Pennsylvania Code & Bulletin

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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 § 1221.41. Participation requirements.


§ 1221.41. Participation requirements.

 (a)  In addition to the participation requirements established in Chapter 1101 (relating to general provisions) clinics and hospital emergency rooms shall:

   (1)  Have an established fee schedule for billing third parties and private payors.

   (2)  Have a patient referral process that ensures follow up treatment by other physicians or appropriate specialists.

   (3)  Abide by applicable Federal and State statutes and regulations, including but not limited to Title XIX of the Social Security Act (42 U.S.C.A. § §  1396—1396p), the Public Welfare Code (62 P. S. §  443.1 et seq.) and applicable licensing statutes.

 (b)  In addition to the participation requirements set forth in subsection (a) hospital clinics, medical school clinics and independent medical clinics shall:

   (1)  Not be enrolled in the MA Program as a Rural Health Clinic.

   (2)  Be licensed/approved by the Department of Health if abortions are performed in the facility.


   The provisions of this §  1221.41 adopted December 5, 1980, effective December 1, 1980, 10 Pa.B. 4599; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial pages (58131) and (79327).

Cross References

   This section cited in 55 Pa. Code §  1221.42 (relating to additional participation requirements for hospital clinics and emergency rooms); 55 Pa. Code §  1221.44 (relating to additional participation requirements for independent clinics); and 55 Pa. Code §  1221.45 (relating to additional participation requirements for medical school clinics).

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