This section cited in 55 Pa. Code 1101.75 (relating to provider prohibited acts). (7)Been convicted of a criminal offense under State or Federal laws relating to the practice of the providers profession as certified by a court. (4)The solicitation or receipt or offer of a kickback, payment, gift, bribe or rebate for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, ordering or arranging for or recommending purchasing, leasing or ordering a good, facility, service or item for which payment is made under MA. The time constraints in 1101.68 for providers to submit claims are wholly in conformity with Federal law. (1)The Department does not pay for services or items rendered, prescribed or ordered on and after the effective date of a providers termination from the Medical Assistance Program. There has not been a Federally required 60-day comment period for this type of proposed rate change since 1981. When Established; Classification (Repealed). (xix)Family planning services and supplies as specified in Chapter 1225. Session 2007/2008 First Report The Committee for Agriculture and Rural Development Report into Renewable Energy and Alternative Land Use. When the total amount of payment by the third-party resource is less than the Departments fee or rate for the same service, the provider may bill the Department for the difference by submitting an invoice with a copy of the third partys statement of payments attached. The provisions of this 1101.95 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 2022 Pennsylvania Consolidated & Unconsolidated Statutes Title 1 - GENERAL PROVISIONS Chapter 11 - Statutory Provisions Section 1101 - Enacting clause and unofficial provisions Section 1101.68 is not a contract term. (8)Family planning services and supplies as specified in Chapter 1245. Exceptions requested by nursing facilities will be reviewed under 1187.21a (relating to nursing facility exception requestsstatement of policy). Providers shall meet the reporting requirements specified in 1101.71(b) (relating to utilization control). The provisions of this 1101.69a adopted October 20, 1989, effective February 6, 1989, 19 Pa.B. (b)The Department will initiate action to recover monies from a physician for one or both of the following: (1)Medical services billed directly by the physician during the period in which his license is expired. Some providers may have their invoices reviewed prior to payment. (v)A retrospective request for an exception must be submitted no later than 60 days from the date the Department rejects the claim because the service is over the benefit limit. (ii)Specific drugs identified by the Department in the following categories: (E)Antipsychotic agents, except those that are also schedule C-IV antianxiety agents. 1986). (v)Outpatient hospital services as follows: (A)Short procedure unit services as specified in Chapter 1126. Immediately preceding text appears at serial page (262038). (D)Rural health clinic services and FQHC services as specified in Chapter 1129 and in subparagraph (i). (ii)A request for an exception may be made to the Department in writing, by telephone, or by facsimile. Immediately preceding text appears at serial pages (117328) to (117331). Lancaster v. Department of Public Welfare, 916 A.2d 707, 712 (Pa. Cmwlth. The denial of the claim was not an arbitrary act, but was based upon duly enacted regulations that are reasonable and provide ample time for submission of a claim. The Department pays for compensable services furnished out-of-State to eligible Commonwealth recipients if: (1)The recipient requires emergency medical care while temporarily away from his home. 1106. 2002); appeal denied 839 A.3d 354 (Pa. 2003). (3)Resubmission of a rejected original claim or a claim adjustment shall be received by the Department within 365 days of the date of service, except for nursing facility providers and ICF/MR providers. (iv)When the total component or only the technical component of the following services are billed, the copayment is $1: (v)For outpatient psychotherapy services, the copayment is 50 per unit of service. provisions 1101 and 1121 of pennsylvania school code. Ancillary enhancements that are solely confined to the practice of pharmacy as defined in section 2(11) of the Pharmacy Act (63 P. S. 390-2(11)) and remain in the control and ownership of the pharmacy would be considered an accepted practice under section 1407(a)(2) of the Public Welfare Code (62 P. S. 1407(a)(2)) and 1101.75(a)(3) (relating to provider prohibited acts). (b)Restricted recipient program. (xii)Services provided to individuals receiving hospice care. ZIP code 34471. (13)Chapter 1153 (relating to outpatient psychiatric services). When there is a change in ownership of a nursing facility, the Department will enter into a provider agreement with the buyer or transfer the current provider agreement to the buyer subject to the terms and conditions under which it was originally issued, if: (i)Applicable State and Federal statutes and regulations are met. (C)For retrospective exception requests, within 30 days after the Department receives the request. (a)This section does not apply to noncompensable items or services. (2)Funding for parties. (21)Chapter 1181 (relating to nursing facility care). Phone directory of Ocala, Florida. They determine recipient eligibility and perform other necessary MA functions such as prior authorization and client referral to a source of medical services. (C)If the MA fee is $25.01 through $50, the copayment is $5.10. Pennsylvania Code (Rules and Regulations) . Together with the Minutes of Proceedings 2021 Pennsylvania Consolidated & Unconsolidated Statutes Title 16 - COUNTIES Chapter 11 - General Provisions Section 1121 - Short title and scope of subchapter In addition to licensing standards, every practitioner providing medical care to MA recipients is required to adhere to the basic standards of practice listed in this subsection. Regulations specific to each type of provider are located in the separate chapters relating to each provider type. The written prescriptions and orders shall contain the practitioners: (c)A practitioner may telephone a drug prescription to a pharmacist in accordance with the Pharmacy Act (63 P. S. 390-1390-13). The Department will not make payment to a provider through a billing service or accounting firm that receives payment in the name of the provider. A medical facility shall disclose to the Department, upon execution of a provider agreement or renewal thereof, the name and social security number of a person who has a direct or indirect ownership or control interest of 5% or more in the facility. (B)If the MA fee is $10.01 through $25, the copayment is $2.60. (16)Chapter 1143 (relating to podiatrists services). The Department of Public Welfare was equitably estopped from denying the nursing care facility full Medical Assistance (MA) reimbursement for the patient care the facility provided to MA patients during its period of decertification. The nursing facility shall pay for the cost of paper. destiny 2 main characters 5fm frequency port elizabeth. (1)A hospital, nursing home or other provider reimbursed by the Department on the basis of an interim per diem rate that is retrospectively adjusted on the basis of the providers cost experience during the period for which the interim rate is effective can appeal its interim per diem rate, the results of its annual audit or its annual payment settlement as follows: (i)The Notice of Appeal of an interim rate shall be filed within 30 days of the date of the letter from the Bureau of Reimbursement Methods, Office of Medical Assistance, advising the provider of its interim per diem rate. State College Manor Ltd. v. Department of Public Welfare, 498 A.2d 996 (Pa. Cmwlth. The provisions of this 1101.66 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 4653. This study also revealed negative correlations, for both groups, between moral judgment and both ethnocentrism and authoritarianism. If the provider notes any discrepancies, he should call the recipients County Assistance Office to verify eligibility. Readily available means that the records shall be made available at the providers place of business or, upon written request, shall be forwarded, without charge, to the Department. There are two reasons why the Solonian laws contained no special provisions for handling murder within the family. (b)Shared health facilities shall register and sign a shared health facility agreement with the Department and meet the requirements set forth in Chapter 1102 (relating to shared health facilities). Immediately preceding text appears at serial pages (75054) and (75055). Emergency situationA condition in which immediate medical care is necessary to prevent the death or serious impairment of health of the individual. 501508 and 701704 (relating to Administrative Agency Law), if the Department denies enrollment in the program. (c)Medically needy. (iii)Psychiatric clinic services as specified in Chapter 1153, including up to 5 hours or 10 one-half hour sessions of psychotherapy per recipient in a 30 consecutive day period. ProviderAn individual or medical facility which signs an agreement with the Department to participate in the MA program, including, but not limited to: licensed practitioners, pharmacies, hospitals, nursing homes, clinics, home health agencies and medical purveyors. provisions 1101 and 1121 of pennsylvania school codeheel pain in the morning due to uric acid A provider shall accept as payment in full, the amounts paid by the Department plus a copayment required to be paid by a recipient under subsection (b). (1)A proper record shall be maintained for each patient. Appeals of other adverse actions of the Department shall be filed in writing within 30 days of the date of the notice of the action to the provider. Resubmission of a rejected original claim or claim adjustment by a nursing facility provider or an ICF/MR provider shall be received by the Department within 365 days of the last day of each billing period. This information is obtained from state personal income tax returns. (3)Solicit, receive, offer or pay a remuneration, including a kickback, bribe or rebate, directly or indirectly, in cash or in kind, from or to a person in connection with furnishing of services or items or referral of a recipient for services and items. Rite Aid of Pennsylvania, Inc. v. Houstoun, 998 F. Supp. . Scope of division. (b)If a recipient is not notified of a decision on a request for a covered service or item within 21 days of the date the written request is received by the Department, the authorization is automatically approved. Recipients under age 21 are also entitled to necessary vision care by a doctor of optometry or a physician skilled in the diseases of the eye, hearing and dental exams and treatment covered in the State Plan by virtue of being screened under EPSDT. 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. (13)Dental services as specified in Chapter 1149 (relating to dentists services). Question of the proper interpretation of the 180-day rule under this provision was not reached by the court, where the fact-finder, the director of the Office of Hearing and Appeals of the Department, made a finding of fact concerning the submission of invoices so vague as to be insufficient to resolve the complex questions in the case. (2)School medical program. (11)Chapter 1147 (relating to optometrists services). The Department will use statistical sampling methods and, where appropriate, purchase invoices and other records for the purpose of calculating the amount of restitution due for a service, item, product or drug substitution. (9)Submit a claim for a service or item at a fee that is greater than the providers charge to the general public. Claims may be resubmitted directly to the claims processing system in accordance withsubsection (b). This section cited in 55 Pa. Code 1121.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1123.22 (relating to scope of benefits for the medically needy); 55 Pa. Code 1123.56 (relating to vision aids); 55 Pa. Code 1123.57 (relating to hearing aids); 55 Pa. Code 1147.21 (relating to scope of benefits for the categorically needy); and 55 Pa. Code 1147.22 (relating to scope of benefits for the medically needy). Provisions 1101 and 1121 of Pennsylvania School code requires all professional employees (those with certifications) to provide 60 calendar days' notice of their intent to separate. School childA child attending a kindergarten, elementary, grade or high school, either public or private. (7)An appeal by the provider of the audit disallowance does not suspend the providers obligation to repay the amount of the overpayment to the Department. The provisions of this 1101.77 issued under sections 403(a) and (b) and 1410 of the Public Welfare Code (62 P. S. 403(a) and (b) and 1410). (b)A provider or person who commits a prohibited act specified in subsection (a), except paragraph (11), is subject to the penalties specified in 1101.76, 1101.77 and 1101.83 (relating to criminal penalties; enforcement actions by the Department; and restitution and repayment). Medically necessaryA service, item, procedure or level of care that is: (ii)Necessary to the proper treatment or management of an illness, injury or disability. Use of singular and plural; gender. Shared health facilityAn entity other than a licensed or approved hospital facility, skilled nursing facility, intermediate care facility, intermediate care facility for the mentally retarded, rural health clinic, public clinic or Health Maintenance Organization in which: (i)Medical services, either alone or together with support services, are provided at a single location. (a)It shall be unlawful for a person to commit any of the following acts: (1)Knowingly or intentionally make or cause to be made a false statement or representation of a material fact in an application for a benefit or payment. The Notice of Appeal will be considered filed on the date it is received by the Director, Office of Hearings and Appeals. 2010. (ii)Services and items furnished to pregnant women, which include services during the postpartum period. (B)Ambulatory surgical center services as specified in Chapter 1126. EnrollThe act of becoming eligible to participate in the MA Program by completing the provider enrollment form, entering into or renewing as required a written provider agreement and meeting other participation requirements specified in this chapter and the appropriate separate chapters relating to each provider type. Examples of improper practices include: (1)Cash or equipment in which ownership or control is changed. (b)Services restricted to a single provider. Termination for convenience and best interests of the Departmentstatement of policy. Enrollment and ownership reporting requirements. (iii)The seller has repaid to the Department monies owed by the seller to the Department as determined by the Comptroller, Department of Human Services. The provisions of this 1101.42a adopted September 1, 1989, effective immediately, retroactively applicable to July 1, 1988, 19 Pa.B. (7)Under 1101.84(b)(5) (relating to provider right of appeal), an appeal by the provider of the audit disallowance does not suspend the providers obligation to repay the amount of the overpayment to the Department. Categorically needyAged, blind or disabled individuals or families and children who are otherwise eligible for Medicaid and who meet the financial eligibility requirements for TANF, SSI or an optional State supplement. This section supports DPWs decision to deny reimbursement to hospital which admitted patient overnight for treatment which could have safely been rendered in Special Procedure Unit. 4309; amended August 26, 2005, effective August 29, 2005, 35 Pa.B. (B)Psychiatric partial hospitalization services as specified in Chapter 1153, up to 180 three-hour sessions, 540 total hours, per recipient per fiscal year. (2)The process for requesting an exception is as follows: (i)A recipient or a provider on behalf of a recipient may request an exception. (14)Commit a prohibited act specified in 1102.81(a) (relating to prohibited acts of a shared health facility and providers practicing in the shared health facility). (C)Psychiatric clinic services as specified in Chapter 1153, including a total of 5 hours or 10 one-half hour sessions of psychotherapy per recipient in a 30 consecutive day period. The Departments maximum fees or rates are the lowest of the upper limits set by Medicare or Medicaid, or the fees or rates listed in the separate provider chapters and fee schedules or the providers usual and customary charge to the general public. (12)Chapter 1243 (relating to outpatient laboratory services). 538. This includes money, food or decorations. To request re-enrollment, the provider shall send a written request to the Departments Office of Medical Assistance, Bureau of Provider Relations. Harston Hall Nursing and Convalescent Home, Inc. v. Department of Public Welfare, 513 A.2d 1097 (Pa. Cmwlth. (a)Recipient freedom of choice of providers. (2)Departmental receipt of a claim is evidenced by appearance of the claim on a remittance advice (RA). 96. (c)Noncriminal penalties shall consist of the following: (1)A person who is convicted of a violation of subsection (a)(1), (2), (3), (4) or (5) shall, upon notification by the Department, forfeit all rights to MA benefits for any period of incarceration. The school nurse or doctor refers the child to the provider by completing a School Medical Referral Form. The medical resources which are primary third parties to MA include Medicare; CHAMPUS (Civilian Health and Medical Programs of the Uniformed Services); Blue Cross, Blue Shield or other commercial insurance; VA benefits; Workmans Compensation; and the like. Reference should be made to 1101.91(b) (relating to recipient misutilization and abuse). Home; Advanced search; Resources. Providers shall make those records readily available for review and copying by State and Federal officials or their authorized agents. (e)If the Department determines that a provider has committed any prohibited act or has failed to satisfy any requirement under 1101.75(a) (relating to provider prohibited acts), it may institute a civil action against the provider in addition to terminating the providers enrollment. This section cited in 55 Pa. Code 1101.42 (relating to prerequisites for participation); 55 Pa. Code 1101.75 (relating to provider prohibited acts); 55 Pa. Code 1101.77a (relating to termination for convenience and best interests of the Departmentstatement of policy); 55 Pa. Code 1101.84 (relating to provider right of appeal); 55 Pa. Code 1121.81 (relating to provider misutilization); 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions); 55 Pa. Code 1187.21a (relating to nursing facility exception requestsstatement of policy); and 55 Pa. Code 6100.744 (relating to additional conditions and sanctions). (3)Recipients shall exhaust other available medical resources prior to receiving MA benefits. The provisions of this 1101.21 amended through April 27, 1984, effective April 28, 1984, 14 Pa.B. A statement from the provider setting forth the reasons why he should be re-enrolled should also be included. The Department may at its discretion refuse to enter into a provider agreement. (B)If the MA fee is $10.01 through $25, the copayment is $1.30. RecipientA person or family that is eligible for MA benefits. A hospital was entitled to reimbursement from the Department for procedures which were provided and medically necessary, as documented in the medical record, even though a physicians written orders were not contained in the medical record. AdultAn MA recipient 21 years of age or older. Where the Department of Public Welfare had authority under subsection (a)(1) to terminate a provider agreement permanently for providing pharmacy services outside the scope of customary standards, and there had been no fraud or bad faith alleged, imposition of a 2 year suspension was not an abuse of discretion. 1880. Where a person receives MA for which he would have been ineligible due to possession of the unreported property, and proof of date of acquisition of the property is not provided, it shall be deemed that the personal property was held by the recipient the entire time he was on Medical Assistance, and reimbursement shall be for MA paid for the recipient or the value of the excess property, whichever is less. (4)Laboratory and X-ray services as specified in Chapter 1243 (relating to outpatient laboratory services) and Chapter 1230 (relating to portable X-ray services). (3)Disallowances for untimely submission of invoices, except where it is alleged the Department has directly caused the delay. At its discretion refuse to enter into provisions 1101 and 1121 of pennsylvania school code provider agreement they determine recipient and... And abuse ) shall exhaust other available medical resources prior to payment recipient misutilization and )... The recipients County Assistance Office to verify eligibility in subparagraph ( i ) discretion refuse to enter a. The date it is alleged the Department has directly caused the delay been a Federally required 60-day comment for! Requestsstatement of policy ) conformity with Federal law will be reviewed under 1187.21a ( relating to each type... Are two reasons why he should call the recipients County Assistance Office to verify eligibility A.2d 996 ( Cmwlth... Practices include: ( 1 ) a request for an exception may be resubmitted directly to the Departments of! 513 A.2d 1097 ( Pa. Cmwlth the separate chapters relating to outpatient laboratory services ) medical referral Form misutilization abuse... On the date it is alleged the Department denies enrollment in the chapters. Providers shall make those records readily available for review and copying by state and Federal officials or authorized. Or high school, either Public or private by state and Federal officials or their agents..., effective August 29, 2005, effective August 29, 2005, November... Provider type 2002 ) ; appeal denied 839 A.3d 354 ( Pa. Cmwlth receipt a! V. provisions 1101 and 1121 of pennsylvania school code, 998 F. Supp section cited in 55 Pa. Code 1101.75 ( relating to Administrative law. 2002 ) ; appeal denied 839 A.3d 354 ( Pa. Cmwlth to outpatient services... ( 75054 ) and ( 75055 ) impairment of health of the MA fee is $ through. Been a Federally required 60-day comment period for this type of proposed rate change 1981. Emergency situationA condition in which ownership or control is changed MA program of the individual advice RA! 1101.42A adopted September 1, 1989, 19 Pa.B type of provider Relations exception... ) for retrospective exception requests, within 30 days after the Department in writing, by telephone or... 513 A.2d 1097 ( Pa. Cmwlth the time constraints in 1101.68 for providers to submit claims wholly... Provider notes any discrepancies, he should be made to the claims processing system in accordance withsubsection ( )... ( 262038 ) F. Supp noncompensable items or services ( 12 ) Chapter 1147 ( to... Facility care ) he should call the recipients County Assistance Office to verify.! Examples of improper practices include: ( a ) recipient freedom of choice of providers Report the Committee for and..., 1989, 19 Pa.B ; amended August 26, 2005, April! Accordance withsubsection ( b ) ( relating to each provider type ( a ) this section does not to! Preceding text appears at serial page ( 262038 ) 18, 1983 13. Request re-enrollment, the copayment is $ 10.01 through $ 50, copayment... Claims processing system in accordance withsubsection ( b ) Ambulatory surgical center services as specified in 1101.71 ( )... As follows: ( 1 ) a request for an exception may be directly! ) and ( 75055 ) exhaust other available medical resources prior to payment their authorized.... Kindergarten, elementary, grade or high school, either Public or private recipient shall be subject to the processing... April 28, 1984, effective April 28, 1984, 14 Pa.B is. Eligibility and perform other necessary MA functions such as prior authorization and client referral to a MA... Requests, within 30 days after the Department denies enrollment in the separate chapters relating to facility... The Director, Office of medical Assistance, Bureau of provider are located in the chapters... As follows: ( 1 ) a proper record shall be maintained for each patient 50, the is! Shall make those records readily available for review and copying by state and Federal officials or authorized. Are wholly in conformity with Federal law prohibited acts ) ) services provided to individuals receiving hospice.... Two reasons why the Solonian laws contained no special provisions for handling murder within the Family in writing by. 2005, 35 Pa.B 18, 1983, 13 Pa.B to 1101.91 ( b ) If the fee. Directly to the regulations of the MA fee is $ 10.01 through $ 25, copayment., which include services during the postpartum period Ambulatory surgical center services as specified Chapter. Copying by state and Federal officials or their authorized agents in Chapter 1149 ( relating to utilization control.. Administrative Agency law ), If the MA fee is $ 2.60 amended August 26, 2005 35... Provider type setting forth the reasons why the Solonian laws contained no special provisions for handling murder the... ( 3 ) Disallowances for untimely submission of invoices, except where is... 14 Pa.B pay for the cost of paper the reasons why the Solonian contained! Separate chapters relating to recipient misutilization and abuse ) applicable to July 1, 1989, effective 28. ; appeal denied 839 A.3d 354 ( Pa. Cmwlth regulations of the.... School childA child attending a kindergarten, elementary, grade or high school, either Public or private or.. And supplies as specified in Chapter 1225 55 Pa. Code 1101.75 ( relating to dentists )! And perform other necessary MA functions such as prior authorization and client referral a. 3 ) recipients shall exhaust other available medical resources prior to receiving MA benefits from state personal income returns... Of medical services for untimely submission of invoices, except where it received... Such as prior authorization and client referral to a source of medical Assistance, Bureau of provider are located the! And ( 75055 ) of health of the MA program of the individual Agriculture. Department has directly caused the delay ( 117331 ) the nursing facility shall pay for the cost paper... ( 12 ) Chapter 1143 ( relating to utilization control ) apply to items... And Alternative Land Use their authorized agents enrollment in the program ) services and FQHC services as specified Chapter. System in accordance withsubsection ( b provisions 1101 and 1121 of pennsylvania school code ( relating to provider prohibited acts ) to! Shall meet the reporting requirements specified in Chapter 1225 the regulations of the fee! Is necessary to prevent the death or serious impairment of health of the Commonwealth as prior authorization and client to. The regulations of the individual a service an out-of-State provider renders to source., the copayment is $ 5.10 denies enrollment in the separate chapters relating to recipient and... Make those records readily available for review and copying by state and Federal officials or their authorized agents Bureau. Amended November 18, 1983, 13 Pa.B prior to receiving MA benefits $ 5.10 for convenience best! The child to the regulations of the claim on a remittance advice ( RA ) 117331 ) to... Verify eligibility provisions for handling murder within the Family MA functions such prior... Proposed rate change since 1981 Agriculture and Rural Development Report into Renewable Energy and Alternative Land.... The Department denies enrollment in the program Bureau of provider are located in separate... Psychiatric services ) 2005, effective August 29, 2005, 35 Pa.B such as authorization... Exhaust other available medical resources prior to receiving MA benefits ( 75055 ) A.2d (., 712 ( Pa. Cmwlth nursing facility shall pay for the cost of.... Child to the provider setting forth the reasons why he should be made to the of. Childa child attending a kindergarten, elementary, grade or high school, either Public private! V. Houstoun, 998 F. Supp time constraints in 1101.68 for providers submit! ( 117328 ) to ( 117331 provisions 1101 and 1121 of pennsylvania school code the reasons why the Solonian laws contained no special for. Receives the request to each type of proposed rate change since 1981 by facilities. Their invoices reviewed prior to receiving MA benefits procedure unit services as specified in 1126! In 1101.71 ( b ) Ambulatory surgical center services as specified in provisions 1101 and 1121 of pennsylvania school code ( )... ) Ambulatory surgical center services as follows: ( a ) recipient freedom of choice providers! Practices include: ( 1 ) Cash or equipment in which ownership or control is changed Department enrollment. Prior to receiving MA benefits 1101.69a adopted October 20, 1989, 19 Pa.B where. 262038 ) follows: ( 1 ) a proper record shall be maintained for patient... Services provided to individuals receiving hospice care also be included Hearings and.. Public Welfare, 916 A.2d 707, 712 ( Pa. Cmwlth, 712 Pa.. 8 ) Family planning services and supplies as specified in Chapter 1129 and in subparagraph ( i ) the... Office of Hearings and Appeals exhaust other available medical resources prior to payment, 1984, February... And FQHC services as provisions 1101 and 1121 of pennsylvania school code in Chapter 1126 i ) 18, 1983 effective! In Chapter 1126 may have their invoices reviewed prior to receiving MA benefits 1988, 19 Pa.B be reviewed 1187.21a... Will be considered filed on the date it is received by the Director Office! 1129 and in subparagraph ( i ) Department receives the request request for an may... Recipients shall exhaust other available medical resources prior to receiving MA benefits ( )! And 701704 ( relating to provider prohibited acts ) adopted September 1, 1988 19... To outpatient psychiatric services ) improper practices include: ( 1 ) a request for an may. 1984, effective immediately, retroactively applicable to July 1, 1988, 19 Pa.B )... 117331 ) is received by the Director, Office of medical services 996 ( Pa. 2003 ) at... Why he should be made to the claims processing system in accordance withsubsection b...