Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1187 - NURSING FACILITY SERVICES
Subchapter C - NURSING FACILITY PARTICIPATION
Section 1187.22 - Ongoing responsibilities of nursing facilities

(1) Assure that every individual applying for admission to the facility is prescreened by the Department as required by section 1919 of the Social Security Act (42 U.S.C.A. § 1396r(e)(7)) and 42 CFR Part 483 , Subpart C (relating to preadmission screening and annual review of mentally ill and mentally retarded individuals).

(2) Assure that every individual who receives MA, who is eligible for MA or who is applying for MA, is reviewed and assessed by the Department or an independent assessor and found to need nursing facility services prior to admission to the nursing facility, or in the case of a resident, before authorization for MA payment.

(3) Assure immediate access to a resident by the following individuals:

(4) Assure that it is necessary for each resident to remain in the nursing facility.

(5) Assure that the data in each resident's Federally-approved PA Specific MDS are accurate and that all assessment records and tracking forms for the resident are completed and submitted to the Department as required by applicable Federal and State regulations and instructions, including the Centers for Medicare and Medicaid Services Long-Term Care Resident Assessment Instrument User's Manual and the Resident Data Reporting Manual.

(6) Assure and verify that the information contained on the quarterly CMI report is accurate for the picture date as specified in § 1187.33(a)(5) (relating to resident data and picture date reporting requirements) and the Resident Data Reporting Manual.

(7) Assure that each invoice for nursing facility services provided to each MA resident is accurate.

(8) Have in operation a system for managing residents' funds that, at a minimum, fully complies with the requirements established by Federal law and

Federal and State regulations in accordance with § 1187.78 (relating to accountability requirements related to resident personal fund management).

(9) Cooperate with reviews and audits conducted by the Department and furnish the residents' clinical and fiscal records to the Department upon request.

(10) Provide written responses to the Department for UMR reports requiring corrective action.

(11) Take corrective action within acceptable time frames as described in UMR reports.

(12) File an acceptable cost report with the Department within the time limit specified in § 1187.73 or § 1187.75 (relating to annual reporting; and final reporting).

(13) In addition to meeting the reporting requirements of § 1101.43 (relating to enrollment and ownership reporting requirements), notify the Department in writing within 30 days of a change in the name or address of corporate officers.

(14) Submit a written request for MA nursing facility participation to the Department if the nursing facility changes ownership and the new owner wishes the nursing facility to participate in the MA Program. The agreement in effect at the time of the ownership change will be assigned to the new owner subject to applicable statutes and regulations and the terms and conditions under which it was originally issued.

(15) Assure that individual resident information collected in accordance with this chapter is kept confidential and released only for purposes directly connected to the administration of the MA Program.

(16) Maintain a separate written record in accordance with instructions by the Department, identifying the requests or physician's orders received by the facility for exceptional DME or other DME as specified by the Department.

(17) Notify the Department in writing within 15 days if an MA eligible resident refuses DME that the Department has determined is medically necessary.

(18) Submit the initial Federally-approved PA Specific MDS record for each resident admitted to the nursing facility to the Department within 7 calendar days of the date the record is completed.