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

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(a) Section 1406(a) of the Public Welfare Code (62 P. S. § 1406(a)) and MA regulations in § 1101.63(a) (relating to payment in full) mandate that all payments made to providers under the MA Program plus any copayment required to be paid by a recipient shall constitute full reimbursement to the provider for covered services rendered.
(b) A provider who seeks or accepts supplementary payment of another kind from the Department, the recipient or another person for a compensable service or item is required to return the supplementary payment.
(c) A provider may bill an MA recipient for a noncompensable service or item if the recipient is told before the service is rendered that the program does not cover it.

The provisions of this § 1101.63a adopted October 29, 1999, effective October 30, 1999, 29 Pa.B. 5622.

Notation

Cross References

This section cited in 55 Pa. Code § 1187.158 (relating to appeals).

                    
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