55 Pa. Code § 1181.45 - Ongoing responsibilities of providers
(a) In addition to the ongoing
responsibilities established in Chapter 1101 (relating to general provisions),
a nursing facility shall, as a condition of participation:
(1) Submit a Utilization Review Plan to the
Office of MA for approval.
(2) Have
in operation a system for managing patients' funds that, at a minimum, fully
complies with the Medicare long term care certification requirements
established at 42 CFR 405.1121(k)(6) (relating to conditions of
participation-governing body and management).
(i) The facility in which a qualified Medical
Assistance recipient dies may, under the circumstances described in this
subparagraph, make payment of funds, if any remain in the patient's care
account, for the decedent's burial expenses. Payment may be made only to a
qualified funeral director and may not exceed $1,000. The payment may be made
whether or not a personal representative has been appointed.
(ii) Subparagraph (i) applies only in
circumstances where there is no will, if this is ascertainable, and if no
relative or friend of the deceased patient takes responsibility for the burial.
Under 20 Pa.C.S. (relating to Probate, Estates and Fiduciaries Code) a facility
making such a payment is released from responsibility to the same extent as if
payment had been made to an appointed personal representative of the decedent
and the facility is not required to oversee the manner in which the funeral
director applies the payment.
(3) File an acceptable cost report with the
Department within the time limit specified in §
1181.64 (relating to cost
reporting) if the facility is continuing its participation in the MA Program or
within the time limit specified in §
1181.73 (relating to final
reporting) if the facility is sold, transferred by merger or consolidation,
terminated or withdraws from participation in the MA Program. An acceptable
cost report is one that meets the requirements of §
1181.66(a)(1)(i)-(iv)
(relating to setting ceilings on allowable
net operating costs).
(4) Except
for non-State operated intermediate care facilities for the mentally retarded,
if making initial application for participation, submit a projected MA 11 cost
report to the Bureau of Long Term Care Programs for the purpose of establishing
an interim per diem rate.
(5)
Undergo at least an annual onsite inspection of care by the Department's
Inspection of Care Team and within 30 days of receipt of the team's report,
submit a written response, if required by the Department.
(6) Submit to the Bureau of Long Term Care
Programs changes in ownership of persons having a direct or indirect interest
of 5% or more in the nursing facility and, if a corporation, changes in the
name or address of corporate officers.
(7) Have a written transfer agreement with
one or more general hospitals to provide needed diagnostic and other medical
services to patients of the nursing facility, and under which acutely ill
patients may be transferred to ensure timely admission. Hospital based units
are exempt from this requirement.
(b) If the facility changes ownership and the
new owner wishes the facility to participate in MA, the facility shall submit a
written request for participation to the Bureau of Long Term Care Programs. 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 to the terms and
conditions under which it was originally issued.
Notes
This section cited in 55 Pa. Code § 1181.42 (relating to additional participation requirements for hospital-based nursing units); 55 Pa. Code § 1181.43 (relating to additional participation requirements for intermediate care facilities for the mentally retarded); and 55 Pa. Code § 1181.44 (relating to additional participation requirements for State-operated nursing facilities other than intermediate care facilities for the mentally retarded).
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