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Hospitals and Hospital Units under Cost Reimbursement Principles | Midpage
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Pennsylvania Code
Title 55
Part III
Chapter 1163
Hospitals and Hospital Units under Cost Reimbursement Principles
Hospitals and Hospital Units under Cost Reimbursement Principles
1163.401
Policy.
1163.402
Definitions.
1163.421
Scope of benefits for the categorically needy.
1163.422
Scope of benefits for the medically needy.
1163.423
Scope of benefits for State Blind Pension recipients.
1163.424
Scope of benefits for General Assistance recipients.
1163.441
General participation requirements.
1163.442
Requirements for reimbursement under this subchapter.
1163.443
Ongoing responsibilities of providers.
1163.451
General payment policy.
1163.451a
Clarification of the term ‘‘in writing’’—statement of policy.
1163.452
Payment methods and rates.
1163.453
Allowable and nonallowable costs.
1163.454
Limitations on payment.
1163.455
Noncompensable services and items.
1163.455a
Utilization guidelines for inpatient hospital drug and alcohol services under the MA Program—statement of policy.
1163.456
Third-party liability.
1163.457
Payment policies relating to out-of-State hospitals.
1163.458
Payment policies relating to same-calendar-day admissions and discharges.
1163.459
Disproportionate share payments.
1163.471
Scope of claim review process.
1163.472
Concurrent hospital review.
1163.473
Hospital utilization review plan.
1163.474
Requirements for hospital utilization review committees.
1163.475
Responsibilities of the hospital utilization review committee.
1163.476
Plan of care.
1163.477
Admission review requirements.
1163.478
Continued stay review requirements.
1163.479
Medical Care Evaluation studies.
1163.480
Adverse determinations.
1163.481
Utilization review sanctions.
1163.491
Provider misutilization.
1163.492
Payment policy relating to administrative sanctions.
1163.501
Provider right to appeal.
1163.511
Change of ownership or control.