55 Pa. Code § 1187.21 - Nursing facility participation requirements

In addition to meeting the participation requirements established in Chapter 1101 (relating to general provisions), a nursing facility shall meet the following requirements:

(1) The nursing facility shall be licensed by the Department of Health.

(2) Every bed licensed by the Department of Health in a nursing facility that participates in the MA Program shall be certified for MA participation.

(3) The nursing facility shall abide by applicable Federal, State and local statutes and regulations, including Title XIX of the Social Security Act (42 U.S.C.A. §§ 1396-1396q), sections 443.1-443.6 of the Public Welfare Code (62 P. S. §§ 443.1-443.6) and applicable licensing statutes.

(4) An MA-enrolled nursing facility with 60 or more licensed beds providing skilled nursing and rehabilitation services in accordance with the Medicare requirements shall also be enrolled in the Medicare Program to the extent that it has sufficient beds to accommodate the Medicare-eligible residents it is required to serve. This does not preclude a nursing facility with a bed complement of under 60 beds from enrolling in the Medicare Program.

(i) A nursing facility certified to participate in the Medicare Program shall have sufficient beds to accommodate its Medicare-eligible residents. Payment will be based on criteria found in § 1187.101(b) (relating to general payment policy).

(ii) Failure to be enrolled and certified in the Medicare Program will result in denial of claims for a resident with both Medicare and MA coverage.

(5) The nursing facility shall meet the requirements of Subchapter L (relating to nursing facility participation requirements and review process).

Notes

55 Pa. Code § 1187.21

The provisions of this § 1187.21 amended June 29, 2012, effective 6/30/2012, 42 Pa.B. 3733.