55 Pa. Code § 52.62 – Prohibition of services.

(a) A provider may be sanctioned, prohibited or disenrolled from providing services for failure to perform any of the following:
1. (1) Protect the health and welfare of a participant during service delivery.
2. (2) Comply with applicable Federal or State laws and this chapter.
3. (3) Comply with a provision of the MA provider agreement, including the waiver addendum.
4. (4) Deliver a service in the type, scope, amount, duration and frequency required by the approved service plan when the participant is available for the delivery of the service.
5. (5) Develop or implement a CAP.
6. (6) Maintain licenses or certifications, or both, as required by Federal or State agencies.
7. (7) Maintain accurate records.
(b) The Department may prohibit a provider from providing new participants with services if the provider violates subsection (a).
(c) A disenrolled provider shall cooperate with the Department, new providers of services and participants with transition planning to ensure participant’s continuity of care.