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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 6142 (September 30, 2023).

55 Pa. Code § 1129.51. General payment policy.


§ 1129.51. General payment policy.

 (a)  Payment will be made for rural health clinic services rendered at the clinic, at a hospital or at the place of residence of the patient.

 (b)  Payment for rural health clinic services will be made on the basis of an all-inclusive visit fee established by the Medicare carrier. When the cost for a service provided by the clinic is included in the established visit fee, the practitioner rendering the service shall not bill the MA Program for it separately.

 (c)  An adjustment to the all-inclusive visit fee will be made when the Medicare carrier determines the difference, if any, between the total payment due the clinic and the total payment made during the reported period. The adjustment will be made as follows:

   (1)  If the clinic has been underpaid, the Department will make a lump sum payment for the amount due.

   (2)  If the clinic has been overpaid, the clinic shall make a lump sum payment to the Department for the amount due. A repayment plan not to exceed 1 year will be arranged by the Department at the request of the clinic if the Department is satisfied that a lump sum payment would impose severe financial hardship on the clinic.


   The provisions of this §  1129.51 adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4597; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; corrected August 14, 1987, effective December 24, 1983, 17 Pa.B. 3407. Immediately preceding text appears at serial page (117359).

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