§ 1163.43. Ongoing responsibilities of providers.
In addition to the ongoing responsibilities established in Chapter 1101 (relating to general provisions), and as a condition of continued participation in the MA Program, general hospitals shall comply with the following:
(1) Maintain transfer agreements with skilled nursing and intermediate care facilities, private psychiatric hospitals and rehabilitation hospitals, for the prompt and appropriate transfer of patients who no longer need acute inpatient hospital care.
(2) For services provided to MA recipients, keep separate patient statistics and fiscal records on the cost of, and charges for, those services provided in:
(i) A distinct part psychiatric unit.
(ii) A distinct part drug and alcohol rehabilitation unit.
(iii) A distinct part medical rehabilitation unit.
(iv) A hospital-based nursing facility.
(v) Other inpatient settings.
(3) Retain complete, accurate and auditable medical and fiscal records for 4 years for MA patients under Chapter 1101.
(4) Furnish to the Department or its agents, Federal and State auditors, auditable copies of patient records and fiscal records upon request under Chapter 1101.
(5) For those hospitals not participating in Medicare, submit to the Office of MA for review and approval, details of changes to the hospitals utilization review system, including revisions to the utilization review plan, within 30 days of the date of the change.
The provisions of this § 1163.43 amended under section 443.1(1) of the Public Welfare Code (62 P. S. § 443.1(1)).
The provisions of this § 1163.43 adopted September 23, 1983, effective September 24, 1983, 13 Pa.B. 2881; amended June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185; amended June 16, 1989, effective immediately and applies retroactively to July 1, 1988, 19 Pa.B. 2563. Immediately preceding text appears at serial pages (131019) to (131020).
Notes of Decisions
During the first year of implementation of the prospective payment plan, it was appropriate to allow a hospital to request retroactive adjustments to its cost reports, even though the errors were unilateral and committed by the hospital. Lancaster General Hospital v. Department of Public Welfare, 535 A.2d 1238 (Pa. Cmwlth. 1988).
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