Section 1128.52. Payment criteria

(a) The Department will establish maximum reimbursement fees for dialysis facilities based on the following criteria:

(1) The level of reimbursement will be consistent with efficiency, economy and quality of care.

(2) The level of reimbursement will be sufficient to assure availability of services.

(3) Rate increases and decreases, and changes in the actual methodology used in establishing the maximum fees will be published as a notice in the Pennsylvania Bulletin.

(b) The fee for dialysis services may be decreased by the Department if:

(1) Medicare or the Department of Health Chronic Renal Disease Program payment rates decrease.

(2) The providers’ Statewide average usual charge decreases.

(3) Other compelling circumstances occur under which, in the interest of the general public, the Department revises its decisions regarding maximum payment levels.

(c) With the exception of the fee for ongoing maintenance dialysis, payment is made to participating dialysis facilities at the Department of Health, Chronic Renal Disease Program rates in effect as of July 1, 1986. Changes in payment rates will be published in the Pennsylvania Bulletin in the form of a notice.

Notation

Cross References

This section cited in 55 Pa. Code § 1128.51 (relating to general payment policy).