55 Pa. Code § 1102.2

Current through Register Vol. 54, No. 49, December 7, 2024

Section 1102.2 - Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Administrator-An individual designated by a shared health facility operator to handle day-to-day operations of the facility.

Department-The Department of Public Welfare of the Commonwealth.

Medical care-Services or items covered under the Medical Assistance Program.

Operator-The person responsible for the central coordination and management of the activities of a shared health facility and for the compliance by the facility with applicable State law.

Practitioner-A medical doctor, doctor of osteopathy, dentist, optometrist, podiatrist, chiropractor or other medical professional who is licensed by the Commonwealth or by another state and is enrolled in the Medical Assistance Program.

Provider-An individual or medical facility which signs an agreement with the Department to participate in the Medical Assistance Program, including, but not limited to: licensed practitioners, pharmacies, hospitals, nursing homes, clinics, home health agencies and medical purveyors.

Public clinic-A health clinic operated by a Federal, State or local governmental agency.

Purveyor-A person other than a practitioner who, directly or indirectly, engages in the business of supplying to patients medical supplies, equipment or services for which reimbursement under the Medical Assistance Program is received, including, but not limited to: clinical laboratory services or supplies, X-ray laboratory services or supplies, inhalation therapy services or equipment, ambulance services, sick room supplies, physical therapy services or equipment and orthopedic or surgical appliances or supplies.

Shared health facility-An entity other than a licensed or approved hospital facility, skilled nursing facility, intermediate care facility, intermediate care facility for the mentally retarded, rural health clinic, public clinic or Health Maintenance Organization in which:

(i) Medical services, either alone or together with support services, are provided at a single location.

(ii) Services are provided by three or more practitioners, two or more of whom are practicing within different professions.

(iii) Practitioners share common waiting areas, examining rooms, equipment, supporting staff or records.

(iv) At least one practitioner receives payment on a fee for service basis.

(v) A provider received more than $30,000 in payment from the Medical Assistance Program during the 12 month period prior to the date of the initial or renewal application of the shared health facility for registration in the Medical Assistance Program.

55 Pa. Code § 1102.2