1. (a) If the Department identifies delays in assigning the initial or continued length of stay, the Department will deny payment for all or part of the stay.
2. (b) If the utilization review committee fails to conduct a continued stay review or fails to notify the Department on or before the expiration of the previously assigned length of stay, the Department will not certify facility days between the expiration of the previously assigned length of stay and the date the request for continued stay is made and approved.
3. (c) If the Department determines that services or items provided by the facility were not medically justified or were unnecessary, inappropriate or otherwise noncompensable, the Department will deny payment for those services as well as services and items related to the provision of that service or item. Payment will also be denied to the practitioner.

Authority

The provisions of this § 1151.92 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1)).

Source

The provisions of this § 1151.92 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2796; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial pages (181815) to (181816).