Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › PROVIDER PARTICIPATION › Section 22.62 - Conditions of provider participation

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Enrollment
.
(1) Only providers who have been enrolled in
				  the PACE Program are qualified to receive payments made under the
				  program.
(2) A provider seeking
				  enrollment as a PACE provider may seek to be enrolled as a provider of walk-in
				  prescription services, as a provider of prescription services by mail or as a
				  provider of both kinds of services. The Department will assign separate and
				  distinct provider numbers to be used in identifying claims submitted for
				  reimbursement as claims for walk-in services or mail-order services and
				  delivery as required under §
											22.11(f)(3)
				  (relating to general payment principles).
(3) In order to become enrolled in the PACE
				  Program as a provider of walk-in prescription services, a provider shall:
(i) Meet the conditions of eligibility set
				  forth in §
												22.61 (relating to conditions of
				  provider eligibility), both at the time of initial application for enrollment
				  and on an ongoing basis.
(ii)
				  Satisfactorily complete and submit to the Department the appropriate enrollment
				  forms.
(iii) Submit a signed
				  provider agreement with the enrollment forms which sets forth the provisions
				  and assurances required of all participating providers and makes specific
				  reference to the instructions in the standard provider manual relating to the
				  dispensing of walk-in prescription services.
(4) In order to become enrolled as a provider
				  of PACE prescription services by mail, a provider shall:
(i) Meet the conditions of eligibility set
				  forth in § 22.61, both at the time of initial application for enrollment
				  and on an ongoing basis.
(ii)
				  Satisfactorily complete and submit to the Department the appropriate enrollment
				  forms which shall include information which establishes the provider's methods
				  and procedures for carrying out the requirements of subsection (e)(3) and
				  §
												22.63 (relating to other provisions
				  for providing services by mail).
(iii) Submit with the enrollment forms a
				  signed provider agreement which sets forth the standard provisions and
				  assurance required of participating providers and makes specific reference to
				  §
												22.63 and instructions in the
				  standard provider manual relating to the dispensing of prescription services by
				  mail.
(5) Providers who
				  meet all of the following conditions will not be considered to be providers of
				  PACE benefits by mail:
(i) Those who do not
				  have or do not take steps to develop a systematic mail order
				  operation.
(ii) Those who limit
				  their use of mail delivery of PACE Program benefits to claimants with whom they
				  have already established a face-to-face customer relationship and comply with
				  § 22.63(c)(1).
(iii) Those who
				  do not dispense to PACE Program claimants more than ten PACE claims by mail in
				  a given month.
(6) A
				  provider's enrollment in the PACE Program shall be effective on the date when
				  the signatures of the Department's authorized representatives have been affixed
				  to the provider agreement. Except as provided for in subsection (b), no
				  services rendered prior to that date shall be eligible for
				  reimbursement.
(7) A provider's
				  enrollment shall cease to be effective on the date when the Department suspends
				  or terminates the provider agreement under §
											22.84 (relating to administrative
				  actions and penalties). Payments or reimbursements will not be made for
				  prescription drugs dispensed on dates when a provider's enrollment is not
				  effective.