Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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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 § 1229.41. Participation requirements.

PROVIDER PARTICIPATION


§ 1229.41. Participation requirements.

 In addition to the participation requirements established in Chapter 1101 (relating to general provisions), Health Maintenance Organizations (HMOs) shall meet the following participation requirements:

   (1)  Have signed a contract with the Office of Medical Assistance for provision of HMO services to Medical Assistance eligibles.

   (2)  Comply with applicable Federal and State laws and regulations including but not limited to, Title XIX of the Social Security Act (42 U.S.C.A. § §  1396—1396k); Article IV of the Public Welfare Code (62 P. S. § §  401—489), and, when applicable, the Voluntary Nonprofit Health Service Act of 1972 (40 P. S. § §  1551—1557).

   (3)  Have arrangements with other providers for referring recipients for services for which they are eligible under the Medical Assistance Program but which are not provided by the HMO.

Source

   The provisions of this §  1229.42 adopted October 31, 1980, effective November 1, 1980, 10 Pa.B. 4255.



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