The MA Program provides payment for specific chiropractors services rendered to eligible recipients by chiropractors enrolled as providers under the program. Payment for chiropractors services is subject to this chapter, Chapter 1101 (relating to general provisions) and the limitations established in Chapter 1150 (relating to MA Program payment policies) and the MA Program fee schedule.
Source
The provisions of this § 1145.1 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial page (117384).
The MA Program covers the following chiropractors services as specified in § § 1145.211145.23 (relating to scope of benefits):
(1) Evaluation by means of examination of the patient.
(2) Treatment by means of manual manipulation of the spine to adjust misaligned or displaced vertabrae.
Source
The provisions of this § 1145.11 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Chiropractors services are covered when rendered in the chiropractors office, the home of the patient or in a skilled nursing or intermediate care facility.
Source
The provisions of this § 1145.12 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Chiropractors services are not covered when rendered in a location in a hospital, including but not limited to a hospital emergency room, a hospital short procedure unit or a hospital clinic.
Source
The provisions of this § 1145.12 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Payment will not be made for the following types of services regardless of where or to whom they are provided:
(1) Treatment other than manual manipulation of the spine to correct a subluxation.
(2) Physical therapy.
(3) Traction procedures.
(4) Physical examinations.
(5) Consultations.
Source
The provisions of this § 1145.14 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Categorically needy recipients are eligible for covered chiropractors services.
Source
The provisions of this § 1145.21 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Cross References
This section cited in 55 Pa. Code § 1145.11 (relating to types of services covered).
Medically needy recipients are eligible for covered chiropractors services.
Source
The provisions of this § 1145.22 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Cross References
This section cited in 55 Pa. Code § 1145.11 (relating to types of services covered).
State Blind Pension recipients are eligible for chiropractors services provided in the office or home.
Source
The provisions of this § 1145.23 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Cross References
This section cited in 55 Pa. Code § 1145.11 (relating to types of services covered).
General Assistance recipients, age 21 to 65, whose MA benefits are funded solely by State funds, are eligible for medically necessary basic health care benefits as defined in Chapter 1101 (relating to general provisions). See § 1101.31(e) (relating to scope).
Source
The provisions of this § 1145.24 adopted December 11, 1992, effective January 1, 1993, 22 Pa.B. 5995.
In addition to the participation requirements established in Chapter 1101 (relating to general provisions), chiropractors are required, as a condition of participation, to be licensed by the State Board of Chiropractic Examiners or, for drugless therapy, by the State Board of Medicine.
Source
The provisions of this § 1145.41 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Ongoing responsibilities of providers are established in Chapter 1101 (relating to general provisions).
Source
The provisions of this § 1145.42 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Payment is made for covered services provided by participating chiropractors subject to the conditions and limitations established in this section, § 1145.54 (relating to noncompensable services), and Chapters 1101 and 1150 (relating to general provisions; and MA Program payment policies) and the MA Program fee schedule. Payment will not be made for compensable chiropractors service if payment is available from another public agency or insurance or health program. Chiropractors services shall be billed in the name of the chiropractor providing the service.
Source
The provisions of this § 1145.51 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial page (117387).
Source
The provisions of this § 1145.53 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105; reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial page (51261).
Payment will not be made to a chiropractor for the following:
(1) Orthotics.
(2) Prosthetics.
(3) Medical supplies.
(4) X-rays.
(5) Services not included in Chapter 1150 (relating to MA Program payment policies) and the MA Program fee schedule. Payment will be made to approved medical suppliers for compensable items ordered by a chiropractor.
Source
The provisions of this § 1145.54 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial pages (117387) to (117388).
Cross References
This section cited in 55 Pa. Code § 1145.51 (relating to general payment policy).
Claims for payment under the MA Program are subject to the utilization review procedures established in Chapter 1101 (relating to general provisions).
Source
The provisions of this § 1145.71 adopted July 25, 1980, effective September 1, 1980, 10 Pa.B. 3105.
Providers determined to have billed for services inconsistent with MA Program regulations, to have provided services outside the scope of customary standards of chiropractic practice, or to have otherwise violated the standard set forth in the provider agreement, are subject to the sanctions imposed in Chapter 1101 (relating to general provisions).
Source
The provisions of this Appendix A reserved December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932. Immediately preceding text appears at serial page (54221).
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