Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 1806 (March 30, 2024).

31 Pa. Code § 152.6. Provider contracts.

§ 152.6. Provider contracts.

 (a)  Changes in standard form contracts with physicians or providers enabling a risk-assuming preferred provider organization to offer preferred provider arrangements shall be submitted to the Secretary within 10 days of implementation. The Secretary may review the provider contract changes to ascertain whether the changes may lead to undertreatment or poor quality health services.

 (b)  If the Secretary determines that the changes to the provider contract may lead to undertreatment or poor quality health services, the Secretary will notify the risk-assuming preferred provider organization and the Commissioner of the disapproval and the reasons in writing.

 (c)  Within 30 days from the date of mailing of a notice of disapproval to the preferred provider organization, the preferred provider organization may make written application to the Secretary for a hearing. The hearing will be held within 30 days after receipt of the application. The procedure before the Secretary will be under adjudication procedure in 2 Pa.C.S. § §  501—508 and 701—704 (relating to the Administrative Agency Law). The preferred provider organization is entitled to judicial review as provided by statute.

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