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§ 1401. Definitions

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. § 1401
§ 1401. Definitions
The following words and phrases when used in this article shall have, unless the context clearly indicates otherwise, the meanings given to them in this section:
“Eligible person” means anyone who lawfully receives or holds a medical assistance eligibility identification card from the department.
“Health services corporation” means a nonprofit hospital plan corporation or a nonprofit professional health service plan corporation approved under Pennsylvania law.
“Medical assistance” means medical services rendered to eligible persons under Articles IV and V of this act1.
“Medical assistance program” means the services funded and operations administered by the department under Articles IV and V of this act.
“Medical facility” means a licensed or approved hospital, skilled nursing facility, intermediate care facility, clinic, shared health facility, pharmacy, laboratory or other medical institution.
“Practitioner” means any medical doctor, doctor of osteopathy, dentist, optometrist, podiatrist, chiropractor or other medical professional personnel licensed by the Commonwealth or by any other state who is authorized to participate in the medical assistance program.
“Provider” means any individual or medical facility which signs an agreement with the department to participate in the medical assistance program, including, but not limited to, licensed practitioners, pharmacies, hospitals, nursing homes, clinics, home health agencies and medical purveyors.
“Purveyor” means any person other than a practitioner, who, directly or indirectly, engages in the business of supplying to patients any medical supplies, equipment or services for which reimbursement under the program is received including, but not limited to, clinical laboratory services or supplies, x-ray laboratory services or supplies, inhalation therapy services or equipment, ambulance services, sick room supplies, physical therapy services or equipment and orthopedic or surgical appliances or supplies.
“Recipient” means an eligible person who receives medical assistance from a participating provider.
“Shared health facility” means an entity which provides the services of three or more health care practitioners, two or more of whom are practicing within different professions, in one physical location. To meet this definition, the practitioners must share any of the following: common waiting areas, examining rooms, treatment rooms, equipment, supporting staff or common records. In addition, to meet this definition, at least one practitioner must receive payment on a fee-for-services basis, and payments under the medical assistance program to any person or entity providing services or merchandise at the location must exceed thirty thousand dollars ($30,000) per year. “Shared health facility” does not mean or include any licensed or approved hospital facility, a skilled nursing facility, intermediate care facility, public health clinics, or any entity organized or operating as a facility wherein ambulatory medical services are provided by an organized group of practitioners all of whom practice the same profession pursuant to an arrangement between such group and a health services corporation or a Federally approved health maintenance organization operating under Pennsylvania law, and where a health services corporation or a health maintenance organization is reimbursed on a prepaid capitation basis for the provision of health care services under the medical assistance program.

Credits

1967, June 13, P.L. 31, No. 21, art. 14, § 1401, added 1980, July 10, P.L. 493, No. 105, § 3, effective in 60 days.

Footnotes

62 P.S. §§ 401 et seq., 501 et seq.
62 P.S. § 1401, PA ST 62 P.S. § 1401
Current through 2022 Regular Session Act 20. Some statute sections may be more current, see credits for details.
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