Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1102 - SHARED HEALTH FACILITIES › ADMINISTRATIVE SANCTIONS › Section 1102.81 - Prohibited acts of a shared health facility and providers practicing in the shared health facility

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Prohibited acts of shared health facilities, their owners, operators and
				  administrators and providers practicing in the shared health facility are as
				  follows:
(1) The rental fee for letting space
				  to providers in a shared health facility may not be calculated wholly or
				  partially, directly or indirectly, as a percentage of earnings or billings of
				  the provider for services rendered on the premises in which the shared health
				  facility is located. The operator of each facility shall file a copy of each
				  lease and a renewal thereof with the Department.
(2) No purveyor, whether or not located in a
				  building which houses a shared health facility, shall directly or indirectly
				  offer, pay or give to a shared health facility or its providers, and no shared
				  health facility or its providers may solicit, request, receive or accept from a
				  purveyor, either directly or indirectly, a sum of money, credit or other
				  valuable consideration for:
(i) Recommending
				  or procuring goods, services or equipment of the purveyor.
(ii) Directing patronage or clientele to the
				  purveyor.
(iii) Influencing a
				  person to refrain from using or utilizing goods, services or equipment of a
				  purveyor.
(3) No provider
				  or purveyor may demand or collect a reimbursement contrary to the payment
				  policy of the Medical Assistance Program.
(4) No purveyor may provide to a recipient
				  services, equipment, pharmaceuticals or other medical supplies differing in
				  quantity or in another respect from that described in the payment invoice
				  submitted by the provider to the Department. No purveyor may provide to a
				  recipient services, equipment, pharmaceutical or medical supplies differing in
				  quality, quantity or in another respect from that prescribed.
(5) No recipient may be referred by a
				  provider in a shared health facility or by a person employed in the facility to
				  another provider in the shared health facility except under the following
				  circumstances and restrictions:
(i) The
				  referral shall be medically justified and the record maintained by the
				  referring provider shall clearly indicate the justification for the
				  referral.
(ii) A provider in a
				  shared health facility to whom a recipient is referred shall communicate in
				  writing to the referring provider the diagnostic evaluation and therapy
				  rendered. The referring provider shall incorporate this information into the
				  permanent medical record of the recipient.
(iii) The invoices submitted to the
				  Department by the provider to whom a recipient has been referred shall contain
				  the name and provider number of the referring provider and identify the medical
				  problem which necessitated the referral.
(6) If a pharmacy is located in, or adjacent
				  to, the building in which a shared health facility is located, no recipient may
				  be required to purchase pharmaceuticals at the pharmacy. The shared health
				  facility shall prominently post a notice in the common waiting area informing
				  recipients that all pharmaceuticals prescribed by providers in the facility may
				  be obtained at any participating pharmacy of the choice of the recipient.
(7) No provider may submit an
				  invoice for services or items rendered at a shared health facility which does
				  not contain the provider number of the provider who rendered the service or
				  item and is not signed by the provider after the service or item has been
				  rendered.
(8) No order may be
				  issued by a provider for ancillary clinical services, including, but not
				  limited to X-rays, electrocardiograms, clinical laboratory services,
				  electroencephalograms or medical supplies and equipment which does not contain
				  the professional license number and the medical assistance identification
				  number of the prescriber and the provider number assigned to the facility at
				  which the order was written.
(9)
				  Each provider shall submit a true bill or invoice for services rendered under
				  the program.