Managing Healthcare Compliance in Pennsylvania

Sarah Jones
Outline of Pennsylvania over a healthcare photo

Just like all states, healthcare compliance in Pennsylvania entails distinct healthcare regulations and requirements that compliance teams need to consider. Healthcare providers, facilities, and organizations in Pennsylvania are tasked with the challenge of traversing the complicated regulatory framework to ensure the delivery of efficient and ethical healthcare services, while also preventing legal and financial pitfalls.

To handle compliance efficiently, healthcare organizations in Pennsylvania need to develop a strong system for monitoring and interpreting regulatory changes and promptly modify policies and procedures if needed. Read on for insights into the essential aspects of healthcare compliance in Pennsylvania.

Pennsylvania Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The Pennsylvania Department of Health (DOH) is responsible for safeguarding public health, preventing disease outbreaks, and ensuring access to quality healthcare services. It has various departments, including the Office of Compliance, which is committed to ethics, integrity, and compliance with regulations, laws, and policies. 
  • The Pennsylvania State Board of Medicine is responsible for regulating medical provider licensing requirements. This licensing body ensures healthcare professionals meet the necessary qualifications and standards to practice safely and effectively.
  • The Pennsylvania Department of Human Services – Office of Mental Health and Substance Abuse Services (OMHSAS) oversees licensure and regulations for mental and behavioral health providers, including outpatient and inpatient mental health providers.
  • The Hospital and Healthsystem Association of Pennsylvania (HAP) collaborates closely with state and federal officials and a range of stakeholders. Its member hospitals and health systems, dedicated to enhancing health outcomes and offering cost-effective care, deliver comprehensive health services across the care spectrum in Pennsylvania.
  • The Pennsylvania Department of Human Services (DHS) is the state’s Medicaid agency. DHS’s mission is to empower Pennsylvanians to lead secure, healthy, and fulfilling lives by providing fair, trauma-aware, and results-driven services, while advocating for a society devoid of bias and inequality. 

These agencies help maintain the integrity and quality of healthcare services in Pennsylvania, protecting the public and promoting patient safety. The resources provided by these Pennsylvania state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Pennsylvania.

Regulations Unique to Pennsylvania

To meet the standards of healthcare compliance in Pennsylvania, there are a few additional regulations.

Telehealth Policy

Pennsylvania’s telehealth policy allows Medicaid reimbursement for live video and audio-only telehealth services but does not cover store-and-forward methods or remote patient monitoring. While Federally Qualified Health Centers (FQHCs) also allow live video sessions so long as the patient and provider are face-to-face (known as an encounter), audio-only visits are not reimbursable. Of note, the state lacks private payer laws mandating payment parity for telehealth. Providers are required to obtain consent from patients or their legal guardians prior to delivering telehealth services.

Medical Marijuana and Cannabis Regulations

The Pennsylvania Medical Marijuana Program, established under the Medical Marijuana Act since April 17, 2016, regulates the access and distribution of medical marijuana to patients with serious medical conditions. Focused on safe and effective delivery, the program integrates patients, caregivers, growers, processors, dispensaries, physicians, schools, and laboratories, ensuring a balanced approach to patient access and care. It features a comprehensive electronic tracking system (ETS), including registries and a tracking system covering all stages “from seed to sale,” enhancing transparency and security. Additionally, the program upholds stringent confidentiality measures to protect sensitive information related to patients, caregivers, and practitioners. Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs) that have an active license with the Pennsylvania Department of State can apply for registration with the Department of Health, and must complete the required Department of Health-approved training in order to prescribe medical marijuana. 

Tips To Manage Healthcare Compliance in Pennsylvania

Effectively managing healthcare compliance in Pennsylvania is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Pennsylvania-approved training.
  • Organize Policies By Requirement: Including “PA” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Pennsylvania

In Pennsylvania, medical provider credentialing is a crucial process that ensures healthcare providers meet the necessary qualifications to offer services. As outlined in the Pennsylvania Code, health plans must develop, maintain, and comply with a credentialing system to assess and enroll competent healthcare providers. This system is fundamental in forming a sufficient healthcare provider network​​​​.

The state’s Medical Assistance Program also incorporates five Behavioral Health Managed Care Organizations (BHMCO), each with its own credentialing procedures for autism and other behavioral health providers. This includes organizations like the Community Care Behavioral Health Organization and Magellan Behavioral Health, Inc., emphasizing the tailored approach to credentialing in various healthcare sectors​​.

Meet Pennsylvania Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Pennsylvania

MedTrainer’s all-in-one compliance platform can streamline management of Pennsylvania healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information.


See how MedTrainer can streamline your compliance.