Section 1101.11. General provisions

Section 1101.21. Definitions

Section 1101.21a. Clarification regarding the definition of ‘‘medically necessary’’—statement of policy

Section 1101.31. Scope

Section 1101.31a. [Reserved]

Section 1101.32. Coverage variations

Section 1101.33. Recipient eligibility

Section 1101.41. Provider participation and registration of shared health facilities

Section 1101.42. Prerequisites for participation

Section 1101.42a. Policy clarification regarding physician licensure—statement of policy

Section 1101.42b. Certificate of Need requirement for participation—statement of policy

Section 1101.43. Enrollment and ownership reporting requirements

Section 1101.51. Ongoing responsibilities of providers

Section 1101.61. Reimbursement policies

Section 1101.62. Maximum fees

Section 1101.63. Payment in full

Section 1101.63a. Full reimbursement for covered services rendered—statement of policy

Section 1101.64. Third-party medical resources (TPR)

Section 1101.65. Method of payment

Section 1101.66. Payment for rendered, prescribed or ordered services

Section 1101.66a. Clarification of the terms ‘‘written’’ and ‘‘signature’’—statement of policy

Section 1101.67. Prior authorization

Section 1101.68. Invoicing for services

Section 1101.69. Overpayment—underpayment

Section 1101.69a. Establishment of a uniform period for the recoupment of overpayments from providers (COBRA)

Section 1101.70. [Reserved]

Section 1101.71. Utilization control

Section 1101.72. Invoice adjustment

Section 1101.73. Provider misutilization and abuse

Section 1101.74. Provider fraud

Section 1101.75. Provider prohibited acts

Section 1101.75a. Business arrangements between nursing facilities and pharmacy providers—statement of policy

Section 1101.76. Criminal penalties

Section 1101.77. Enforcement actions by the Department

Section 1101.77a. Termination for convenience and best interests of the Department—statement of policy

Section 1101.81. [Reserved]

Section 1101.82. Re-enrollment

Section 1101.83. Restitution and repayment

Section 1101.84. Provider right of appeal

Section 1101.91. Recipient misutilization and abuse

Section 1101.92. Recipient prohibited acts, criminal penalties and civil penalties

Section 1101.93. Restitution by recipient

Section 1101.94. Recipient right of appeal

Section 1101.95. Conflicts between general and specific provisions