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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 2336 (April 27, 2024).

55 Pa. Code § 1101.63a. Full reimbursement for covered services rendered—statement of policy.

§ 1101.63a. Full reimbursement for covered services rendered—statement of policy.

 (a)  Section 1406(a) of the Public Welfare Code (62 P. S. §  1406(a)) and MA regulations in §  1101.63(a) (relating to payment in full) mandate that all payments made to providers under the MA Program plus any copayment required to be paid by a recipient shall constitute full reimbursement to the provider for covered services rendered.

 (b)  A provider who seeks or accepts supplementary payment of another kind from the Department, the recipient or another person for a compensable service or item is required to return the supplementary payment.

 (c)  A provider may bill an MA recipient for a noncompensable service or item if the recipient is told before the service is rendered that the program does not cover it.


   The provisions of this §  1101.63a adopted October 29, 1999, effective October 30, 1999, 29 Pa.B. 5622.

Cross References

   This section cited in 55 Pa. Code §  1187.158 (relating to appeals).

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