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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 8238 (December 30, 2023).

55 Pa. Code § 1102.34. Responsibilities relating to provider performance.

§ 1102.34. Responsibilities relating to provider performance.

 The operator of a shared health facility shall insure, either directly or through the administrator, that providers rendering services to recipients at a shared health facility and persons employed by the facility shall:

   (1)  Refer a recipient to another provider located inside or outside the shared health facility only when there is medical justification for the referral and the medical records of the referring practitioner clearly set forth the medical justification for the referral.

   (2)  Whenever treating a recipient referred by another provider inside or outside the shared health facility, communicate in writing to the referring practitioner the diagnostic evaluation and therapy rendered and incorporate this information into the record of the recipient.

   (3)  Obtain the signature of the recipient on outpatient orders or prescriptions written for the recipient by practitioners at a shared health facility.

   (4)  Maintain proper recipient records, for a minimum of 4 years, which contain at least:

     (i)   The full name, address and Medical Assistance record number of each recipient.

     (ii)   The dates of visits by a recipient to providers in the shared health facility and a statement as to whether the recipient is instructed to return for further treatment and the dates of return visits.

     (iii)   The major complaint and diagnostic impressions for each visit to a provider in the shared health facility.

     (iv)   Pertinent history and physical examinations rendered by each provider in the shared health facility;

     (v)   A listing of medications prescribed by a provider in the shared health facility.

     (vi)   The precise dosage and prescription regimens for each medication prescribed by a provider in the shared health facility.

     (vii)   Orders for X-rays, laboratory work and diagnostic tests written by or under the direction of a provider at the shared health facility.

     (viii)   The results of the tests ordered under subparagraph (vii).

     (ix)   The medical documentation justifying the necessity of diagnostic procedures ordered by a practitioner in a shared health facility regardless of whether the procedure is performed directly by the onlining practioner or by someone under the direct supervision of the practitioner or is referred to another practioner or purveyor.

     (x)   Referrals by practitioners in the shared health facility to other providers and the reasons for the referrals.

Cross References

   This section cited in 55 Pa. Code §  1102.31 (relating to general responsibilities); and 55 Pa. Code §  1102.34a (relating to clarification of the term ‘‘written’’—statement of policy).

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