55 Pa. Code § 6100.803 – Organized health care delivery system.

(a) OHCDS is an organized health care delivery system. An OHCDS is an arrangement in which a provider that renders an HCBS chooses to offer a different vendor of an HCBS through a subcontract to facilitate the delivery of vendor goods or services to an individual.
(b) The following requirements of this chapter do not apply to an OHCDS:
1. (1) Sections 6100.47—6100.49 (relating to criminal history checks; funding, hiring, retention and utilization; and child abuse history certification) for public transportation and indirect services and supplies.
2. (2) Training as specified in § § 6100.141—6100.143 (relating to training).
3. (3) Section 6100.405 (relating to incident analysis).
4. (4) Medication administration as specified in § § 6100.461—6100.469.
5. (5) Section 6100.571 (relating to fee schedule rates).
6. (6) Sections 6100.641—6100.672, 6100.681—6100.694 and 6100.711.
7. (7) Section 6100.805 (relating to vendor goods and services).
(c) In addition to this chapter, the following requirements apply to OHCDS.
1. (1) An OHCDS shall:
  1. (i) Be an enrolled Medical Assistance waiver provider.
  2. (ii) Be enrolled in the Medicaid management information system.
  3. (iii) Provide at least one Medical Assistance service.
  4. (iv) Agree to provide the identified vendor goods or services to individuals.
  5. (v) Bill the Medicaid management information system for the amount of the vendor goods or services.
  6. (vi) Pay the vendor that provided the vendor goods or services the amount billed for in the Medicaid management information system.
2. (2) An OHCDS may bill a separate administrative fee in accordance with the following:
  1. (i) The administrative fee may not exceed the limit set by Federal requirements.
  2. (ii) The administrative activities must be required to deliver the vendor good or HCBS to an individual and must be documented to justify the separate administrative fee.
3. (3) An OHCDS shall ensure that each vendor with which it contracts meets the applicable provisions of this chapter.
4. (4) Only vendor goods and services may be subcontracted through the OHCDS. A provider that subcontracts shall have written agreements specifying the duties, responsibilities and compensation of the subcontractor.
5. (5) An OHCDS shall provide the Department with an attestation that the cost of the good or service is the same as or less than the cost charged to the general public.