Pennsylvania Code › Title 55 - HUMAN SERVICES › Part III - MEDICAL ASSISTANCE MANUAL › Chapter 1181 - NURSING FACILITY CARE › Subchapter D - NURSING HOME REFORM-STATEMENT OF POLICY › CONDITIONS OF PARTICIPATION › Section 1181.511 - Provider conditions of participation

Current through Register Vol. 54, No. 28, July 13, 2024
(a) OBRA-87, as amended, establishes a number
					 of conditions of participation (42 U.S.C.A. §§
												1396r(a), (b), (c) and
					 (d)). Most of these conditions of
					 participation are not effective until October 1, 1990; however, some are
					 effective prior to that date (OBRA-87, section 4214(a), as amended by sections
					 411(i)(3)(c) of the Medicare Catastrophic Coverage Act (42 U.S.C.A. §
												1396r note)).
(b) OBRA-87, as amended, requires providers
					 to meet the conditions of participation established in sections 1861(j) and
					 1905(c) of the Social Security Act (42 U.S.C.A. §§
												1395x(j) and
					 1396d(c)), as
					 applicable, in addition to those sections of OBRA-87 itself expressly made
					 effective prior to October 1, 1990 until all of the OBRA-87 conditions of
					 participation become effective (OBRA-87, section 4214(a) and (c))
					 (42 U.S.C.A. §
												1396r note). Providers are required to comply
					 with OBRA-87 requirements as they become effective. See §
											1181.41(3)
					 (relating to provider participation requirements).
(c) The changes in conditions of
					 participation which OBRA-87, as amended, makes effective prior to October 1,
					 1990, are:
(1) Effective July 1, 1988, a
					 provider shall permit immediate access to a resident-whether or not the
					 resident is applying for or receiving MA or Medicare benefits-by the resident's
					 individual physician, by a representative of the Secretary of the United States
					 Department of Health and Human Services, by a representative of the
					 Commonwealth, by an ombudsman authorized by the Department of Aging-including
					 those employed by a local Area Agency on Aging-and, with respect to residents
					 with developmental disabilities or who are mentally ill, by a representative of
					 Pennsylvania Protection and Advocacy, 116 Pine Street, Harrisburg, Pennsylvania
					 17101, the agency designated under subchapter III of the Developmental
					 Disabilities Assistance and Bill of Rights Act (42 U.S.C.A. §§
													6041-6043) and the Protection and
					 Advisory for Mentally Ill Individuals Act of 1986 (42 U.S.C.A. §§
													10801-10851). See
					 42 U.S.C.A. §
													1396r(c)(3)(A).
(2) Effective January 1, 1989, a provider
					 facility may not admit a new resident-whether or not the person seeking
					 admission is applying for or receiving, or otherwise eligible for MA or
					 Medicare benefits-who is mentally ill or is mentally retarded or has another
					 related condition, as defined in OBRA-87, unless the Department has determined
					 and notified the provider that the individual requires nursing facility
					 services and, if the individual does, whether the individual requires active
					 treatment for mental illness, mental retardation or other related conditions,
					 as defined by regulations and guidelines issued by the United States Department
					 of Health and Human Services. See
					 42 U.S.C.A. §
													1396r(b)(3)(F).