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Care Coordination/Care Management in Pennsylvania

        Pennsylvania’s Patient Bill of Rights affords every patient the right, upon request, to be given the name of his attending physician, the names of all other physicians directly participating in the patient’s care, and the names and functions of other health care persons having direct contact with the patient.1  Additionally, patients may be afforded additional rights regarding the coordination of their care depending on the type of facility the patient is located in.  For instance, patients in older adult daily living centers also have the right to participate in the development and implementation of his or her individual plan of care.2  Patients in outpatient facilities have the right to be informed of the identity of the physician primarily responsible for his or her care, as well as to be informed of the extent of participation of trainees and other physicians in the care regimen.3  For patients in birth centers, the facility must ensure that the patient’s record accompanies the mother and newborn during any transfers within the facility4; additionally, any expecting mother that is enrolled in the Healthy Beginnings PLUS Program will be provided a care coordinator that acts as a facilitator of multidisciplinary communications and arranges for transmission of the mother’s prenatal records to the expected hospital of delivery.5

 

Footnotes

  • 1. 28 Pa. Code § 103.22
  • 2. 6 Pa. Code § 11.9 (2012)
  • 3. 28 Pa. Code § 119.23 (2012)
  • 4. 28 Pa. Code § 501.62 (2012)
  • 5. 55 Pa. Code § 1140.41 (2012)

 

Care Coordination/Care Management in Pennsylvania

Subtopic Statute/Regulation Description
Care Coordination/Care Management Client Rights - 6 Pa. Code § 11.9 Clients in older adult daily living centers have a number of rights, which include the following: To participate in the development and...
Consumer Protections - 35 Pa. Stat. Ann. § 448.806c A consumer of home health care services have the right to be involved in the service planning process and to receive services with reasonable...
Department investigations - 28 Pa. Code § 9.605 The department of health may investigate plans to determine their compliance with regulations; the department may access enrollees’ medical...
Health record transfer, retention and confidentiality - 28 Pa. Code § 501.62 Birth centers must comply with the following requirements pertaining to patient medical records: If a patient is transferred or referred to...
HMO external quality assurance assessment - 28 Pa. Code § 9.654 Within 18 months of enrollment, and every three years thereafter, an HMO must use an acceptable external quality review organization to conduct a...
Implementation - 28 Pa. Code § 103.22 All hospitals must establish a Patient’s Bill of Rights that contains the following provisions relating to patients: The right, upon...
Participation requirements - 55 Pa. Code § 1140.41 The Healthy Beginnings PLUS Program (HBP) is a comprehensive package of prenatal and postpartum services provided to eligible medical assistance...
Patient information - 28 Pa. Code § 119.23 Patients treated in the outpatient service of a hospital have the following rights: To be informed of the identity of the physician primarily...
Patient’s rights - 28 Pa. Code § 501.46 Birthing centers must have written policies and procedures that provide the following rights to patients: Right to confidentiality, anonymity and...
Plan reporting requirements - 28 Pa. Code § 9.604 A plan must annually submit to the department of health a detailed report of its activities, including the following provisions: ...
Quality assurance standards - 28 Pa. Code § 9.674 A managed care plan must have an ongoing quality assurance program that includes review, analysis and assessment of the access, availability and...
Records - 28 Pa. Code § 561.22 Ambulatory surgical facilities must provide pharmaceutical services; drug transactions of such services must be recorded, and those records must be...
Responsibilities relating to the provision of medical services - 55 Pa. Code § 1102.33 The operator of a registered shared health facility must do the following: Insure that a recipient is treated by a practitioner who is familiar...