(a) The following
words and terms, when used in this chapter, have the following meanings, unless
the context clearly indicates otherwise:
Agency action-
(i) An adjudicative action of the Department
or a program office that relates to the administration of the MA
Program.
(ii) The term includes the
actions identified in §§
1101.84(a)-(c)
and
1187.141(a)
(relating to
provider right of appeal; and nursing facility's right to appeal
and to a
hearing) and other actions relating to a
provider's enrollment in,
participation in, claims for payment or damages under or penalties imposed
under the MA Program.
Bureau-The Bureau of Hearings and
Appeals of the Department.
Department-The Department of Public
Welfare.
Dispositive motion-
(i) A motion that seeks a final determination
of one or more of the issues in a provider appeal without the need for hearing
or further hearing.
(ii) The term
includes the following:
(A) A motion to quash
the provider appeal.
(B) A motion
to dismiss the provider appeal.
(C)
A motion for summary judgment.
(D)
A motion for partial summary judgment.
(iii) The term does not include a motion in
limine.
GRAPP-The General Rules of
Administrative Practice and Procedure set forth in 1 Pa. Code Part II (relating
to General Rules of Administrative Practice and Procedure).
Hearing-One of the following:
(i) A provider appeal.
(ii) A proceeding before a presiding officer
for the purpose of creating a factual evidentiary record relative to the merits
of one or more issues raised in a request for hearing.
(iii) A proceeding conducted by a presiding
officer for the purpose of resolving an interlocutory matter, including, but
not limited to, a petition for supersedeas.
Legal document-
(i) A motion, answer, brief, petition to
intervene, request for reconsideration of an interlocutory order, request for
review by the Secretary or other paper filed with the Bureau in a provider
appeal, other than a pleading.
(ii)
The term does not include attachments or exhibits.
MA-Medical Assistance.
Pa.R.C.P.-Pennsylvania Rules of Civil
Procedure.
Party-A provider, a program office or an
intervener.
Person-An individual, partnership,
association, corporation, political subdivision, municipal authority or other
entity.
Petition for relief-A document filed
under 1 Pa. Code §35.17, §35.18 or §35.19 (relating to petitions
generally; petitions for issuance, amendment, waiver or deletion of
regulations; and petitions for declaratory orders) of the GRAPP.
Pleading-A request for hearing,
including amendments thereto.
Presiding officer-A member of the
agency, or one or more trial examiners appointed according to law and
designated, to preside at hearings or conferences, or other officers specially
provided for and designated under statute to conduct specified classes of
proceedings, but not including the agency head when sitting as such.
Program office-
(i) An office within the Department that is
managed and operated by an individual who reports directly to the Secretary,
including a deputy secretary, or a bureau or other administrative unit of an
office within the Department that is managed and operated by an individual who
reports directly to a deputy secretary.
(ii) The term does not include the
Bureau.
Provider-One of the following:
(i) A person currently enrolled in the MA
Program as a provider of services.
(ii) A person who has applied for enrollment
in the MA Program as a provider of services.
(iii) A person whose enrollment in the MA
Program as a provider of services has been suspended or terminated by the
Department.
Provider appeal-A proceeding to obtain
review of an agency action that is commenced by a provider by filing a request
for hearing.
Request for hearing-The pleading filed
by a provider in order to commence a provider appeal.
Secretary-The Secretary of Public
Welfare.
Senior Department official-the
Comptroller, the Chief Counsel of the Department, a nonclerical individual who
works in the office of the Secretary or who reports directly to the Secretary,
including a deputy secretary, or a director of a bureau within a program
office.
Supersedeas-An order suspending the
effect of an agency action pending the Bureau's determination in a provider
appeal.
Waiver request-A request that the
Secretary waive the application of a provision set forth in a Department
regulation.
