Current through Register Vol. 54, No. 44, November 2, 2024
Section 1101.63a - Full reimbursement for covered services rendered-statement of policy(a) Section 1406(a) of the Public Welfare Code (62 P. S. § 1406(a)) and MA regulations in § 1101.63(a) (relating to payment in full) mandate that all payments made to providers under the MA Program plus any copayment required to be paid by a recipient shall constitute full reimbursement to the provider for covered services rendered.(b) A provider who seeks or accepts supplementary payment of another kind from the Department, the recipient or another person for a compensable service or item is required to return the supplementary payment.(c) A provider may bill an MA recipient for a noncompensable service or item if the recipient is told before the service is rendered that the program does not cover it.The provisions of this §1101.63a adopted October 29, 1999, effective 10/30/1999, 29 Pa.B. 5622. This section cited in 55 Pa. Code § 1187.158 (relating to appeals).