§ 1101.66. Payment for rendered, prescribed or ordered services.
(a) The Department pays for compensable services or items rendered, prescribed or ordered by a practitioner or provider if the service or item is:
(1) Within the practitioners scope of practice.
(2) Medically necessary.
(3) Not in an amount that exceeds the recipients needs.
(4) Not ordered or prescribed solely for the recipients convenience.
(5) Ordered with the recipients knowledge.
(b) Prescriptions and orders shall be written, except telephoned prescriptions addressed in subsection (c). The written prescriptions and orders shall contain the practitioners:
(1) Printed name.
(3) Professional license number.
(c) A practitioner may telephone a drug prescription to a pharmacist in accordance with the Pharmacy Act (63 P. S. § § 390-1390-13). The pharmacist shall:
(1) Record the complete prescription on a standard prescription form.
(2) Keep the recorded prescription on file.
(d) The practitioners signature on the prescription is waived only for a telephoned drug prescription.
(e) Payment is not made for services or items rendered, prescribed or ordered by providers who have been terminated from the Medical Assistance program.
The provisions of this § 1101.66 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3653. Immediately preceding text appears at serial page (75059).
This section cited in 55 Pa. Code § 1101.66a (relating to clarification of the terms written and signaturestatement of policy).
Notes of Decisions
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. Childrens Hospital of Philadelphia v. Department of Public Welfare, 621 A.2d 1230 (Pa. Cmwlth. 1993); appeal denied 634 A.2d 225 (Pa. 1993).
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. Episcopal Hospital v. Department of Public Welfare, 528 A.2d 676 (Pa. Cmwlth. 1987).
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