Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart E - Home and Community-based Services › Chapter 52 - LONG-TERM LIVING HOME AND COMMUNITY-BASED SERVICES › Subchapter B - PROVIDER QUALIFICATIONS AND PARTICIPATION › Section 52.11 - Prerequisites for participation

Current through Register Vol. 54, No. 28, July 13, 2024
(a) As a condition of participation in a
					 waiver or Act 150 program, an applicant shall meet the following
					 qualifications:
(1) Complete and submit an MA
					 application including a waiver addendum to that application.
(2) Complete and submit a signed MA provider
					 agreement including the waiver addendum to that agreement.
(3) Verify fiscal solvency by submitting a
					 copy of the following:
(i) Applicant's most
					 recent corporate or nonprofit tax return. If an applicant does not have a
					 corporate or nonprofit tax return, then the applicant shall submit the most
					 recent individual tax return for the owner of the entity which is applying for
					 enrollment.
(ii) Applicant's most
					 recent monthly balance sheet. If an applicant does not have a balance sheet,
					 then an applicant shall submit a copy of the business plan indicating assets,
					 liabilities, and anticipated costs and revenues for the next fiscal
					 year.
(iii) Articles of
					 incorporation, if the applicant is incorporated.
(iv) Partnership agreement, if the applicant
					 is a partnership.
(v) Most recent
					 audit or financial review if the applicant has completed an audit or financial
					 review within the previous 5 years.
(4) Area Agencies on Aging that are units of
					 county government are not required to submit documentation under paragraph
					 (3).
(5) Create and follow policies
					 and procedures relating to the following:
(i)
					 Compliance with this chapter.
(ii)
					 Provision of services in a nondiscriminatory manner.
(iii) Compliance with the Americans with
					 Disabilities Act of 1990 (42
					 U.S.C.A. §§
														12101-12213).
(iv) Compliance with the Healthcare Insurance
					 Portability and Accountability Act of 1996 (Pub. L. 104-191).
(v) Staff member training. The policy must be
					 in accordance with this chapter and licensing requirements that the applicant
					 is required to meet.
(vi)
					 Participant complaint management process.
(vii) Critical incident management. The
					 policy must be in accordance with this chapter and licensing requirements that
					 the applicant is required to meet.
(viii) Quality management. The policy must be
					 in accordance with this chapter and licensing requirements that the applicant
					 is required to meet.
(ix) Staff
					 member screening for criminal history.
(x) Employee Social Security Number
					 verification.
(xi) Initial and
					 continued screening for staff members and contractors to determine if they have
					 been excluded from participation in Federal health care programs by reviewing
					 the LEIE, EPLS and Medicheck.
(xii)
					 Process for participants with limited English proficiency to access language
					 services.
(6) Obtain and
					 maintain appropriate licenses and certifications from other State or Federal
					 agencies as required.
(7) Obtain
					 the following insurances:
(i) Commercial
					 general liability insurance.
(ii)
					 Worker's compensation insurance.
(iii) Professional liability insurance if
					 required by a profession.
(8) Comply with the applicable approved
					 waiver, including approved waiver amendments as posted on the Department's
					 publicly accessible web site.