reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › PROVIDER RIGHTS AND RESPONSIBILITIES › Section 21.78 - Nutrition responsibilities of providers

Current through Register Vol. 54, No. 28, July 13, 2024
The provider shall assure that:
(1) A client is served daily at least three
				  well-balanced meals which are designed to meet the daily nutritional
				  requirements of the client and which are prepared either by the provider, or as
				  indicated in the care plan, by the client with the supervision of the
				  provider.
(2) A substitute meal is
				  available to the client, if a client misses a meal.
(3) Dietary restrictions prescribed by the
				  client's personal physician are followed.
(4) Meals are served to clients in a dining
				  area, except that:
(i) Meal service to a
				  client's bedroom shall be made available only if the client is temporarily ill
				  or indisposed.
(ii) Meal service to
				  other rooms in the home may be made available if the client requests that
				  service and the provider agrees to deliver that service.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › PROVIDER RIGHTS AND RESPONSIBILITIES › Section 21.79 - Fire and safety activities

Current through Register Vol. 54, No. 28, July 13, 2024
The provider shall assure that:
(1) First aid supplies such as bandages,
				  adhesive tape, bandaids, slings, cotton, sterile dressings, antiseptics, safety
				  pins and scissors, are available in the home.
(2) The telephone number of the local fire
				  department, police, poison control and ambulance serving the home is posted by
				  the telephones.
(3) A minimum of
				  one operational fire extinguisher is located on each occupied floor, with at
				  least one fire extinguisher located in the kitchen or cooking area, unless
				  otherwise prescribed by the local fire inspecting authority under §
										21.27(12)
				  (relating to domiciliary care home certification and recertification
				  standards). The provider and each staff person shall be trained to use the fire
				  extinguishers.
(4) A written plan
				  is available for evacuation of the building in case of a fire or other
				  emergency, and the clients and residents of the home are made aware of the
				  plan.
(5) Fire drills are conducted
				  at least quarterly in accordance with the plan established under paragraph (4).
				  A written record listing the time and date of the drills shall be kept by the
				  provider. Annually, at least one fire drill shall be conducted without prior
				  notice to clients.
(6) Proper
				  safeguards are taken against the fire hazards involved in smoking. For example,
				  ashtrays and special smoking areas and nonsmoking areas shall be
				  provided.
(7) Firearms kept on the
				  premises are stored in a locked area which is inaccessible to
				  clients.
(8) Containers of
				  poisonous, caustic, toxic, flammable or other dangerous materials kept in the
				  home are prominently and distinctly marked or labeled as hazardous and stored
				  in an area that is inaccessible to clients. The use and storage of these
				  materials may not constitute a hazard to the clients.
(9) Combustible trash is stored in fire
				  resistant containers.
(10)
				  Fireplaces are securely screened when in use.
(11) Portable space heaters are not used. If
				  nonportable electric baseboard space heaters are used, they shall be installed
				  with permanent connectors and protectors.
This section cited in 6 Pa. Code §
												21.27 (relating to domiciliary care
						home certification and recertification standards); 6 Pa. Code §
												21.52 (relating to AAA service
						responsibilities); 6 Pa. Code §
												21.55 (relating to AAA placement
						activities); and 6 Pa. Code §
												21.81 (relating to provider
						financial accountability).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › PROVIDER RIGHTS AND RESPONSIBILITIES › Section 21.80 - Domiciliary care home maintenance activities

Current through Register Vol. 54, No. 28, July 13, 2024
The provider shall assure that:
(1) The atmosphere and routine of the
				  domiciliary care home enables clients to spend the majority of their hours
				  outside of their bedrooms.
(2)
				  Furnishings and housekeeping standards are of a standard that the domiciliary
				  care home is comfortable and clean. Closets, attics, basements, cellars and
				  furnace rooms shall be kept free from accumulation of extraneous material, such
				  as discarded furniture, clothing, newspapers or magazines. Garbage and rubbish
				  shall be removed from the premises at least once per week, and shall be stored
				  in containers that have tight fitting covers.
(3) A minimum temperature of 68°F during
				  waking hours and 65°F during sleeping hours is maintained in rooms used by
				  clients. If the clients are 65 years of age or older, a minimum temperature of
				  70°F is maintained during waking hours and 65°F during sleeping hours
				  in rooms used by those clients. If the temperature in rooms used by clients
				  exceeds 85°F, a fan or air conditioner shall be provided.
(4) A client's bedroom is not used for other
				  purposes by the provider.
(5) Doors
				  into rooms used by clients are not locked from the outside when a client is in
				  the room.
This section cited in 6 Pa. Code §
												21.52 (relating to AAA service
						responsibilities); 6 Pa. Code §
												21.55 (relating to AAA placement
						activities); 6 Pa. Code §
												21.74 (relating to basic
						furnishings); and 6 Pa. Code §
												21.81 (relating to provider
						financial accountability).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › PROVIDER RIGHTS AND RESPONSIBILITIES › Section 21.81 - Provider financial accountability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The provider shall maintain accurate
				  financial records regarding the operation of the domiciliary care home. The
				  records shall include, but not be limited to, records of payments made to
				  utilities and mortgage-holders, and records of purchases made and costs
				  incurred to meet the provider responsibilities as outlined in this section and
				  §§ 21.71-21.80 and 21.82.
(b) The provider may not manage the client's
				  finances unless prior approval is received from the client and the AAA and the
				  activity is specified in the care plan developed by the AAA.
(c) If the care plan requires that the
				  provider manage the client's finances, the provider shall:
(1) Maintain detailed and accurate financial
				  records of each individual client's assets, expenditures and payments received.
				  These records shall include the client's banking statements, receipts for
				  client deposits to accounts and expenditures exceeding $25, records of payments
				  from the client to the provider for home provider services and the client's
				  current fund balance. The provider may not commingle his money with that of the
				  client's.
(2) Notify the client and
				  offer assistance with establishing an interest-bearing account in the client's
				  name at a local financial institution protected by the Federal Deposit
				  Insurance Corporation or the Federal Savings and Loan Insurance Corporation, if
				  the client's excess funds exceed $200 at the end of 2 consecutive
				  months.
(3) Surrender to the
				  administrator or executor of the client's estate the assets of that client
				  which have been entrusted to the provider, upon the death of the client. If
				  there is no administrator or executor appointed within 1 week, the provider
				  shall surrender the assets to the AAA pending probate. An itemized written
				  account of the client's fund balance and an inventory of the assets shall be
				  furnished by the provider.
(4)
				  Immediately provide the client with an itemized written account of the funds
				  and pay to the client the remaining balance in funds, upon termination of
				  domiciliary care home provider service.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › PROVIDER RIGHTS AND RESPONSIBILITIES › Section 21.83 - Provider rights

Current through Register Vol. 54, No. 28, July 13, 2024
A domiciliary care provider shall be afforded the following
					 rights:
(1) The right to appeal an
				  adverse action by the Department or the AAA and receive a fair hearing under
				  Chapter 3 (relating to fair hearings and appeals).
(2) The right to prompt action on reasonable
				  requests made to the AAA with regard to problems encountered with the provision
				  of domiciliary care provider services.
(3) The right to timely payments from clients
				  for domiciliary care provider services.
(4) The right to receive training and
				  technical assistance from the AAA regarding domiciliary care provider
				  services.
(5) The right to
				  assistance and support from the AAA when serving special needs or during
				  emergency situations.
This section cited in 6 Pa. Code §
												21.55 (relating to AAA placement
						activities).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › CLIENT RIGHTS AND RESPONSIBILITIES › Section 21.91 - Client rights

Current through Register Vol. 54, No. 28, July 13, 2024
A client residing in a domiciliary care home shall be
					 afforded the following basic rights:
(1) The client may not be restricted in the
				  right to leave and return to the domiciliary care home at reasonable times
				  consistent with the house rules developed under §
										21.55(m) (relating
				  to AAA placement activities).
(2)
				  The client shall have the right to attend and participate in the religious
				  activities of the client's choice or to abstain from religious practice, and
				  shall have the right to be free from the imposition of the religious practices
				  of others.
(3) The client shall be
				  free to receive visitors at times mutually-agreed upon by the client and
				  provider.
(4) The client shall have
				  access to a telephone in the domiciliary care home and may make local calls, in
				  reasonable privacy, without charge. The client shall be allowed to make
				  arrangements for payment of toll calls.
(5) The client shall have access to the
				  United States mails, may write and send uncensored mail at the client's own
				  expense, and receive, unopened, mail addressed to the client.
(6) The client shall be free to voice
				  grievances and recommend changes in the policies and services of the
				  domiciliary care provider during periodic updates of the house rules.
(7) The client shall be allowed to keep in
				  the client's room personal possessions including, but not limited to, radios,
				  pictures, plants, cards, photographs, rockers, footstools and chairs.
(8) The client shall have the right to
				  privacy in all aspects of daily living, including visual privacy in the
				  bathroom and in intimate personal hygiene.
(9) The client shall have the right to a diet
				  consistent with religious or health restrictions.
(10) The client shall have the right to be
				  treated in a courteous manner by the provider and staff of the domiciliary care
				  home.
This section cited in 6 Pa. Code §
												21.55 (relating to AAA placement
						activities); 6 Pa. Code §
												21.82 (relating to other provider
						responsibilities); and 6 Pa. Code §
												21.92 (relating to client
						responsibilities).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › CLIENT RIGHTS AND RESPONSIBILITIES › Section 21.92 - Client responsibilities

Current through Register Vol. 54, No. 28, July 13, 2024
A client residing in a domiciliary care home is responsible
					 for the following:
(1) Paying the
				  monthly domiciliary care provider fee as established by the Department under
				  §
										21.41(6) (relating
				  to Departmental responsibilities) to the provider in a timely manner.
(2) Paying for personal expenses not
				  specified in §
										21.74 (relating to basic
				  furnishings).
(3) Treating the
				  provider, the staff and other residents of the home in a courteous
				  manner.
(4) Respecting the rights
				  of the other clients in the home as specified in §
										21.91 (relating to client
				  rights).
(5) Complying with the
				  house rules of the agreement entered into with the domiciliary care home
				  provider established under §
										21.75 (relating to client and
				  provider agreement), as long as the provisions of that agreement do not
				  conflict with §
										21.91.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › FAIR HEARINGS AND APPEALS › Section 21.101 - Fair hearings and appeals

Current through Register Vol. 54, No. 28, July 13, 2024
(a) All
				  parties have the right to express grievances and complaints and to appeal and
				  receive a fair hearing on adverse actions regarding services or activities
				  funded by the Department under Chapter 3 (relating to fair hearings and
				  appeals).
(b) The AAA shall utilize
				  the domiciliary care review team to handle complaints or appeals from
				  domiciliary care providers and applicants for or recipients of domiciliary care
				  services.
This section cited in 6 Pa. Code §
												21.23 (relating to application
						process for domiciliary care service and domiciliary care supplement); and 6
						Pa. Code §
												21.25 (relating to termination of
						eligibility for domiciliary care service or the domiciliary care
						supplement).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 21 - DOMICILIARY CARE SERVICES FOR ADULTS › OTHER ADMINISTRATIVE PROVISIONS › Section 21.111 - Forms, documents and other written materials

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may supplement or interpret this chapter by
					 developing and issuing forms, documents or other written materials necessary
					 for the effective administration of the program.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › GENERAL PROVISIONS › Section 22.1 - Scope and authority

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This
				  chapter sets forth regulations governing the administration, provision and
				  receipt of prescription drug benefits available to older Pennsylvanians under
				  the Pharmaceutical Assistance Contract for the Elderly (PACE)
				  Program.
(b) This chapter applies
				  to the Department, providers who wish to participate in the PACE Program,
				  applicants for program benefits and claimants.
(c) This chapter is issued under the
				  Pharmaceutical Assistance Contract for the Elderly Act (62 P. S.
				  §§
											2901-2908).
(d) The Department will develop PACE Program
				  policies and regulations, and reserves the right to delegate administrative
				  responsibilities as may be necessary to implement the PACE Program.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › GENERAL PAYMENT PRINCIPLES › Section 22.11 - General payment principles

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Provider billing.
A provider is required to bill the
				  Department at the usual charge for the drug dispensed.
(b)
Payment elements.
A
				  payment to an enrolled provider under the PACE Program shall consist of the
				  following:
(1) The copayment required of
				  claimants on each prescription billed under the PACE Program.
(2) The payment of the generic differential
				  required of claimants under subsection (g).
(3) The approved PACE Program
				  payment.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.21 - General claimant eligibility policy

Current through Register Vol. 54, No. 28, July 13, 2024
To be eligible to participate in PACE, an applicant shall
					 be a resident of this Commonwealth, be 65 years of age or older, have annual
					 income less than the maximum annual income and not be qualified for payment for
					 prescription drug benefits under a public assistance program or qualified for
					 full coverage of prescription drugs under another plan of insurance or
					 assistance. These eligibility conditions are detailed in §§
					 22.22-22.26.
This section cited in 6 Pa. Code §
												22.2 (relating to
						definitions).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.22 - Residence provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Residence criteria.
Except as set forth in subsection (d), a
				  resident is a person who has lived within this Commonwealth, under color of
				  law, for a period of at least 90 consecutive days immediately preceding the
				  date the applicant's application to participate in PACE is received by the
				  Department. The applicant shall have or intend to have a fixed place of abode
				  in this Commonwealth, with the present intent of maintaining a permanent home
				  in this Commonwealth for the indefinite future. The burden of establishing
				  proof of residence within this Commonwealth is on the applicant. Included in
				  this section are persons residing in long-term care institutions located within
				  this Commonwealth.
(b)
Documentation of residence.
The following are categories of
				  documents which may be submitted as proof of residence in this Commonwealth.
				  Documents submitted shall show the applicant's name and address. If the
				  application submitted has the applicant's current name and address preprinted
				  upon it, no other piece of documentation of residence is required to be
				  submitted. Otherwise, one document from one of the following categories shall
				  be photocopied and be provided as reasonable proof of residence:
(1) Motor vehicle records, such as a valid
				  driver's license.
(2) Housing
				  records, such as mortgage records, rent receipts or certification of residency
				  in a nursing home.
(3) Public
				  utility records and receipts, such as electric bills.
(4) Local tax records.
(5) A completed and signed, Federal, State or
				  local income tax return with the applicant's name and address preprinted on
				  it.
(6) Records of contacts with
				  public or private social agencies.
(7) Employment records, including records of
				  unemployment compensation.
(8)
				  Additional documents or records determined acceptable by the Department and
				  indicated in the instructions which accompany the PACE application
				  form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.23 - Age provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Age limit.
An applicant shall be 65 years of age or older to
				  participate in the PACE Program.
(b)
Early application.
An
				  applicant may, in order to assist in the timely determination of eligibility,
				  submit a completed application to participate in PACE up to 30 calendar days
				  prior to the actual date that the applicant will become 65 years of
				  age.
(c)
Documentation of
				  age.
The following are examples of documents, one of which shall be
				  photocopied and provided as reasonable proof of age:
(1) Birth certificate or delayed birth
				  certificate.
(2) Church baptismal
				  record showing date of birth.
(3)
				  Hospital birth record established during the first few years of life and
				  certified by the custodian of the record.
(4) Additional documents or records
				  determined acceptable by the Department and indicated on the instructions which
				  accompany the PACE application form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.24 - Income provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Income limits.
Applicants shall have an annual income of
				  $11,999.99 or less in the case of a single individual, or $14,999.99 or less
				  combined income in the case of married couples, with the following exceptions:
(1) Married applicants will be subject to the
				  income provisions for single individuals if each spouse maintains a separate
				  residence and neither spouse has access to, or receives support from, the
				  other's income during the year for which income is declared as provided for in
				  subsections (d) and (f).
(2)
				  Married applicants will be subject to the income provisions for single
				  individuals if either spouse is a resident of a long-term care facility during
				  the year for which income is declared as provided for in subsections (d) and
				  (f).
(3) Recently widowed or
				  divorced applicants, will be subject to the income provisions for married
				  couples if they had access to, or received support from, the former spouse's
				  income during the year for which income is declared as provided for in
				  subsections (d) and (f).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.25 - Other third-party benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Applicants who are qualified for coverage of payments for prescription drugs
				  under a public assistance program are ineligible for PACE as long as they are
				  so qualified.
(b) Applicants who
				  are qualified for full coverage of payments for prescription drugs under
				  another plan of assistance or insurance are ineligible for PACE as long as they
				  are so qualified.
(c) Applicants or
				  claimants who are qualified for partial payments for prescription drugs under
				  another insurance plan are eligible for PACE, but may receive reduced
				  assistance from PACE.
This section cited in 6 Pa. Code §
												22.2 (relating to definitions); 6
						Pa. Code §
												22.21 (relating to general claimant
						eligibility policy); 6 Pa. Code §
												22.33 (relating to responsibilities
						of the applicant in the application process); 6 Pa. Code §
												22.42 (relating to responsibilities
						of the claimant in the eligibility redetermination process); and 6 Pa. Code
						§
												22.51 (relating to responsibilities
						regarding eligibility).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CLAIMANT ELIGIBILITY › Section 22.26 - PACE eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Eligibility for PACE is established during a calendar year when a valid PACE
				  application is approved, and remains in effect until the expiration date stated
				  on the PACE identification card, unless there is cause for earlier
				  termination.
(b) The PACE
				  eligibility effective date and expiration date shall appear on the face of the
				  PACE identification card issued by the Department to claimants.
This section cited in 6 Pa. Code §
												22.2 (relating to definitions); and
						6 Pa. Code §
												22.21 (relating to general claimant
						eligibility policy).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.31 - General provisions

Current through Register Vol. 54, No. 28, July 13, 2024
The application process includes all activity relating to a
					 request for eligibility determination. It begins with the receipt by the
					 Department of an eligibility application and continues until there is an
					 official disposition of the request by the Department.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.32 - Initiating the application process

Current through Register Vol. 54, No. 28, July 13, 2024
An applicant requests a determination of eligibility to
					 participate in the PACE Program by completing a PACE application form and
					 submitting it to the Department.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.33 - Responsibilities of the applicant in the application process

Current through Register Vol. 54, No. 28, July 13, 2024
The applicant has the responsibility to conform to the
					 following:
(1) Complete the PACE
				  application form legibly and accurately.
(i)
				  Answer questions fully.
(ii)
				  Present necessary evidentiary documents under the following requirements:
(A) Regarding residence, one of the documents
				  listed in §
												22.22(b) (relating
				  to residence provisions) or other documentation of residence acceptable to the
				  Department, except when the application has the applicant's name and current
				  address preprinted on it.
(B)
				  Regarding age, one of the documents listed in §
												22.23(c) (relating
				  to age provisions), or two of the other types of documentation of age listed in
				  § 22.23(d).
(C) Regarding
				  income, documents required to substantiate each source of income, as defined in
				  §
												22.2 (relating to definitions) and
				  as set forth in §
												22.24(e) (relating
				  to income provisions), whenever required to do so by the Department.
(D) Regarding qualification for other
				  benefits, information identifying participation in any of the other programs
				  referred to in §
												22.25 (relating to other
				  third-party benefits).
(iii) Read the certification and
				  authorization statement.
(iv) Sign
				  or mark the application form.
(v)
				  Obtain signatures required by the Department on the instructions which
				  accompany the application form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.34 - Authorized agent

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Adjudicated incompetency.
When the applicant is adjudicated
				  incompetent, the Department will accept the court-appointed guardian as an
				  authorized agent for the purpose of initiating an application on behalf of the
				  applicant.
(b)
Incapacity.
If the applicant is incapable of filing an application on his own
				  behalf, the Department will accept one of the following persons designated by
				  the applicant, listed in the order of priority, as an authorized agent for the
				  purpose of initiating the application if a power of attorney or agent's
				  affidavit of authority accompanies the application:
(1) A close relative by blood or marriage,
				  such as a parent, spouse, son, daughter, brother or sister.
(2) A representative payee designated by the
				  Social Security Administraton.
(3)
				  A representative of a public/private social service agency, of which the
				  applicant is a client, who has been designated by the agency to so
				  act.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.35 - Certification

Current through Register Vol. 54, No. 28, July 13, 2024
The applicant shall certify that the answers to the
					 questions and items on the application form are true and accurate to the best
					 of the applicant's knowledge. Before the application can be processed, the
					 certificate shall be dated and signed by the applicant and any other party
					 whose signature is required by the Department in the instructions which
					 accompany the application form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.36 - Authorization

Current through Register Vol. 54, No. 28, July 13, 2024
By signing/marking the certification and authorization
					 statement on the application form, the applicant authorizes:
(1) The Department to verify any information
				  on the form by contacting the Social Security Administration, the Internal
				  Revenue Service, the Department of Revenue, employers or others, as the need
				  arises.
(2) The Department to
				  visit, with reasonable prior notice to the applicant, for the purpose of
				  determining the validity of claims made under the PACE Program.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › APPLICATION PROCESS › Section 22.37 - Right of appeal

Current through Register Vol. 54, No. 28, July 13, 2024
Departmental actions against an applicant which relate to
					 the application process are subject to the right of appeal under §§
										22.91-22.95 (relating to claimant
					 hearings and appeals).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.41 - General provisions

Current through Register Vol. 54, No. 28, July 13, 2024
A claimant requests a redetermination of eligibility to
					 participate in the PACE Program each year by completing a PACE application form
					 and submitting it to the Department. Eligibility will continue without
					 interruption each year if the claimant completes and submits the application
					 form on or before the date specified by the Department. If the application form
					 is not submitted at that time, eligibility will begin after the date when a
					 completed application form is received and approved by the
					 Department.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.42 - Responsibilities of the claimant in the eligibility redetermination process

Current through Register Vol. 54, No. 28, July 13, 2024
The claimant has the responsibility to conform to the
					 following:
(1) Complete the PACE
				  application form legibly and accurately.
(i)
				  Answer questions fully.
(ii)
				  Present necessary evidentiary documents under the following requirements:
(A) Regarding residence, a photocopy of one
				  of the documents listed in §
												22.22(b) (relating
				  to residence provisions) or other documentation acceptable to the Department,
				  except when the application has the claimant's current name and address
				  preprinted on it. A claimant applying for redetermination of eligibility is not
				  required to submit documentation of residence if the claimant's name and
				  current address is preprinted on the application form.
(B) Regarding income, documents required to
				  substantiate each source of income, as defined in §
												22.2 (relating to definitions) and
				  as set forth in §
												22.24(e) (relating
				  to income provisions), whenever required to do so by the Department.
(C) Regarding qualification for other
				  benefits, information identifying participation in the other programs referred
				  to in §
												22.25 (relating to other
				  third-party benefits).
(iii) Read the certification and
				  authorization statement.
(iv) Sign
				  or mark the application form.
(v)
				  Obtain signatures required by the Department on the instructions which
				  accompany the application form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.43 - Authorized agent

Current through Register Vol. 54, No. 28, July 13, 2024
In those instances when the claimant is either adjudicated
					 incompetent or is incapable of filing an application form on the claimant's own
					 behalf, the Department will accept as authorized agents the persons designated
					 in §
										22.34(a) and (b)
					 (relating to authorized agent) for the purpose of submitting the application
					 form on behalf of the claimant.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.44 - Certification

Current through Register Vol. 54, No. 28, July 13, 2024
The claimant shall certify that all the answers to the
					 questions and items on the application form are true and accurate to the best
					 of the claimant's knowledge. Before the application form can be processed, the
					 certification shall be dated and signed by the claimant and by any other party
					 whose signature is required by the Department in the instructions which
					 accompany the application form.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.45 - Authorization

Current through Register Vol. 54, No. 28, July 13, 2024
By signing or marking the certification and authorization
					 statement on the application form, the claimant authorizes:
(1) The Department to verify information on
				  the form by contacting the Social Security Administration, the Internal Revenue
				  Service, the Department of Revenue, employers or others, as the need
				  arises.
(2) The Department to
				  visit, with reasonable prior notice to the claimant, for the purpose of
				  determining the validity of claims made under the PACE Program.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › ELIGIBILITY REDETERMINATION PROCESS › Section 22.46 - Right of appeal

Current through Register Vol. 54, No. 28, July 13, 2024
Departmental actions against a claimant which relate to the
					 eligibility redetermination process are subject to the right of appeal under
					 §§
										22.91-22.95 (relating to claimant
					 hearings and appeals).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CONTINUING CLAIMANT RESPONSIBILITIES › Section 22.51 - Responsibilities regarding eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
The claimant has the responsibility to:
(1) Notify the Department whenever the
				  claimant becomes eligible for another plan of assistance or insurance, as set
				  forth in §
										22.25 (relating to other
				  third-party benefits).
(2) Return
				  the PACE identification card to the Department whenever becoming ineligible due
				  to one of the following:
(i) Establishing
				  residence outside of this Commonwealth.
(ii) Becoming eligible for full coverage of
				  payment for prescription drugs under another plan of assistance or insurance
				  under § 22.25(a) and (b).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › CONTINUING CLAIMANT RESPONSIBILITIES › Section 22.52 - Use of the PACE identification card

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  The PACE identification card shall be retained in the possession of claimant or
				  the claimant's authorized representative and not be given to providers except
				  for inspection and immediate return. The claimant remains responsible for its
				  appropriate use to claim benefits. In no case may a claimant send the PACE
				  identification card through the mail to a provider.
(b) A claimant may claim PACE benefits only
				  if the claimant, or the claimant's designated representative, presents the
				  enrolled provider with a validated PACE identification card except when the
				  claimant orders prescriptions services by mail.
(c) An incapacitated claimant who is, because
				  of the incapacity, unable to personally claim PACE benefits may designate
				  another person to do so. Persons so designated shall, whenever they claim PACE
				  benefits on behalf of an incapacitated claimant, present the enrolled provider
				  with the claimant's validated PACE identification card except when they request
				  prescription services by mail; inform the enrolled provider of their
				  designation; and sign their own name and indicate their relationship to the
				  incapacitated claimant on the PACE claim form. To claim PACE Program benefits
				  through prescription services by mail, designated representatives of an
				  incapacitated claimant shall have legal authority to represent the claimant as
				  evidenced by power of attorney or other legal document and shall sign all forms
				  requiring the claimant's signature.
(d) Eligibility for PACE benefits terminates
				  upon the death of a claimant. A deceased claimant's PACE identification card
				  should be promptly returned to the Department by the claimant's relative,
				  representative or by another responsible person.
This section cited in 6 Pa. Code §
												22.62 (relating to conditions of
						provider participation).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › PROVIDER PARTICIPATION › Section 22.61 - Conditions of provider eligibility

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Only pharmacies and dispensing physicians that are currently licensed by the
				  Commonwealth and which have their principal place of business in this
				  Commonwealth are eligible to participate as providers in the PACE
				  Program.
(b) Only services of
				  enrolled providers which are performed and delivered within this Commonwealth
				  are eligible for coverage under the PACE Program.
(c) Pharmacies or dispensing physicians whose
				  PACE provider agreements have been terminated for cause, or who have been
				  precluded or excluded for cause from participation in the Medicare Program or
				  the Commonwealth's Medical Assistance Program are not eligible to participate
				  as providers in the PACE Program unless they meet the requirements for
				  re-enrollment in §
										22.85 (relating to re-enrollment of
				  providers whose agreements have been terminated).
This section cited in 6 Pa. Code §
												22.2 (relating to definitions); and
						6 Pa. Code §
												22.62 (relating to conditions of
						provider participation).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › PROVIDER PARTICIPATION › Section 22.63 - Other provisions for providing services by mail

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Mail orders for prescription
				  drugs
. Providers shall provide PACE claimants who wish to request PACE
				  Program benefits by mail with order forms and clear instructions for submitting
				  mail orders. As a minimum, order forms submitted shall include the claimant's
				  signature, address, telephone number, where applicable and PACE identification
				  card number. For each initial mail-ordered prescription to be filled, a valid
				  prescription as written by the licensed prescriber shall accompany the order
				  form. When mail-ordered prescription drugs can not be delivered by mail as
				  restricted by the standards of the State Board of Pharmacy, 49 Pa. Code §
										27.18 (relating to standards of
				  practice) and other applicable State and Federal statutes, or can not be
				  dispensed for another reason, the provider shall, within 2 working days of the
				  provider's receipt of the mail order, notify the claimant and the prescriber by
				  telephone or mail and return the written prescription to the claimant, except
				  as provided for under §
										22.62(g)(3)
				  (relating to conditions of provider participation).
(b)
Telephone prescription
				  orders
. Refill prescription orders may be accepted by telephone.
				  Providers of prescription services by mail may not accept initial prescription
				  orders for PACE Program benefits by telephone except when all of the following
				  control steps have been taken:
(1) The
				  provider has secured the name, address and telephone number of the licensed
				  prescriber making the telephone order.
(2) The provider has secured the license
				  number assigned by the appropriate State licensing board to the licensed
				  prescriber making the telephone order.
(3) The provider has secured the United
				  States Drug Enforcement Administration registration number of the licensed
				  prescriber making the telephone order unless that prescriber has no
				  registration number.
(4) The
				  provider has verified that the information secured is correct and that the
				  telephone order originated from the licensed prescriber.
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › MISUTILIZATION AND ABUSE OF PROGRAM BENEFITS › Section 22.71 - False or fraudulent claims by applicants and claimants

Current through Register Vol. 54, No. 28, July 13, 2024
Applicants, claimants or other persons submit a false or
					 fraudulent claim subject to administrative action and penalties of §
										22.73 (relating to administrative
					 actions and penalties) if they commit one or more of the following acts:
(1) Make or cause to be made a false
				  statement or representation of a material fact in any application for any
				  benefit.
(2) Attempt to secure for
				  personal use or the use of another individual an unauthorized benefit by
				  concealing or failing to disclose known information which would result in the
				  rejection of an application for initial or continued eligibility for the
				  benefit.
(3) Having made
				  application to receive a benefit for personal use or the use of another and
				  having received it, convert the benefit or a part thereof to a use other than
				  that for which it was intended.
(4)
				  Seek to obtain from providers excessive services or benefits beyond what is
				  reasonably needed, as determined by the Department, for the treatment of a
				  diagnosed condition of the claimant.
(5) Borrow or use a PACE identification card
				  to which the person is not entitled or otherwise gain or attempt to gain
				  benefits under the PACE Program if the person has not been determined eligibile
				  for the program and enrolled in it.
This section cited in 6 Pa. Code §
												22.73 (relating to administrative
						actions and penalties).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › MISUTILIZATION AND ABUSE OF PROGRAM BENEFITS › Section 22.72 - Prohibited acts and criminal penalties

Current through Register Vol. 54, No. 28, July 13, 2024
(a) It is unlawful for a person to submit a
				  false or fraudulent claim or application under the act; to aid or abet another
				  in the submission of a false or fraudulent claim or application; to receive
				  benefits or reimbursement under a private, State or Federal program for
				  prescription assistance and claim or receive duplicative benefits under this
				  chapter; to solicit, receive, offer or pay a kickback, bribe or rebate, in cash
				  or in-kind, from or to a person in connection with the furnishing of services
				  under the act; or to otherwise violate the act. A person who commits a
				  prohibited act shall be charged with a criminal offense under 18 Pa.C.S.
				  (relating to the Crimes Code).
(b)
				  A person who is found guilty of a criminal offense under the act is subject to
				  repay three times the value of any material gain received as a result of the
				  offense.
This section cited in 6 Pa. Code §
												22.24 (relating to income
						provisions).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › MISUTILIZATION AND ABUSE OF PROGRAM BENEFITS › Section 22.73 - Administrative actions and penalties

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A person who is convicted of a violation
				  of §
										22.71 (relating to false or
				  fraudulent claims by applicants and claimants) shall, upon notification by the
				  Department, be terminated from the program.
(b) If the Department determines that a
				  claimant misuses or abuses PACE benefits, the Department is authorized to
				  restrict that claimant to a provider of the Department's choice.
(c) If the Department determines that a
				  claimant has violated §
										22.71, the Department will have the
				  authority to suspend or terminate the claimant's enrollment in the PACE
				  Program.
(d) If the Department
				  determines that a claimant has violated § 22.71, the Department may
				  request the Attorney General to initiate appropriate proceedings against the
				  claimant.
This section cited in 6 Pa. Code §
												22.71 (relating to prohibited acts
						by applicants and claimants).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › MISUTILIZATION AND ABUSE OF PROGRAM BENEFITS › Section 22.74 - Claimant right of appeal

Current through Register Vol. 54, No. 28, July 13, 2024
Departmental actions against an applicant or claimant for
					 misutilization and abuse of program benefits are subject to the right of appeal
					 under §§
										22.91-22.95 (relating to claimant
					 hearings and appeals).
Pennsylvania Code › Title 6 - AGING › Part I - Department of Aging › Chapter 22 - PHARMACEUTICAL ASSISTANCE CONTRACT FOR THE ELDERLY › PROVIDER MISUTILIZATION AND ABUSE › Section 22.81 - Utilization control

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Enrolled
				  providers are required, upon request, to furnish the Department with medical
				  and fiscal records relating to participation in PACE. Providers shall fully
				  cooperate with audits and reviews made by the Department for the purpose of
				  determining the validity of claims and the reasonableness and necessity of
				  benefits provided or for another purpose.
(b) Providers shall furnish to the
				  Department, within 15-calendar days of request, complete information related to
				  PACE-related business transactions.
(c) Under §
										22.84 (relating to administrative
				  actions and penalties), failure of a provider to comply with the Department's
				  request for information referred to in this section may result in the
				  termination of a provider's enrollment in the PACE Program.
(d) Enrolled providers shall respond in a
				  complete manner to inquiries by utilization review committees within 7 business
				  days of a committee's request.