Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1101 - GENERAL PROVISIONS › PARTICIPATION › Section 1101.43 - Enrollment and ownership reporting requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Request for approval.
Written requests to participate in the MA Program should be sent to the
				  Department's Office of MA, Bureau of Hospital and Outpatient Programs. The
				  Bureau of Hospital and Outpatient Programs will forward an enrollment form and
				  provider agreement to the applicant to be completed and returned to the
				  Department.
(b)
Ownership
				  reporting requirements.
(1)
Medical facilities.
A medical facility shall disclose to the
				  Department, upon execution of a provider agreement or renewal thereof, the name
				  and social security number of a person who has a direct or indirect ownership
				  or control interest of 5% or more in the facility. Disclosure shall include the
				  identity of a person who has been convicted of a criminal offense under section
				  1407 of the Public Welfare Code (62 P. S. §
												1407) and the specific nature of the offense.
				  A change in ownership or control interest of 5% or more shall be reported to
				  the Department within 30 days of the date the change occurs. Failure to submit
				  a complete and accurate report constitutes a deceptive practice under section
				  1407(a)(1) of the Public Welfare Code (62 P. S. §
												1407(a)(1)) and justifies a
				  termination of the provider agreement by the Department.
(2)
Additional reporting requirements
				  for nursing facilities.
In addition to the reporting requirements
				  specified in paragraph (1), nursing facilities shall meet the requirements of
				  this paragraph.
(i) If a provider enters into
				  an agreement of sale that will result in a change of ownership of its nursing
				  facility, the provider shall notify the Department of the sale no less than 30
				  days prior to the effective date of the sale.
(ii) The provider shall include in the notice
				  of the agreement of sale the effective date of the sale and a copy of the sales
				  agreement. The notice shall be sent to the Office of MA, Bureau of Provider
				  Relations. The notice requirement shall be deemed met on the date it is
				  received by the Department, not the date of mailing.
(iii) If a provider fails to notify the
				  Department as specified in subparagraphs (i) and (ii), the provider forfeits
				  all reimbursement for nursing care services for each day that the notice is
				  overdue.
(3)
The
				  effect of change in ownership of a nursing facility.
When there is a
				  change in ownership of a nursing facility, the Department will enter into a
				  provider agreement with the buyer or transfer the current provider agreement to
				  the buyer subject to the terms and conditions under which it was originally
				  issued, if:
(i) Applicable State and Federal
				  statutes and regulations are met.
(ii) The buyer has applied to the Division of
				  Provider Enrollment, Bureau of Provider Relations, Office of MA, Department of
				  Human Services, and has been determined to be eligible to participate in the MA
				  Program.
(iii) The seller has
				  repaid to the Department monies owed by the seller to the Department as
				  determined by the Comptroller, Department of Human Services.
(4)
Additional reporting
				  requirements for a shared health facility.
In addition to the
				  reporting requirements specified in paragraph (1), a shared health facility
				  shall meet the requirements of section 1403 of the Public Welfare Code
				  (62
				  P. S. §
												1403) and Chapter 1102 (relating
				  to shared health facilities).
(5)
Providers.
Providers shall meet the reporting requirements
				  specified in §
											1101.71(b)
				  (relating to utilization control).