Source: http://www.healthinfolaw.org/state-topics/39,59/f_topics
Timestamp: 2019-11-19 09:43:45
Document Index: 244034188

Matched Legal Cases: ['§ 1101', '§ 1101', '§ 1403', '§ 1153', '§ 1181', '§ 1102', '§ 1163', '§ 1402', '§ 912', '§ 1121', '§ 1153', '§ 1121', '§ 1102', '§ 1121']

Medicaid/CHIP Data Requirements in Pennsylvania | Health Information & the Law
Medicaid/CHIP Data Requirements in Pennsylvania
Individuals enrolled in Pennsylvania’s medical assistance programs may obtain services from any institution, agency, pharmacy, or organization that tis approved by the Department of Public Welfare to provide such services; providers are prohibited from denying the services or discriminating against medical assistance patients on the grounds of race, color, national origin or handicap.1 Moreover, every practitioner must adhere to basic standards of practice, included maintaining a proper record for each patient that contains a complete medical history of the patient, all treatment plans, results of any interventions, as well as other critical information.2 The patient record should also include certain demographic and personal identification information, such as the patient’s full name and address, and dates of all visits.3
Various types of practices within the state may have additional record keeping and cost reporting requirements under the medical assistance program, including outpatient psychiatric clinics4, inpatient psychiatric facilities5, nursing facilities6, pharmacies7, shared health facilities8, and hospitals.9 Regardless of practice type, all providers must retain copies of all financial records to fully support claims and charges for payment under the medical assistance program for at least four years.10
1. 55 Pa. Code § 1101.51 (2012)
2. 55 Pa. Code § 1101.51 (2012)
3. 62 Pa. Stat. Ann. § 1403 (West 2012)
4. 55 Pa. Code § 1153.42 (2012)
6. 55 Pa. Code § 1181.64 (2012)
7. 55 Pa. Code, Chapter 1121 (2012)
8. 55 Pa. Code § 1102.34 (2012)
9. 55 Pa. Code § 1163.64 (2012)
10. 62 Pa. Stat. Ann. § 1402 (West 2012)
Medicaid/CHIP Data Requirements Annual audited financial statements - 28 Pa. Code § 912.61 Hospitals and ambulatory service facilities must annually file audited and certified financial statements within 120 days after the close of the...
Ongoing responsibilities of providers - 55 Pa. Code § 1121.42 As a condition of participation in the medical assistance program, pharmacies must permit authorized officials to conduct onsite reviews for the...
Ongoing responsibilities of providers - 55 Pa. Code § 1153.42 Outpatient psychiatric clinics and outpatient psychiatric partial hospitalization facilities must include the following information in the medical...
Payment conditions for various services - 55 Pa. Code § 1121.52 Medical assistance prescriptions must contain the following information on the prescription form:1 The...
Responsibilities relating to provider performance - 55 Pa. Code § 1102.34 The operator of a shared health facility must insure that providers rendering services to recipients at the facility and persons employed by the...
Scope of claims review procedures - 55 Pa. Code § 1121.71 Claims submitted by pharmacies under the medical assistance program are subject to utilization review. 55 Pa. Code Chapter 1121, “Scope of...