55 Pa. Code § 6210.35 - Ongoing provider responsibilities

(a) A utilization review plan shall be submitted to the Department's Office of Medical Assistance Programs.

(b) A system for managing recipients' funds that is in compliance with 42 CFR 483.420 (relating to conditions of participation: client protections) shall be in operation. If a recipient dies and there is no will, and if no relative or friend takes responsibility for burial, the following requirements apply:

(1) The facility may make payment of funds for burial expenses, if funds remain in the decedent's personal care account.

(2) Payment may be made only to a person licensed as a funeral director by the Department of State for a debt due and owing and may not exceed $1,000.

(3) The payment may be made whether or not a personal representative has been appointed.

(4) Under 20 Pa.C.S. § 3101 (relating to payments to family and funeral directors), a facility making the payment is released from responsibility to the same extent as if payment had been made to an appointed personal representative of the decedent. The facility is not required to oversee the manner in which the funeral director applies the payment.

(c) A cost report shall be filed with the Department's Office of Developmental Programs for non-State operated ICFs/ID and with the Department's Bureau of Financial Operations for State operated ICFs/ID within the time limit specified in § 6210.77 (relating to cost finding) if the facility is continuing its participation in the MA Program or within the time limit specified in § 6210.92 (relating to final reporting) if the facility is sold, transferred by merger or consolidation, terminated or withdraws from participation in the MA Program.

(d) Cost reports shall meet the requirements specified in § 6210.79 (relating to setting interim per diem rates).

(e) An onsite inspection shall be conducted at least annually by the Department's Office of Medical Assistance Programs Inspection of Care Team to determine compliance with the regulations at 42 CFR 456.600 (relating to purpose).

(f) Within 30 days of receipt of the inspection of care team report, the facility shall submit a written response, if required by the Department.

(g) The facility shall submit changes in ownership of persons having a direct or indirect interest of 5% or more in the facility to the Department's Office of Medical Assistance Programs.

(h) If the facility is a corporation, the facility shall submit changes in the name or address of corporate officers to the Department's Office of Medical Assistance Programs.

(i) The facility shall have a written transfer agreement with one or more general hospitals to provide needed diagnostic and other medical services to recipients, and under which acutely ill recipients may be transferred to ensure timely admission. Facilities that are based in hospitals are exempt from this subsection.

(j) 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 Department's Office of Medical Assistance Programs. The agreement in effect at the time of the ownership change shall 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

55 Pa. Code § 6210.35

The provisions of this § 6210.35 amended June 17, 2016, effective 6/18/2016, 46 Pa.B. 3177.

The provisions of this § 6210.35 amended under section 443.1(2) and (3) of the Human Services Code (62 P.S. § 443.1(2) and (3)).