PROVIDER PARTICIPATION

1. (a) Only pharmacies and dispensing physicians that are currently licensed by the Commonwealth and which have their principal place of business in this Commonwealth are eligible to participate as providers in the PACE Program.
2. (b) Only services of enrolled providers which are performed and delivered within this Commonwealth are eligible for coverage under the PACE Program.
3. (c) Pharmacies or dispensing physicians whose PACE provider agreements have been terminated for cause, or who have been precluded or excluded for cause from participation in the Medicare Program or the Commonwealth’s Medical Assistance Program are not eligible to participate as providers in the PACE Program unless they meet the requirements for re-enrollment in § 22.85 (relating to re-enrollment of providers whose agreements have been terminated).

Source

The provisions of this § 22.61 adopted June 15, 1984, effective June 16, 1984, 14 Pa.B. 2109; amended March 29, 1985, effective March 30, 1985, 15 Pa.B. 1163; corrected April 12, 1985, effective March 30, 1985, 15 Pa.B. 1353; amended December 13, 1985, effective December 14, 1985, 15 Pa.B. 4427; amended December 14, 1990, effective December 15, 1990, 20 Pa.B. 6143. Immediately preceding text appears at serial page (103129).

Notes of Decisions

Failure to Keep Pharmacy License Current

The failure of a PACE provider to have a current license constitutes a material breach of the provider agreement and the recoupment of all claims made by an unlicensed provider is not excessive and constitutes liquidated damages, not a ‘‘penalty.’’ Calabro v. Department of Aging, 689 A.2d 347 (Pa. Cmwlth. 1997); appeal denied 698 A.2d 596 (Pa. 1997).

Cross References

This section cited in 6 Pa. Code § 22.2 (relating to definitions); and 6 Pa. Code § 22.62 (relating to conditions of provider participation).