Current through Register Vol. 54, No. 44, November 2, 2024
(a)
Request for approval.
Written requests to participate in the MA Program should be sent to the
Department's Office of MA, Bureau of Hospital and Outpatient Programs. The
Bureau of Hospital and Outpatient Programs will forward an enrollment form and
provider agreement to the applicant to be completed and returned to the
Department.
(b)
Ownership
reporting requirements.
(1)
Medical facilities. A medical facility shall disclose to the
Department, upon execution of a provider agreement or renewal thereof, the name
and social security number of a person who has a direct or indirect ownership
or control interest of 5% or more in the facility. Disclosure shall include the
identity of a person who has been convicted of a criminal offense under section
1407 of the Public Welfare Code (62 P. S. §
1407) and the specific nature of the offense.
A change in ownership or control interest of 5% or more shall be reported to
the Department within 30 days of the date the change occurs. Failure to submit
a complete and accurate report constitutes a deceptive practice under section
1407(a)(1) of the Public Welfare Code (62 P. S. §
1407(a)(1)) and justifies a
termination of the provider agreement by the Department.
(2)
Additional reporting requirements
for nursing facilities. In addition to the reporting requirements
specified in paragraph (1), nursing facilities shall meet the requirements of
this paragraph.
(i) If a provider enters into
an agreement of sale that will result in a change of ownership of its nursing
facility, the provider shall notify the Department of the sale no less than 30
days prior to the effective date of the sale.
(ii) The provider shall include in the notice
of the agreement of sale the effective date of the sale and a copy of the sales
agreement. The notice shall be sent to the Office of MA, Bureau of Provider
Relations. The notice requirement shall be deemed met on the date it is
received by the Department, not the date of mailing.
(iii) If a provider fails to notify the
Department as specified in subparagraphs (i) and (ii), the provider forfeits
all reimbursement for nursing care services for each day that the notice is
overdue.
(3)
The
effect of change in ownership of a nursing facility. When there is a
change in ownership of a nursing facility, the Department will enter into a
provider agreement with the buyer or transfer the current provider agreement to
the buyer subject to the terms and conditions under which it was originally
issued, if:
(i) Applicable State and Federal
statutes and regulations are met.
(ii) The buyer has applied to the Division of
Provider Enrollment, Bureau of Provider Relations, Office of MA, Department of
Human Services, and has been determined to be eligible to participate in the MA
Program.
(iii) The seller has
repaid to the Department monies owed by the seller to the Department as
determined by the Comptroller, Department of Human Services.
(4)
Additional reporting
requirements for a shared health facility. In addition to the
reporting requirements specified in paragraph (1), a shared health facility
shall meet the requirements of section 1403 of the Public Welfare Code
(62
P. S. §
1403) and Chapter 1102 (relating
to shared health facilities).
(5)
Providers. Providers shall meet the reporting requirements
specified in §
1101.71(b)
(relating to utilization control).
(c)
Notification by the
Department. The Department will notify applicants in writing either
that they have been approved or disapproved to participate in the program. A
provider who has been approved is eligible to be reimbursed only for those
services furnished on or after the effective date on the provider agreement and
only for services the provider is eligible to render subject to limitations in
this chapter and the applicable provider regulations. An applicant may appeal
under
2
Pa.C.S. §§ 501-508 and
701-704 (relating to
Administrative Agency Law), if the Department denies enrollment in the
program.
This section cited in 55 Pa. Code §
1121.41 (relating to participation
requirements); 55 Pa. Code §
1123.41 (relating to participation
requirements); 55 Pa. Code §
1127.41 (relating to participation
requirements); 55 Pa. Code §
1128.41 (relating to participation
requirements); 55 Pa. Code §
1130.51 (relating to provider
enrollment requirements); 55 Pa. Code §
1130.52 (relating to ongoing
responsibilities of hospice providers); 55 Pa. Code §
1141.41 (relating to participation
requirements); 55 Pa. Code §
1142.41 (relating to participation
requirements); 55 Pa. Code §
1143.41 (relating to participation
requirements); 55 Pa. Code §
1144.41 (relating to participation
requirements); 55 Pa. Code §
1149.41 (relating to participation
requirements); 55 Pa. Code §
1187.22 (relating to ongoing
responsibilities of nursing facilities); and 55 Pa. Code §
1251.41 (relating to participation
requirements).
