Section 1101.66. Payment for rendered, prescribed or ordered services

(a) The Department pays for compensable services or items rendered, prescribed or ordered by a practitioner or provider if the service or item is:

(1) Within the practitioner’s scope of practice.

(2) Medically necessary.

(3) Not in an amount that exceeds the recipient’s needs.

(4) Not ordered or prescribed solely for the recipient’s convenience.

(5) Ordered with the recipient’s knowledge.

(b) Prescriptions and orders shall be written, except telephoned prescriptions addressed in subsection (c). The written prescriptions and orders shall contain the practitioner’s:

(1) Printed name.

(2) Signature.

(3) Professional license number.

(c) A practitioner may telephone a drug prescription to a pharmacist in accordance with the Pharmacy Act (63 P. S. § § 390-1—390-13). The pharmacist shall:

(1) Record the complete prescription on a standard prescription form.

(2) Keep the recorded prescription on file.

(d) The practitioner’s signature on the prescription is waived only for a telephoned drug prescription.

(e) Payment is not made for services or items rendered, prescribed or ordered by providers who have been terminated from the Medical Assistance program.

The provisions of this § 1101.66 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3653. Immediately preceding text appears at serial page (75059).

Notation

Cross References

This section cited in 55 Pa. Code § 1101.66a (relating to clarification of the terms ‘‘written’’ and ‘‘signature’’—statement of policy).

Notes of Decisions

A hospital was entitled to reimbursement from the Department for procedures which were provided and medically necessary, as documented in the medical record, even though a physician’s written orders were not contained in the medical record. Children’s Hospital of Philadelphia v. Department of Public Welfare, 621 A.2d 1230 (Pa. Cmwlth. 1993); appeal denied 634 A.2d 225 (Pa. 1993).

This section supports DPW’s decision to deny reimbursement to hospital which admitted patient overnight for treatment which could have safely been rendered in Special Procedure Unit. Episcopal Hospital v. Department of Public Welfare, 528 A.2d 676 (Pa. Cmwlth. 1987).