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§ 1403. Special participation requirements for shared health facilities

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 62 P.S. Poor Persons and Public Welfare

Purdon's Pennsylvania Statutes and Consolidated Statutes

Title 62 P.S. Poor Persons and Public Welfare (Refs & Annos)

Chapter 1. Human Services Code (Refs & Annos)

Article XIV. Fraud and Abuse Control (Refs & Annos)

62 P.S. § 1403

§ 1403. Special participation requirements for shared health facilities

Currentness

(a) The registration requirements are as follows:

(1) Each shared health facility shall register with the department and specify the kind or kinds of services the facility is authorized to provide and shall establish a uniform system of reports and internal audits which meet the requirements of the department. In addition, the owner of the premises upon which the facility is located, or the lessor of the structure in which the facility is located, if either has a role in operating the facility, shall file a statement specifying the kind or kinds of services the facility is authorized to provide, and shall establish a uniform system of reports and audits meeting the requirements of the department.

(2) Application for registration of a shared health facility shall be made upon forms prescribed by the department. The application shall contain:

(i) the name of the facility;

(ii) the kind or kinds of services to be provided;

(iii) the location and physical description of the facility;

(iv) the name, social security number and residence address of every person, partnership or corporation having any financial interest in the ownership (including leasehold ownership) of the facility and the structure in which the facility is located;

(v) the name, social security number and residence address of every person, partnership or corporation holding any mortgage, lien, leasehold or any other security interest in the shared health facility or in any equipment located in and used in connection with shared health facility and a brief description of such lien or security interest;

(vi) the name, residence address and professional license number of every practitioner participating in the shared health facility;

(vii) the name and residence address of the individual designated as operator to assume responsibility for the central coordination and management of the activities of the shared health facility; and

(viii) such other information as the department may require to carry out the provisions of this act.

(3) Each operator shall apply for an initial registration upon notification by the department and shall apply for renewal of such registration annually thereafter.

(b) The notification requirements are as follows:

(1) Each operator shall notify the department within fifteen days of any change in:

(i) the persons, partnerships or corporations having any financial interest in the ownership (including leasehold ownership) of the shared health facility; or

(ii) the persons, partnerships or corporations holding any mortgage, lien, leasehold or any other security interests in the shared health facility or in any equipment located in and used in connection with a shared health facility. A statement of the monetary and repayment provisions of that lien or security interest shall accompany such notification.

(2) Each operator shall notify the department within fifteen days of the termination of the services of the individual designated to assume responsibility for coordination and management of the activities of the shared health facility and of the name, residence address and professional qualifications of any new individual appointed to assume such central administrative responsibility.

(3) Each operator shall notify the department within fifteen days of any termination of the services of any practitioner in the shared health facility and of the name, residence address and license number of each practitioner newly participating in the facility.

(1) To ensure quality, continuity and proper coordination of medical care, each shared health facility shall:

(i) designate an individual who shall coordinate and manage the facility's activities. The person so designated shall be responsible for compliance with the provisions of this act;

(ii) devise an appropriate means of assuring that a recipient will be treated by a practitioner familiar with the recipient's medical history;

(iii) post conspicuously the names and scheduled office hours of all practitioners practicing in the facility;

(iv) maintain proper recipient records which shall contain at least the following information:

(A) the full name, address and medical assistance record number of each recipient;

(B) the dates of all visits to all providers in the shared health facility;

(D) pertinent history and all physical examinations rendered by each provider in the shared health facility;

(E) diagnostic impressions for each visit to any provider in the shared health facility;

(F) all medications prescribed by any provider in the shared health facility;

(G) the precise dosage and prescription regimens for each medication prescribed by a provider in the shared health facility;

(H) all x-ray, laboratory work and electrocardiograms ordered at each visit by any provider in the shared health facility and their results;

(I) all referrals by providers in the shared health facility to other medical practitioners and the reason for such referrals; and

(J) a statement as to whether or not the recipient is expected to return for further treatment and the dates of all return appointments;

(v) assign a clearly identified general practitioner to each recipient. This assignment may be changed at any time at the recipient's request;

(vi) make available to registered recipients either:

(A) the central answering services telephone number of each recipient's designated practitioner service or such practitioner's personally designated colleagues; or

(B) a centralized twenty-four-hour-a-day, seven-day-weekly telephone line for off-hour recipient emergency questions;

(vii) maintain a central day-book registry which shall record:

(A) the name and medical assistance record number of all recipients entering the facility; and

(B) the chief complaint and the names of all providers whose services were requested by the recipient and/or to whom such recipient was referred;

(viii) insure that the physical facilities of each shared health facility shall provide for privacy for all recipients during examination, interview and treatment; and

(ix) post conspicuously the telephone number of the office within the department which is responsible for providing information concerning shared health facilities and/or for receiving complaints concerning the provision of health care services at shared health facilities.

(2) It shall be the responsibility of each facility's administrator to ensure that recipient records and summaries of all recipient visits include diagnosis and pharmaceuticals prescribed and are at all times available at either the facility or at a place immediately accessible to all health providers at the facility.

(3) Nothing in this act shall in any way be interpreted as infringing upon the recipient's rights to free selection of a personal practitioner.

(4) The department shall have the right to inspect the business records, recipient records, leases and other contracts executed by any provider in a shared health facility. Such inspections may be by site visits to the facility.

(d) Prohibited acts of shared health facilities are as follows:

(1) the rental fee for letting space to providers in a shared health facility shall 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 any 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 any provider, and no provider shall directly or indirectly solicit, request, receive or accept from any purveyor any sum of money, credit or other valuable consideration for:

(i) recommending or procuring goods, services or equipment of such purveyor;

(ii) directing patronage or clientele to such purveyor; or

(iii) influencing any person to refrain from using or utilizing goods, services or equipment of any purveyor;

(3) no provider or purveyor shall demand or collect any reimbursement contrary to the fee schedule of the medical assistance program;

(4) no purveyor shall provide to a recipient eligible to receive benefits under the provisions of the medical assistance program any services, equipment, pharmaceutical or other medical supplies differing in quantity or in any other respect from that described in the payment invoice submitted by such purveyor to the department. No purveyor shall provide to any recipient eligible to receive benefits under the provisions of the program any services, equipment, pharmaceutical or medical supplies differing in quality, quantity or in any other respect from that prescribed by the provider;

(5)(i) no provider in a shared health facility or person employed in such facility shall refer a recipient to another provider located in such facility unless there is a medical justification for such referral and unless the records of the referring provider pertaining to such recipient clearly set forth the justification for such referral;

(ii) no provider practicing in a shared health facility who treats a recipient referred to him by another provider shall fail to communicate in writing to the referring provider the diagnostic evaluation and the therapy rendered. The referring provider shall incorporate such information into the recipient's permanent record;

(iii) the invoice submitted to the department by the provider to whom such 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, such shared health facility shall prominently post a notice in the common waiting room or area informing recipients that all pharmaceuticals prescribed by practitioners in the facility may be obtained at any participating pharmacy of the recipient's choice;

(7) all provider invoices submitted for services rendered at a shared health facility shall contain the provider number of the facility at which the service was performed, clearly identify the practitioner who provided the service and be signed by the provider after the service has been performed;

(8) all orders issued by providers for ancillary clinical services, including but not limited to, x-rays, electrocardiograms, clinical laboratory services, electroencephalograms, as well as orders for medical supplies and equipment, shall contain the prescriber's medical assistance number and the provider number assigned to the facility at which the order was written; and

(9) each provider and purveyor shall submit a true bill or invoice for services rendered in the program.

Credits

1967, June 13, P.L. 31, No. 21, art. 14, § 1403, added 1980, July 10, P.L. 493, No. 105, § 3, effective in 60 days.

62 P.S. § 1403, PA ST 62 P.S. § 1403

Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.

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