reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › ENFORCEMENT › Section 6100.741 - Sanctions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department
					 has the authority to enforce compliance with this chapter through an array of
					 sanctions.
(b) A sanction may be
					 implemented by the Department for the following:
(1) Failure to comply with this
					 chapter.
(2) Failure to submit an
					 acceptable corrective action plan in accordance with the time frame specified
					 by the Department and as specified in §
												6100.42(e) 
					 (relating to monitoring compliance).
(3) Failure to implement a corrective action
					 plan or a directed corrective action plan, including the compliance steps and
					 the timelines in the plan.
(4)
					 Fraud, deceit or falsification of documents or information related to this
					 chapter.
(5) Failure to provide the
					 Department, the designated managing entity and other authorized Federal and
					 State officials, free and full access to the provider's policies and records
					 and the individuals receiving services in accordance with this
					 chapter.
(6) Failure to provide
					 documents or other information in a timely manner upon the request of the
					 Department, the designated managing entity or an authorized Federal or State
					 agency.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › ENFORCEMENT › Section 6100.742 - Array of sanctions

Current through Register Vol. 54, No. 28, July 13, 2024
The Department may implement the following sanctions:
(1) Recouping, suspending or
					 disallowing payment.
(2)
					 Terminating a provider agreement for participation in an HCBS waiver
					 program.
(3) Prohibiting the
					 delivery of services to a new individual.
(4) Prohibiting the provision of specified
					 services at a specified service location.
(5) Prohibiting the enrollment of a new
					 service location.
(6) Ordering the
					 appointment of a master as approved by the Department, at the provider's
					 expense and not eligible for reimbursement from the Department, to manage and
					 direct the provider's operational, program and fiscal functions.
(7) Removing an individual from a service
					 location.
This section cited in 55 Pa. Code §
													6100.81 (relating to HCBS provider
						  requirements); 55 Pa. Code §
													6100.743 (relating to
						  consideration as to type of sanction utilized); and 55 Pa. Code §
													6100.805 (relating to vendor goods
						  and services).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › ENFORCEMENT › Section 6100.743 - Consideration as to type of sanction utilized

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The Department may impose one or more of
					 the sanctions in §
											6100.742 (relating to array of
					 sanctions), based on the Department's review of the facts and circumstances
					 specified in §
											6100.741(b)
					 (relating to sanctions).
(b) The
					 Department has the authority to implement a single sanction or a combination of
					 sanctions.
(c) The Department will
					 consider the following factors when determining and implementing a sanction or
					 combination of sanctions:
(1) The seriousness
					 of the condition specified in § 6100.741(b).
(2) The continued nature of the condition
					 specified in § 6100.741(b).
(3) The repeated nature of the condition
					 specified in § 6100.741(b).
(4) A combination of the conditions specified
					 in § 6100.741(b).
(5) The
					 history of provisional licenses issued by the Department.
(6) The provider's history of compliance with
					 this chapter, Departmental regulations such as licensure regulations and
					 applicable regulations of other State and Federal agencies.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › ENFORCEMENT › Section 6100.744 - Additional conditions and sanctions

Current through Register Vol. 54, No. 28, July 13, 2024
In addition to sanctions and sanction conditions
						specified in this chapter, the provider is subject to the following:
(1) Sections 1101.74 and 1101.77.
(2) Other sanctions as provided by applicable
					 statutes and regulations.
This section cited in 55 Pa. Code §
													6100.81 (relating to HCBS provider
						  requirements); and 55 Pa. Code §
													6100.805 (relating to vendor goods
						  and services).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.801 - Agency with choice

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Agency
					 with choice (AWC) is a type of self-directed financial management service in
					 which the agency is the common law employer and the individual or the
					 individual's representative is the managing employer.
(b) The requirements in this chapter do not
					 apply to an AWC, with the exception of the following provisions:
(1) General provisions as specified in
					 §§
												6100.1-6100.3 (relating to general
					 provisions).
(2) General
					 requirements as specified in §§
												6100.41-6100.44 (relating to general
					 requirements) and 6100.46-6100.56.
(3) Training as specified in §§
												6100.141-6100.143 (relating to training),
					 except for the following that do not apply:
(i) The number of annual training hours in
					 §
													6100.143 (relating to annual
					 training).
(ii) The training course
					 in § 6100.143(c)(5).
(iii) The
					 requirements for training in §§
													6100.141-6100.143 for staff persons who
					 work fewer than 30 days in a 12-month period.
(4) Individual rights as specified in
					 §§ 6100.181-6100.186.
(5)
					 Individual plan as specified in §§ 6100.221-6100.227.
(6) Restrictive procedures as specified in
					 §§ 6100.341-6100.350.
(7)
					 Incident management as specified in §§
					 6100.401-6100.404.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.802 - Support coordination, targeted support management and base-funding support coordination

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Support coordination is an HCBS Federal waiver program under section 1915(c) of
					 the Social Security Act (42
					 U.S.C.A. §
												1396n(c))
					 designed to provide community-based service and support to locate, coordinate
					 and monitor needed HCBS and other support for individuals.
(b) Targeted support management (TSM) is a
					 service under the State plan that is designed to provide community-based
					 support to locate, coordinate and monitor needed service and support for an
					 individual. TSM is not an HCBS.
(c)
					 Base-funding support coordination is a program designed to provide
					 community-based service and support to locate, coordinate and monitor needed
					 support for individuals who receive a service through base-funding.
(d) The following requirements of this
					 chapter do not apply to support coordination, TSM or base-funding support
					 coordination.
(1) Section
					 6100.81(b)(4) 
					 (relating to HCBS provider requirements).
(2) Section
					 6100.227 (relating to progress
					 notes).
(3) Section
					 6100.441 (relating to request for
					 and approval of changes).
(4)
					 Sections 6100.461-6100.469.
(5)
					 Sections 6100.641-6100.672, 6100.681-6100.694 and 6100.711.
(6) Section
					 6100.805 (relating to vendor goods
					 and services).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.803 - Organized health care delivery system

Current through Register Vol. 54, No. 28, July 13, 2024
(a) OHCDS is an organized health care
					 delivery system. An OHCDS is an arrangement in which a provider that renders an
					 HCBS chooses to offer a different vendor of an HCBS through a subcontract to
					 facilitate the delivery of vendor goods or services to an individual.
(b) The following requirements of this
					 chapter do not apply to an OHCDS:
(1)
					 Sections 6100.47-6100.49 (relating to criminal
					 history checks; funding, hiring, retention and utilization; and child abuse
					 history certification) for public transportation and indirect services and
					 supplies.
(2) Training as specified
					 in §§
												6100.141 -6100.143 (relating to
					 training).
(3) Section
					 6100.405 (relating to incident
					 analysis).
(4) Medication
					 administration as specified in §§ 6100.461-6100.469.
(5) Section
					 6100.571 (relating to fee schedule
					 rates).
(6) Sections
					 6100.641-6100.672, 6100.681-6100.694 and 6100.711.
(7) Section
					 6100.805 (relating to vendor goods
					 and services).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.804 - Base-funding

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A base-funding
					 only service is a State-only funded service provided through the county program
					 to either an individual who is not eligible for an HCBS or for a support that
					 is not eligible as an HCBS.
(b) The
					 requirements in this chapter do not apply to base-funding only services, with
					 the exception of the following provisions that do apply.
(1) General provisions as specified in
					 §§
												6100.1-6100.3 (relating to general
					 provisions).
(2) General
					 requirements as specified in §§ 6100.41-6100.56.
(3) Training as specified in §§
												6100.141 -6100.143 (relating to
					 training).
(4) Individual rights as
					 specified in §§ 6100.181-6100.186.
(5) Individual plan as specified in
					 §§ 6100.221-6100.227.
(6)
					 Transition as specified in §§ 6100.301-6100.307.
(7) Restrictive procedures as specified in
					 §§ 6100.341-6100.350.
(8)
					 Incident management as specified in §§ 6100.401-6100.405.
(9) Medication administration as specified in
					 §§ 6100.461-6100.469.
(10) Room and board as specified in
					 §§ 6100.681-6100.694.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.805 - Vendor goods and services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 vendor is a directly-enrolled provider that sells goods or services to the
					 general public, as well as to an HCBS program.
(b) The requirements in this chapter do not
					 apply to vendor goods and services, with the exception of the following
					 provisions that do apply.
(1) General
					 provisions as specified in §§
												6100.1-6100.3 (relating to general
					 provisions).
(2) General
					 requirements as specified in §§
												6100.41-6100.44,
					 6100.46 (relating to protective
					 services), 6100.47-6100.49 (relating to criminal history checks; funding,
					 hiring, retention and utilization; and child abuse history certification) for
					 services other than public transportation and indirect goods and services,
					 6100.51 (relating to complaints) and 6100.53-6100.56.
(3) Enrollment as specified in §§
					 6100.81-6100.85.
(4) Individual
					 rights as specified in §§
												6100.181-6100.186 for respite camps serving
					 25% or more people with disabilities.
(5) Individual plan as specified in
					 §§
												6100.221-6100.226. Respite camps serving
					 fewer than 25% of people with disabilities are exempt from §§
												6100.221 -6100.225 and 6100.227
					 (relating to progress notes).
(6)
					 Restrictive procedures as specified in §§
												6100.341-6100.350 for respite camps serving
					 25% or more people with disabilities.
(7) Incident management as specified in
					 §§
												6100.401-6100.404 (relating to incident
					 management) for respite camps serving 25% or more people with
					 disabilities.
(8) General payment
					 provisions as specified in §§ 6100.481-6100.485.
(9) Enforcement as specified in §§
					 6100.741-6100.744.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6100 - SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR AUTISM › SPECIAL PROGRAMS › Section 6100.806 - Vendor goods and services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A
					 vendor is a directly-enrolled provider that sells goods or services to the
					 general public, as well as to an HCBS program.
(b) The requirements in this chapter do not
					 apply to vendor goods and services, with the exception of the following
					 provisions that do apply.
(1) General
					 provisions as specified in §§ 6100.1 - 6100.3 (relating to general
					 provisions).
(2) General
					 requirements as specified in §§ 6100.41- 6100.44, 6100.46-6100.51 and
					 6100.53-6100.55.
(3) Enrollment as
					 specified in §§ 6100.81 -6100.86 (relating to enrollment).
(4) PSP as specified in § 6100.226
					 (relating to documentation of support delivery).
(5) Training as specified in §§
					 6100.141-6100.144 (relating to training).
(6) Individual rights as specified in
					 §§ 6100.181 - 6100.186 (relating to individual rights) for respite
					 camps serving 25% or more people with disabilities.
(7) PSP as specified in §§
					 6100.221-6100.226 (relating to person-centered support plan) for respite camps
					 serving 25% or more people with disabilities.
(8) Positive interventions as specified in
					 §§ 6100.341 - 6100.345 (relating to positive intervention) for
					 respite camps serving 25% or more people with disabilities.
(9) Incident management as specified in
					 §§ 6100.401 - 6100.405 (relating to incident management) for respite
					 camps serving 25% or more people with disabilities.
(10) Medications administration as specified
					 in §§ 6100.461-6100.470 (relating to medication administration) for
					 respite camps serving 25% or more people with disabilities.
(11) General payment provisions as specified
					 in §§ 6100.481-6100.487 (relating to general payment
					 provisions).
(12) Enforcement as
					 specified in §§ 6100.741 - 6100.744 (relating to
					 enforcement).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6200 - RESERVED › Section 6200.17 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
This section cited in 55 Pa. Code §
												4000.251 (relating to payments for
						room and board charges).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › GENERAL PROVISIONS › Section 6201.1 - Introduction

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The county
					 program is the means by which minimum services, as described in the Mental
					 Health and Intellectual Disability Act of 1966 (50 P.S. §§
												4101-4704), are available to promote the
					 social, personal, physical and economical habilitation or rehabilitation of
					 persons with an intellectual disability with respect for the full human, social
					 and legal rights of each person. This means that the health, social,
					 educational, vocational, environmental and legal resources that serve the
					 general population shall be marshalled and coordinated by the county program to
					 meet the personal development goals of persons with an intellectual disability,
					 in accordance with the principle of integration. Integration means to ensure
					 for every person with an intellectual disability and his family the right to
					 live a life as close as possible to that which is typical for the general
					 population. The mandated services, the provision of service mechanisms and the
					 fiscal support of the program shall be used to secure for each person and his
					 family the conditions and circumstances of day-to-day life that comes as close
					 as possible to representing typical life patterns.
(b) In keeping with this principle of
					 integration, the county program shall serve as an advocate for persons with an
					 intellectual disability and secure for them their full entitlement to existing
					 and future human services available to the general population.
The provisions of this §
													6201.1 amended under sections
						  201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of
						  1966 (50 P.S. §§
														4201(2) and
						  (8) and
						  4202).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › GENERAL PROVISIONS › Section 6201.2 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter establishes county responsibilities and
						content of services for county MH/ID programs.
The provisions of this §
													6201.2 amended under sections
						  201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of
						  1966 (50 P.S. §§
														4201(2) and
						  (8) and
						  4202).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › GENERAL PROVISIONS › Section 6201.3 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter applies to county MH/ID programs.
The provisions of this §
													6201.3 amended under sections
						  201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of
						  1966 (50 P.S. §§
														4201(2) and
						  (8) and
						  4202).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › GENERAL PROVISIONS › Section 6201.4 - Legal base

Current through Register Vol. 54, No. 28, July 13, 2024
The legal authority for this chapter is section 201(2) of
						the Mental Health and Intellectual Disability Act of 1966 (50 P.S. §
												4201(2)).
The provisions of this §
													6201.4 amended under sections
						  201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of
						  1966 (50 P.S. §§
														4201(2) and
						  (8) and
						  4202).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › SERVICE DELIVERY › Section 6201.11 - County program

Current through Register Vol. 54, No. 28, July 13, 2024
The county is responsible for the following objectives:
(1) Primary prevention of organic and
					 functional intellectual disability.
(2) Earliest possible case finding and
					 diagnosis.
(3) Medical and surgical
					 correction or amelioration of systemic defects, when possible.
(4) Shaping and maintaining an environment
					 most productive of basic human personality qualities involving parent-child and
					 sibling relationships, environmental adaptation, self-awareness and learning
					 motivation and ability.
(5)
					 Specific training and learning situations designed and implemented to develop
					 all potential.
(6) Community
					 development and restructuring to achieve the maximum integration for
					 individuals with an intellectual disability.
The provisions of this §
													6201.11 amended under sections
						  201(2) and (8) and 202 of the Mental Health and Intellectual Disability Act of
						  1966 (50 P.S. §§
														4201(2) and
						  (8) and
						  4202).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › SERVICE DELIVERY › Section 6201.13 - Intake services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Intake
					 into the county program shall be through the base service unit.
(b) The condition and circumstances of each
					 individual presumed to require service shall be thoroughly assessed before a
					 disposition is made of his referral.
(1) If
					 it is determined after the assessment that the individual does not currently
					 require further service from the base service unit, the presenting problem, the
					 results of the assessment and the disposition of the case-alternative referral
					 or recommendation-shall be recorded on Form MH/ID 10, Intake and Proposed
					 Service Plan.
(2) If it is
					 determined after assessment that the person requires service, he shall be
					 provided with coordinated services necessary to identify the presence of an
					 intellectual disability, its cause and complications, and the extent to which
					 the intellectual disability limits or is likely limit the individual's daily
					 living and work activities.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6201 - COUNTY INTELLECTUAL DISABILITY SERVICES › SERVICE DELIVERY › Section 6201.14 - Aftercare services

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 Aftercare services shall be available to prevent unnecessary and prolonged
					 institutionalization and to facilitate the return of persons to their homes or
					 communities. These services shall be designed to enable persons with an
					 intellectual disability to achieve their maximum potential for self-care,
					 self-support, self-sufficiency and social competence.
(b) Aftercare services shall include the
					 following:
(1) Evaluation of persons
					 currently in residential placement.
(2) Preparation of individual life-management
					 plans for persons in placement, to include a definition of the special purpose
					 served by the placement as part of the life-management plan of each
					 individual.
(3) Establishment of an
					 individually appropriate and realistic social development goal to be
					 accomplished by each placement.
(4)
					 Regular liaison with the facility to ensure that time spent in residence is
					 limited to the time required to accomplish the established goal, and that
					 service provided by the facility is consistently more suitable than the person
					 might receive in the community.
(5)
					 Prerelease counseling services to resident and family, referral with
					 follow-through to appropriate community resources for post-release services and
					 follow-along responsibility for post-release life management.
(6) Provision of short-term inpatient,
					 emergency, out-patient, partial hospitalization and rehabilitation and training
					 services, as indicated by individual life-management plans.
(7) Nursing home care for older individuals
					 primarily in need of medically supervised nursing services.
(8) Supervised sheltered personal care living
					 arrangements-groups or singly-for those whose primary need is not medical.
(9) Foster home care, individual
					 and group living.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL PROVISIONS › Section 6210.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
The purpose of this chapter is to specify the
						requirements for State operated and non-State operated ICFs/ID to receive
						payment for services through the MA Program.
The provisions of this §
													6210.1 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL PROVISIONS › Section 6210.2 - Applicability

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This chapter
					 applies to State operated and non-State operated ICFs/ID.
(b) This chapter applies to non-State
					 operated ICFs/ORC.
(c) Section
					 6210.63(1)
					 (relating to diagnosis of an intellectual disability) does not apply to
					 ICFs/ORC.
(d) If a provision
					 specified in Chapter 1101 (relating to general provisions) is inconsistent with
					 this chapter, this chapter prevails.
(e) If a provision specified in this chapter
					 is inconsistent with Chapter 6211 (relating to allowable cost reimbursement for
					 non-State operated intermediate care facilities for individuals with an
					 intellectual disability), Chapter 6211 prevails.
The provisions of this §
													6210.2 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL PROVISIONS › Section 6210.3 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
						have the following meanings, unless the context clearly indicates
						otherwise:
CAO
-County Assistance Office.
Department
-The Department of Public
						Welfare of the Commonwealth.
HIM-15
-The Medicare Provider
						Reimbursement Manual, Health Insurance Manual-15.
ICF/ID-Intermediate care facility for individuals
						with an intellectual disability (facility)-
A State operated or
						non-State operated facility, licensed by the Department in accordance with
						Chapter 6600 (relating to intermediate care facilities for individuals with an
						intellectual disability), to provide a level of care specially designed to meet
						the needs of persons who have an intellectual disability, or persons with
						related conditions, who require specialized health and rehabilitative services;
						that is, active treatment.
ICF/MR-Intermediate care facility for the
						mentally retarded (facility)
-A State operated or nonState operated
						facility, licensed by the Department in accordance with Chapter 6600 (relating
						to intermediate care facilities for the mentally retarded), to provide a level
						of care specially designed to meet the needs of persons who are mentally
						retarded, or persons with related conditions, who require specialized health
						and rehabilitative services; that is, active treatment.
ICF/ORC-Intermediate care facility for persons
						with other related conditions (facility)
-A nonState operated facility,
						licensed by the Department in accordance with Chapter 6600, to provide a level
						of care specially designed to meet the needs of persons with other related
						conditions who require specialized health and rehabilitative services; that is,
						active treatment. Persons with other related conditions are persons with severe
						physical disabilities, such as cerebral palsy, spina bifida, epilepsy or other
						similar conditions which are diagnosed prior to age 22 and result in at least
						three substantial limitations to activities of daily living.
Interim per diem rate
-The rate
						established by the Department for the purpose of making interim payments to the
						facility pending a year-end cost settlement.
MA
-Medical Assistance.
Reserve bed day
-A day counted in the
						facility census, subject to limits, during which a recipient is temporarily
						absent from the facility for more than a continuous 24-hour period either for
						hospitalization or therapeutic leave.
The provisions of this §
													6210.3 amended under sections
						  443.1(2) and (3) of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL REQUIREMENTS › Section 6210.11 - Payment

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The MA Program
					 provides payment for intermediate care for an individual with an intellectual
					 disability provided to eligible recipients by providers enrolled in the MA
					 Program.
(b) Payment for services
					 is made in accordance with this chapter, Chapter 1101 (relating to general
					 provisions), HIM-15, the Medicaid State Plan, Chapter 6211 (relating to
					 allowable cost reimbursement for non-State operated intermediate care
					 facilities for individuals with an intellectual disability) and the
					 Department's "Cost Apportionment Manual for State Mental Hospitals and
					 Intellectual Disability Centers" for State operated ICFs/ID.
The provisions of this §
													6210.11 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL REQUIREMENTS › Section 6210.12 - Applicable statutes and regulations

Current through Register Vol. 54, No. 28, July 13, 2024
The facility shall comply with applicable Federal, State
						and local statutes and regulations, including Title XIX of the Social Security
						Act (42 U.S.C.A.
						§§
												1396-1396u) and the
						regulations promulgated thereunder, and sections 443.1-443.6 of the Public
						Welfare Code (62 P.S. §§
												443.1-443.6).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL REQUIREMENTS › Section 6210.13 - Licensure

Current through Register Vol. 54, No. 28, July 13, 2024
ICFs/ID shall be licensed by the Department in accordance
						with Chapter 6600 (relating to intermediate care facilities for individuals
						with an intellectual disability).
The provisions of this §
													6210.13 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › GENERAL REQUIREMENTS › Section 6210.14 - Time extensions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
					 time limits specified in this chapter for the filing of an application, cost
					 report, waiver request or appeal cannot be extended, except as provided in this
					 section.
(b) Extensions of time in
					 addition to the time otherwise specified for providers in this chapter with
					 respect to the filing of an application, cost report, waiver request or appeal
					 may be permitted only if required because of a breakdown in Department
					 procedures justifying relief or because of an intervening natural disaster
					 making timely compliance impossible or unsafe.
(c) This section supersedes 1 Pa. Code §
											31.15 (relating to extensions of
					 time).
This section cited in 55 Pa. Code §
													41.33 (relating to appeals nunc
						  pro tunc).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › SCOPE OF BENEFITS › Section 6210.21 - Categorically needy and medically needy recipients

Current through Register Vol. 54, No. 28, July 13, 2024
Categorically needy and medically needy recipients are
						eligible for ICF/ID subject to the conditions specified in this chapter and
						Chapters 1101 and 6211 (relating to general provisions; and allowable cost
						reimbursement for non-State operated intermediate care facilities for
						individuals with an intellectual disability).
The provisions of this §
													6210.21 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › SCOPE OF BENEFITS › Section 6210.22 - State Blind Pension recipients

Current through Register Vol. 54, No. 28, July 13, 2024
State Blind Pension recipients are not eligible for
						ICF/ID under the MA Program. Blind and visually impaired individuals are
						eligible for ICF/ID services if they qualify as categorically or medically
						needy recipients.
The provisions of this §
													6210.22 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PROVIDER PARTICIPATION › Section 6210.31 - Provider agreement

Current through Register Vol. 54, No. 28, July 13, 2024
The facility shall enter into a written provider
						agreement with the Department's Office of Medical Assistance
						Programs.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PROVIDER PARTICIPATION › Section 6210.32 - Budgets and cost reports for State operated facilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a) State operated ICFs/ID shall submit
					 budgets to the Department's Office of Developmental Programs.
(b) State operated ICFs/ID shall submit cost
					 reports to the Department's Bureau of Financial Operations.
The provisions of this §
													6210.32 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PROVIDER PARTICIPATION › Section 6210.33 - Budgets and cost reports for non-State operated facilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Non-State
					 operated ICFs/ID shall submit cost reports or a budget, if a waiver is granted
					 in accordance with Chapter 6211 (relating to allowable cost reimbursement for
					 non-State operated intermediate care facilities for individuals with an
					 intellectual disability), to the Department's Office of Developmental
					 Programs.
(b) Cost reports and
					 budgets shall be submitted on forms and by deadlines specified by the
					 Department.
The provisions of this §
													6210.33 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PROVIDER PARTICIPATION › Section 6210.34 - Approved funding level

Current through Register Vol. 54, No. 28, July 13, 2024
The Department's Office of Developmental Programs is
						responsible for establishing an approved funding level for non-State operated
						ICFs/ID.
The provisions of this §
													6210.34 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PROVIDER PARTICIPATION › Section 6210.35 - Ongoing provider responsibilities

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A utilization review plan shall be
					 submitted to the Department's Office of Medical Assistance Programs.
(b) A system for managing recipients' funds
					 that is in compliance with 42 CFR 483.420 (relating to
					 conditions of participation: client protections) shall be in operation. If a
					 recipient dies and there is no will, and if no relative or friend takes
					 responsibility for burial, the following requirements apply:
(1) The facility may make payment of funds
					 for burial expenses, if funds remain in the decedent's personal care
					 account.
(2) Payment may be made
					 only to a person licensed as a funeral director by the Department of State for
					 a debt due and owing and may not exceed $1,000.
(3) The payment may be made whether or not a
					 personal representative has been appointed.
(4) Under
					 20 Pa.C.S. §
													3101
					 (relating to payments to family and funeral directors), a facility making the
					 payment is released from responsibility to the same extent as if payment had
					 been made to an appointed personal representative of the decedent. The facility
					 is not required to oversee the manner in which the funeral director applies the
					 payment.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.41 - Payment available from other sources

Current through Register Vol. 54, No. 28, July 13, 2024
Payment will not be made by the Department if full
						payment, at the MA interim per diem rate, is available from another public
						agency, another insurance or health program, or the recipient's
						resources.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.42 - Certification of initial need for care

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A physician shall certify in writing in
					 the medical record that the applicant or recipient needs intermediate care for
					 individuals with an intellectual disability.
(b) A nurse practitioner or clinical nurse
					 specialist, who is not an employee of the facility, but who is working in
					 collaboration with a physician, may complete the certification specified in
					 subsection (a).
(c) The
					 certification specified in subsections (a) and (b) shall be signed and dated
					 not more than 30 days prior to either the admission of an applicant or
					 recipient to a facility, or, if an individual applies for assistance while in a
					 facility before the Department authorizes payment for intermediate care for
					 individuals with an intellectual disability.
The provisions of this §
													6210.42 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
This section cited in 55 Pa. Code §
													6210.114 (relating to failure to
						  adhere to certification requirements); and 55 Pa. Code §
													6210.115 (relating to failure to
						  adhere to medical evaluation
						  requirements).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.43 - Recertification of continued need for care

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A physician, a physician's assistant
					 under the supervision of a physician or a nurse practitioner, or clinical nurse
					 specialist shall enter into the recipient's medical record a signed and dated
					 statement that the recipient continued to need intermediate care for
					 individuals with an intellectual disability.
(b) In a non-State operated ICF/ID, the
					 person who certifies the need for continued care specified in subsection (a),
					 may not be an employee of the facility but shall work in collaboration with the
					 recipient's physician.
(c) The
					 recertification specified in subsection (a) shall be completed at least once
					 every 365 days after initial certification.
The provisions of this §
													6210.43 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
This section cited in 55 Pa. Code §
													6210.114 (relating to failure to
						  adhere to certification
						  requirements).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.44 - Evaluations

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Before
					 admission to a facility, or before authorization for payment, an
					 interdisciplinary team of health professionals shall make a comprehensive
					 medical, social and psychological evaluation of each applicant's or recipient's
					 need for intermediate care for individuals with an intellectual disability. The
					 psychological evaluation shall be completed within 3 months prior to
					 admission.
(b) If a recipient moves
					 from one facility to another facility, this is not considered a new admission
					 and new evaluations as required in subsection (a) are not required, if the
					 prior evaluations are transferred with the recipient.
(c) Medical, social and psychological
					 evaluations shall be recorded in the recipient's medical record and if
					 applicable on forms specified by the Department.
The provisions of this §
													6210.44 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.45 - Payment authorization

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
					 The Department will send a written notice of the authorization or denial of
					 payment to the recipient and the facility.
(b) The notice from the Department will
					 indicate the effective date of coverage and the amount of money the recipient
					 has available to contribute toward the interim per diem rate.
(c) Obtaining the recipient's share of the
					 interim per diem rate is the responsibility of the facility.
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.46 - Plan of care

Current through Register Vol. 54, No. 28, July 13, 2024
Before admission to an ICF/ID, or before authorization
						for payment, the attending physician shall establish a written plan of care for
						each applicant or recipient. The plan of care shall indicate time-limited and
						measurable care objectives and goals to be accomplished and who is to give each
						element of care.
The provisions of this §
													6210.46 amended under section
						  443.1(2) and (3)
						  of the Human Services Code (62 P.S. §
														443.1(2) and
						  (3)).
Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VIII - Intellectual Disability and Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 6210 - PARTICIPATION REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE INTELLECTUAL DISABILITY PROGRAM › PAYMENT CONDITIONS › Section 6210.47 - Continued review of plan of care

Current through Register Vol. 54, No. 28, July 13, 2024
The interdisciplinary team shall review each plan of care
						at least every 90 days and document the date of the review in the record of the
						recipient.