Current through Register Vol. 54, No. 12, March 23, 2024
(a) As a condition of participation in a
waiver or Act 150 program, an applicant shall meet the following
qualifications:
(1) Complete and submit an MA
application including a waiver addendum to that application.
(2) Complete and submit a signed MA provider
agreement including the waiver addendum to that agreement.
(3) Verify fiscal solvency by submitting a
copy of the following:
(i) Applicant's most
recent corporate or nonprofit tax return. If an applicant does not have a
corporate or nonprofit tax return, then the applicant shall submit the most
recent individual tax return for the owner of the entity which is applying for
enrollment.
(ii) Applicant's most
recent monthly balance sheet. If an applicant does not have a balance sheet,
then an applicant shall submit a copy of the business plan indicating assets,
liabilities, and anticipated costs and revenues for the next fiscal
year.
(iii) Articles of
incorporation, if the applicant is incorporated.
(iv) Partnership agreement, if the applicant
is a partnership.
(v) Most recent
audit or financial review if the applicant has completed an audit or financial
review within the previous 5 years.
(4) Area Agencies on Aging that are units of
county government are not required to submit documentation under paragraph
(3).
(5) Create and follow policies
and procedures relating to the following:
(i)
Compliance with this chapter.
(ii)
Provision of services in a nondiscriminatory manner.
(iii) Compliance with the Americans with
Disabilities Act of 1990 (42
U.S.C.A. §§
12101-12213).
(iv) Compliance with the Healthcare Insurance
Portability and Accountability Act of 1996 (Pub. L. 104-191).
(v) Staff member training. The policy must be
in accordance with this chapter and licensing requirements that the applicant
is required to meet.
(vi)
Participant complaint management process.
(vii) Critical incident management. The
policy must be in accordance with this chapter and licensing requirements that
the applicant is required to meet.
(viii) Quality management. The policy must be
in accordance with this chapter and licensing requirements that the applicant
is required to meet.
(ix) Staff
member screening for criminal history.
(x) Employee Social Security Number
verification.
(xi) Initial and
continued screening for staff members and contractors to determine if they have
been excluded from participation in Federal health care programs by reviewing
the LEIE, EPLS and Medicheck.
(xii)
Process for participants with limited English proficiency to access language
services.
(6) Obtain and
maintain appropriate licenses and certifications from other State or Federal
agencies as required.
(7) Obtain
the following insurances:
(i) Commercial
general liability insurance.
(ii)
Worker's compensation insurance.
(iii) Professional liability insurance if
required by a profession.
(8) Comply with the applicable approved
waiver, including approved waiver amendments as posted on the Department's
publicly accessible web site.
(b) An applicant shall submit verification of
compliance with subsection (a) to the Department.
(c) Application materials shall be submitted
to the Department in a form and manner as prescribed by the
Department.
(d) An applicant may
apply to become a provider of more than one service as long as the provision of
multiple services is not prohibited by this chapter or Federal or State
requirement.
This section cited in 55 Pa. Code §
52.13 (relating to review of
application); and 55 Pa. Code §
52.14 (relating to ongoing
responsibilities of providers).