Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1153 - OUTPATIENT PSYCHIATRIC SERVICES › PROVIDER PARTICIPATION › Section 1153.41 - Participation requirements

Current through Register Vol. 54, No. 28, July 13, 2024
In addition to the participation requirements established
					 in Chapter 1101 (relating to general provisions), psychiatric outpatient
					 clinics and partial hospitalization outpatient facilities shall meet the
					 following participation requirements:
(1) Have current licensure as a psychiatric
				  outpatient clinic or partial hospitalization outpatient facility by the
				  Department's Office of Mental Health and Substance Abuse Services. To remain
				  eligible for MA reimbursement, a psychiatric outpatient clinic or partial
				  hospitalization outpatient facility shall be licensed at all times as a
				  psychiatric outpatient clinic or partial hospitalization outpatient
				  facility.
(2) Have medical
				  personnel currently licensed, certified or registered in accordance with laws
				  of the Commonwealth.
(3) Have a
				  written referral plan for individuals receiving services that provides for
				  inpatient hospital care and 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 psychiatric outpatient clinic or
				  partial hospitalization outpatient facility. Appoint a psychiatrist or
				  psychiatrists responsible for the supervision and direction of services
				  rendered to eligible individuals.
(6) Notify immediately the Department, Office
				  of Medical Assistance Programs, Bureau of Fee-for-Services, in the manner
				  prescribed by the Department, of facility or clinic name, address and service
				  changes prior to the effective date of change. Failure to do so may result in
				  payment interruption or termination of the provider agreement.
(7) Enter into a written provider agreement
				  with the Department.
(8) Have each
				  branch location or satellite of a licensed psychiatric outpatient clinic or
				  partial hospitalization outpatient facility also licensed by the Office of
				  Mental Health and Substance Abuse Services as a psychiatric outpatient clinic
				  site or psychiatric hospitalization outpatient facility, whichever is
				  applicable, and enrolled by the Office of Medical Assistance Programs before
				  reimbursement can be made for services rendered at the branch or satellite.
				  Licensure and enrollment of the parent organization does not constitute
				  licensure and enrollment for any branches or satellites of the same
				  organization.
(9) Be enrolled as a
				  provider in the Medical Assistance Program.
(10) Have medications prescribed by a
				  licensed psychiatrist, physician, certified registered nurse practitioner or
				  physician assistant within the practitioner's scope of practice.
(11) Psychiatric outpatient clinics providing
				  MMHT services shall have a service description approved by the Department under
				  the conditions specified in §
										5200.51 (relating to provider
				  service description).
The provisions of this §
												1153.41 amended under section
						201(2) of the Human Services Code (62 P.S. §
													201(2)).