Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1101 - GENERAL PROVISIONS › PARTICIPATION › Section 1101.42 - Prerequisites for participation

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
In-state providers.
In
				  order to be eligible to participate in the MA Program, Commonwealth-based
				  providers shall be currently licensed and registered or certified or both by
				  the appropriate State agency, complete the enrollment form, sign the provider
				  agreement specified by the Department, and meet additional requirements
				  described in this chapter and the separate chapters relating to each provider
				  type. The Department may at its discretion refuse to enter into a provider
				  agreement. Each individual practitioner or medical facility shall have a
				  separate provider agreement with the Department.
(b)
Out-of-State providers.
Out-of-State providers shall be licensed, and registered or certified or both,
				  by the appropriate agencies in their respective states. A provider shall also
				  be currently participating in the Medicaid program of his state if it has one.
				  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. A service an out-of-State provider renders to a
				  Pennsylvania MA recipient shall be subject to the regulations of the MA Program
				  of the Commonwealth.
(c)
Providers or applicants ineligible for program participation.
Providers whose provider agreements have been terminated by the Department or
				  who have been excluded from the Medicare program or any other state's Medicaid
				  program are not eligible to participate in this Commonwealth's MA Program
				  during the period of their termination. Providers who are ineligible under this
				  subsection are subject to the restrictions in §
										1101.77(c)
				  (relating to enforcement actions by the Department).
This section cited in 55 Pa. Code §
												1101.42a (relating to policy
						clarification regarding physician licensure-statement of policy); 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 §
												1130.51 (relating to provider
						enrollment 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); 55 Pa. Code §
												1187.21a (relating to nursing
						facility exception requests-statement of policy); 55 Pa. Code §
												1225.44 (relating to participation
						requirements for out-of-State family planning clinics); and 55 Pa. Code §
												1251.41 (relating to participation
						requirements).