claims review procedures); 55 Pa. Code 1102.81 (relating to prohibited acts of a shared health facility and providers practicing in the shared health facility); 55 Pa. Code 1121.1 (relating to policy); 55 Pa. Code 1121.11 (relating to types of services covered); 55 Pa. Code 1121.12 (relating to outpatient services); 55 Pa. Code 1121.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1121.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1121.51 (relating to general payment policy); 55 Pa. Code 1121.71 (relating to scope of claims review procedures); 55 Pa. Code 1121.81 (relating to provider misutilization); 55 Pa. Code 1123.1 (relating to policy); 55 Pa. Code 1123.11 (relating to types of services covered); 55 Pa. Code 1123.12 (relating to outpatient services); 55 Pa. Code 1123.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1123.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1123.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1123.51 (relating to general payment policy); 55 Pa. Code 1123.71 (relating to scope of claim review procedures); 55 Pa. Code 1123.81 (relating to provider misutilization); 55 Pa. Code 1126.1 (relating to policy); 55 Pa. Code 1126.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1126.41 (relating to participation requirements); 55 Pa. Code 1126.51 (relating to general payment policy); 55 Pa. Code 1126.71 (relating to scope of utiliza-tion review process); 55 Pa. Code 1126.81 (relating to provider misutilization); 55 Pa. Code 1126.82 (relating to administrative sanctions); 55 Pa. Code 1126.91 (relating to provider right of appeal); 55 Pa. Code 1127.1 (relating to policy); 55 Pa. Code 1127.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1127.51 (relating to general payment policy); 55 Pa. Code 1128.1 (relating to policy); 55 Pa. Code 1128.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1128.51 (relating to general payment policy); 55 Pa. Code 1128.81 (relating to provider misutilization); 55 Pa. Code 1129.1 (relating to policy); 55 Pa. Code 1129.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1129.41 (relating to participation requirements); 55 Pa. Code 1129.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1129.71 (relating to scope of claims review procedures); 55 Pa. Code 1129.81 (relating to provider misutilization); 55 Pa. Code 1130.2 (relating to policy); 55 Pa. Code 1130.23 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1130.81 (relating to scope of utilization review process); 55 Pa. Code 1130.91 (relating to provider misutilization); 55 Pa. Code 1130.101 (relating to hospice right of appeal); 55 Pa. Code 1140.1 (relating to purpose); 55 Pa. Code 1140.41 (relating to participation requirements); 55 Pa. Code 1140.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1140.51 (relating to general payment policy); 55 Pa. Code 1140.71 (relating to scope of claims review procedures); 55 Pa. Code 1140.81 (relating to provider misutilization); 55 Pa. Code 1141.1 (relating to policy); 55 Pa. Code 1141.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1141.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1141.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1141.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1141.51 (relating to general payment policy); 55 Pa. Code 1141.71 (relating to scope of claims review procedures); 55 Pa. Code 1141.81 (relating to provider misutilization); 55 Pa. Code 1142.1 (relating to policy); 55 Pa. Code 1142.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1142.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1142.51 (relating to general payment policy); 55 Pa. Code 1142.71 (relating to scope of claims review procedures); 55 Pa. Code 1142.81 (relating to provider misutilization); 55 Pa. Code 1143.1 (relating to policy); 55 Pa. Code 1143.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1143.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1143.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1143.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1143.51 (relating to general payment policy); 55 Pa. Code 1143.71 (relating to scope of claims review procedures); 55 Pa. Code 1143.81 (relating to provider misutilization); 55 Pa. Code 1144.1 (relating to policy); 55 Pa. Code 1144.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1144.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1144.51 (relating to general payment policy); 55 Pa. Code 1144.71 (relating to scope of claims review procedures); 55 Pa. Code 1144.81 (relating to provider misutilization); 55 Pa. Code 1145.1 (relating to policy); 55 Pa. Code 1145.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1145.41 (relating to participation requirements); 55 Pa. Code 1145.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1145.51 (relating to general payment policy); 55 Pa. Code 1145.71 (relating to scope of claims review procedures); 55 Pa. Code 1145.81 (relating to provider misutilization); 55 Pa. Code 1147.1 (relating to policy); 55 Pa. Code 1147.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1147.41 (relating to participation requirements); 55 Pa. Code 1147.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1147.51 (relating to general payment policy); 55 Pa. Code 1147.53 (relating to limitations on payment); 55 Pa. Code 1147.71 (relating to scope of claims review procedures); 55 Pa. Code 1147.81 (relating to provider misutilization); 55 Pa. Code 1149.1 (relating to policy); 55 Pa. Code 1149.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1149.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1149.23 (relating to scope of benefits for State Blind Pension recipients); 55 Pa. Code 1149.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1149.43 (relating to requirements for dental records); 55 Pa. Code 1149.51 (relating to general payment policy); 55 Pa. Code 1149.54 (relating to payment policies for orthodontic services); 55 Pa. Code 1149.71 (relating to scope of claims review procedures); 55 Pa. Code 1149.81 (relating to provider misutilization); 55 Pa. Code 1150.1 (relating to policy); 55 Pa. Code 1150.51 (relating to general payment policies); 55 Pa. Code 1150.61 (relating to guidelines for fee schedule changes); 55 Pa. Code 1151.1 (relating to policy); 55 Pa. Code 1151.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1151.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1151.24 (relating to scope of benefits for GA recipients); 55 Pa. Code 1151.31 (relating to participation requirements); 55 Pa. Code 1151.33 (relating to ongoing responsibilities of providers); 55 Pa. Code 1151.41 (relating to general payment policy); 55 Pa. Code 1151.70 (relating to scope of claim review process); 55 Pa. Code 1151.91 (relating to provider abuse); 55 Pa. Code 1151.101 (relating to provider right of appeal); 55 Pa. Code 1153.1 (relating to policy); 55 Pa. Code 1153.12 (relating to outpatient services); 55 Pa. Code 1153.41 (relating to participation requirements); 55 Pa. Code 1153.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1153.51 (relating to general payment policy); 55 Pa. Code 1153.71 (relating to scope of claims review procedures); 55 Pa. Code 1153.81 (relating to provider misutilization); 55 Pa. Code 1155.1 (relating to policy); 55 Pa. Code 1155.21 (relating to participation requirements); 55 Pa. Code 1155.22 (relating to ongoing responsibilities of providers); 55 Pa. Code 1155.31 (relating to general payment policy); 55 Pa. Code 1155.41 (relating to scope of claims review procedures); 55 Pa. Code 1155.51 (relating to provider misutilization); 55 Pa. Code 1163.1 (relating to policy); 55 Pa. Code 1163.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1163.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1163.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1163.41 (relating to general participation requirements); 55 Pa. Code 1163.43 (relating to ongoing responsibilities of providers); 55 Pa. Code 1163.51 (relating to general payment policy); 55 Pa. Code 1163.63 (relating to billing requirements); 55 Pa. Code 1163.71 (relating to scope of utilization review process); 55 Pa. Code 1163.91 (relating to provider misutilization); 55 Pa. Code 1163.101 (relating to provider right to appeal); 55 Pa. Code 1163.401 (relating to policy); 55 Pa. Code 1163.402 (relating to definitions); 55 Pa. Code 1163.421 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1163.422 (relating to scope of benefits for the medically needy); 55 Pa. Code 1163.424 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1163.441 (relating to general participation requirements); 55 Pa. Code 1163.443 (relating to ongoing responsibilities of providers); 55 Pa. Code 1163.451 (relating to general payment policy); 55 Pa. Code 1163.456 (relating to third-party liability); 55 Pa. Code 1163.471 (relating to scope of claim review process); 55 Pa. Code 1163.491 (relating to provider misutilization); 55 Pa. Code 1163.501 (relating to provider right to appeal); 55 Pa. Code 1181.1 (relating to policy); 55 Pa. Code 1181.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1181.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1181.25 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1181.41 (relating to provider participation requirements); 55 Pa. Code 1181.45 (relating to ongoing responsibilities of providers); 55 Pa. Code 1181.51 (relating to general payment policy); 55 Pa. Code 1181.62 (relating to noncompensable services); 55 Pa. Code 1181.74 (relating to auditing requirements related to cost reports); 55 Pa. Code 1181.81 (relating to scope of claims review procedures); 55 Pa. Code 1181.86 (relating to provider misutilization); 55 Pa. Code 1181.231 (relating to standards for general and selected costs); 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions); 55 Pa. Code 1187.1 (relating to policy); 55 Pa. Code 1187.11 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1187.12 (relating to scope of benefits for the medically needy); 55 Pa. Code 1187.21 (relating to nursing facility participation requirements); 55 Pa. Code 1187.22 (relating to ongoing responsibilities of nursing facilities); 55 Pa. Code 1187.77 (relating to auditing requirements related to cost report); 55 Pa. Code 1187.101 (relating to general payment policy); 55 Pa. Code 1187.155 (relating to exceptional DME grantspayment conditions and limitations); 55 Pa. Code 1189.1 (relating to policy); 55 Pa. Code 1189.74 (relating to auditing requirements related to MA cost report); 55 Pa. Code 1189.101 (relating to general payment policy for county nursing facilities); 55 Pa. Code 1221.1 (relating to policy); 55 Pa. Code 1221.21 (relating to scope of benefits for the categorically needy); 55 Pa. Code 1221.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1221.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1221.41 (relating to participation requirements); 55 Pa. Code 1221.46 (relating to ongoing responsibilities of providers); 55 Pa. Code 1221.51 (relating to general payment policy); 55 Pa. Code 1221.71 (relating to scope of claims review procedures); 55 Pa. Code 1221.81 (relating to provider misutilization); 55 Pa. Code 1223.1 (relating to policy); 55 Pa. Code 1223.12 (relating to outpatient services); 55 Pa. Code 1223.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1223.41 (relating to participation requirements); 55 Pa. Code 1223.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1223.51 (relating to general payment policy); 55 Pa. Code 1223.71 (relating to scope of claims review procedures); 55 Pa. Code 1223.81 (relating to provider misutilization); 55 Pa. Code 1225.1 (relating to policy); 55 Pa. Code 1225.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1225.41 (relating to general participation requirements); 55 Pa. Code 1225.45 (relating to ongoing responsibilities of providers); 55 Pa. Code 1225.51 (relating to general payment policy); 55 Pa. Code 1225.71 (relating to scope of claims review procedures); 55 Pa. Code 1225.81 (relating to provider misutilization); 55 Pa. Code 1229.1 (relating to policy); 55 Pa. Code 1229.41 (relating to participation requirements); 55 Pa. Code 1229.71 (relating to scope of claims review procedures); 55 Pa. Code 1229.81 (relating to provider misutilization); 55 Pa. Code 1230.1 (relating to policy); 55 Pa. Code 1230.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1230.41 (relating to participation requirements); 55 Pa. Code 1230.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1230.51 (relating to general payment policy); 55 Pa. Code 1230.71 (relating to scope of claim review procedures); 55 Pa. Code 1230.81 (relating to provider misutilization); 55 Pa. Code 1241.1 (relating to policy); 55 Pa. Code 1241.41 (relating to participation requirements); 55 Pa. Code 1241.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1241.71 (relating to scope of claims review procedures); 55 Pa. Code 1241.81 (relating to provider misutilization); 55 Pa. Code 1243.1 (relating to policy); 55 Pa. Code 1243.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1243.41 (relating to participation requirements); 55 Pa. Code 1243.51 (relating to general payment policy); 55 Pa. Code 1243.71 (relating to scope of claims review procedures); 55 Pa. Code 1243.81 (relating to provider misutilization); 55 Pa. Code 1245.1 (relating to policy); 55 Pa. Code 1245.2 (relating to definitions); 55 Pa. Code 1245.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1245.41 (relating to participation requirements); 55 Pa. Code 1245.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1245.51 (relating to general payment policy); 55 Pa. Code 1245.71 (relating to scope of claims review procedures); 55 Pa. Code 1245.81 (relating to provider misutilization); 55 Pa. Code 1247.1 (relating to policy); 55 Pa. Code 1247.41 (relating to participation requirements); 55 Pa. Code 1247.71 (relating to scope of claim review procedures); 55 Pa. Code 1247.81 (relating to provider misutilization); 55 Pa. Code 1249.1 (relating to policy); 55 Pa. Code 1249.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1249.41 (relating to participation requirements); 55 Pa. Code 1249.42 (relating to ongoing responsibilities of providers); 55 Pa. Code 1249.51 (relating to general payment policy); 55 Pa. Code 1249.71 (relating to scope of claims review procedures); 55 Pa. Code 1249.81 (relating to provider misutilization); 55 Pa. Code 1251.1 (relating to policy); 55 Pa. Code 1251.24 (relating to scope of benefits for General Assistance recipients); 55 Pa. Code 1251.71 (relating to scope of claims review procedures); 55 Pa. Code 1251.81 (relating to provider misutilization); 55 Pa. Code 5221.11 (relating to provider participation); 55 Pa. Code 5221.41 (relating to recordkeeping); 55 Pa. Code 5221.42 (relating to payment); 55 Pa. Code 6100.81 (relating to HCBS provider requirements); 55 Pa. Code 6100.482 (relating to payment); 55 Pa. Code 6210.2 (relating to applicability); 55 Pa. Code 6210.11 (relating to payment); 55 Pa. Code 6210.21 (relating to categorically needy and medically needy recipients); 55 Pa. Code 6210.75 (relating to noncompensable services); 55 Pa. Code 6210.82 (relating to annual adjustment); 55 Pa. Code 6210.93 (relating to auditing requirements related to cost reports); 55 Pa. Code 6210.101 (relating to scope of claims review procedures); 55 Pa. Code 6210.109 (relating to provider misutilization); and 55 Pa. Code 6211.2 (relating to applicability). 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