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