Pennsylvania Code
Title 55 - HUMAN SERVICES
Part I - Department of Human Services
Subpart D - Hearings and Appeals
Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES
GENERAL PROVISIONS
Section 41.3 - Definitions

Universal Citation: 55 PA Code ยง 41.3

Current through Register Vol. 54, No. 44, November 2, 2024

(a) The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Agency action-

(i) An adjudicative action of the Department or a program office that relates to the administration of the MA Program.

(ii) The term includes the actions identified in §§ 1101.84(a)-(c) and 1187.141(a) (relating to provider right of appeal; and nursing facility's right to appeal and to a hearing) and other actions relating to a provider's enrollment in, participation in, claims for payment or damages under or penalties imposed under the MA Program.

Bureau-The Bureau of Hearings and Appeals of the Department.

Department-The Department of Public Welfare.

Dispositive motion-

(i) A motion that seeks a final determination of one or more of the issues in a provider appeal without the need for hearing or further hearing.

(ii) The term includes the following:
(A) A motion to quash the provider appeal.

(B) A motion to dismiss the provider appeal.

(C) A motion for summary judgment.

(D) A motion for partial summary judgment.

(iii) The term does not include a motion in limine.

GRAPP-The General Rules of Administrative Practice and Procedure set forth in 1 Pa. Code Part II (relating to General Rules of Administrative Practice and Procedure).

Hearing-One of the following:

(i) A provider appeal.

(ii) A proceeding before a presiding officer for the purpose of creating a factual evidentiary record relative to the merits of one or more issues raised in a request for hearing.

(iii) A proceeding conducted by a presiding officer for the purpose of resolving an interlocutory matter, including, but not limited to, a petition for supersedeas.

Legal document-

(i) A motion, answer, brief, petition to intervene, request for reconsideration of an interlocutory order, request for review by the Secretary or other paper filed with the Bureau in a provider appeal, other than a pleading.

(ii) The term does not include attachments or exhibits.

MA-Medical Assistance.

Pa.R.C.P.-Pennsylvania Rules of Civil Procedure.

Party-A provider, a program office or an intervener.

Person-An individual, partnership, association, corporation, political subdivision, municipal authority or other entity.

Petition for relief-A document filed under 1 Pa. Code §35.17, §35.18 or §35.19 (relating to petitions generally; petitions for issuance, amendment, waiver or deletion of regulations; and petitions for declaratory orders) of the GRAPP.

Pleading-A request for hearing, including amendments thereto.

Presiding officer-A member of the agency, or one or more trial examiners appointed according to law and designated, to preside at hearings or conferences, or other officers specially provided for and designated under statute to conduct specified classes of proceedings, but not including the agency head when sitting as such.

Program office-

(i) An office within the Department that is managed and operated by an individual who reports directly to the Secretary, including a deputy secretary, or a bureau or other administrative unit of an office within the Department that is managed and operated by an individual who reports directly to a deputy secretary.

(ii) The term does not include the Bureau.

Provider-One of the following:

(i) A person currently enrolled in the MA Program as a provider of services.

(ii) A person who has applied for enrollment in the MA Program as a provider of services.

(iii) A person whose enrollment in the MA Program as a provider of services has been suspended or terminated by the Department.

Provider appeal-A proceeding to obtain review of an agency action that is commenced by a provider by filing a request for hearing.

Request for hearing-The pleading filed by a provider in order to commence a provider appeal.

Secretary-The Secretary of Public Welfare.

Senior Department official-the Comptroller, the Chief Counsel of the Department, a nonclerical individual who works in the office of the Secretary or who reports directly to the Secretary, including a deputy secretary, or a director of a bureau within a program office.

Supersedeas-An order suspending the effect of an agency action pending the Bureau's determination in a provider appeal.

Waiver request-A request that the Secretary waive the application of a provision set forth in a Department regulation.

(b) The definition of "pleading" in subsection (a) supersedes the definition of "pleading" in 1 Pa. Code §31.3 (relating to definitions of pleading).

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