Section 1153.41. Participation requirements

In addition to the participation requirements established in Chapter 1101 (relating to general provisions), outpatient psychiatric clinics and outpatient partial hospitalization facilities shall meet the following participation requirements:

(1) Have current full licensure/approval as a psychiatric outpatient clinic or partial hospitalization outpatient facility by the Department’s Office of Mental Health. To remain eligible for MA reimbursement, a clinic or partial hospitalization facility shall be fully licensed/approved at all times as a psychiatric outpatient clinic or partial hospitalization outpatient facility.

(2) Have medical personnel currently licensed, certified or registered in accordance with laws of the Commonwealth.

(3) Have a written patient referral plan that provides for inpatient hospital care and follow-up treatment.

(4) Post a current written fee schedule for billing third party and private payors.

(5) Appoint an administrator or director responsible for the internal operation of the clinic or partial hospitalization facility. Appoint a psychiatrist or psychiatrists responsible for the supervision and direction of services rendered to eligible recipients.

(6) Notify immediately the Department, Office of Medical Assistance, Bureau of Provider Relations, in writing, of a facility or clinic name, address, and service changes prior to the effective date of change. Failure to do so may result in payment interruption or termination of the provider agreement.

(7) Enter into a written provider agreement with the Department.

(8) Have each branch location or satellite of an approved clinic or partial hospitalization facility also licensed or approved by the Office of Mental Health as a psychiatric outpatient clinic site or psychiatric partial hospitalization facility, whichever is applicable, and approved by the Office of Medical Assistance before reimbursement can be made for services rendered at the branch or satellite. Approval of the parent organization does not constitute approval for any branches or satellites of the same organization.

(9) Be approved by the Department’s Office of Medical Assistance.

(10) Have medications prescribed by a licensed physician.

The provisions of this § 1153.41 adopted January 25, 1980, effective February 1, 1980, 10 Pa.B. 267; amended November 13, 1981, effective November 15, 1981, 11 Pa.B. 4046. Immediately preceding text appears at serial pages (47826) and (47827).