Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter A - NURSING FACILITY CARE › PROVIDER PARTICIPATION › Section 1181.45 - Ongoing responsibilities of providers

Current through Register Vol. 54, No. 28, July 13, 2024
(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.