Pennsylvania Code › Title 55 - HUMAN SERVICES › Part I - Department of Human Services › Subpart D - Hearings and Appeals › Chapter 41 - MEDICAL ASSISTANCE PROVIDER APPEAL PROCEDURES › GENERAL PROVISIONS › Section 41.3 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The following
					 words and terms, when used in this chapter, have the following meanings, unless
					 the context clearly indicates otherwise:
Agency action
-
(i) An adjudicative action of the Department
					 or a program office that relates to the administration of the MA
					 Program.
(ii) The term includes the
					 actions identified in §§
												1101.84(a)-(c)
					 and 1187.141(a)
					 (relating to provider right of appeal; and nursing facility's right to appeal
					 and to a hearing) and other actions relating to a provider's enrollment in,
					 participation in, claims for payment or damages under or penalties imposed
					 under the MA Program.
Bureau
-The Bureau of Hearings and
						Appeals of the Department.
Department
-The Department of Public
						Welfare.
Dispositive motion
-
(i) A motion that seeks a final determination
					 of one or more of the issues in a provider appeal without the need for hearing
					 or further hearing.
(ii) The term
					 includes the following:
(A) A motion to quash
					 the provider appeal.
(B) A motion
					 to dismiss the provider appeal.
(C)
					 A motion for summary judgment.
(D)
					 A motion for partial summary judgment.
(iii) The term does not include a motion in
					 limine.
GRAPP
-The General Rules of
						Administrative Practice and Procedure set forth in 1 Pa. Code Part II (relating
						to General Rules of Administrative Practice and Procedure).
Hearing
-One of the following:
(i) A provider appeal.
(ii) A proceeding before a presiding officer
					 for the purpose of creating a factual evidentiary record relative to the merits
					 of one or more issues raised in a request for hearing.
(iii) A proceeding conducted by a presiding
					 officer for the purpose of resolving an interlocutory matter, including, but
					 not limited to, a petition for supersedeas.
Legal document
-
(i) A motion, answer, brief, petition to
					 intervene, request for reconsideration of an interlocutory order, request for
					 review by the Secretary or other paper filed with the Bureau in a provider
					 appeal, other than a pleading.
(ii)
					 The term does not include attachments or exhibits.
MA
-Medical Assistance.
Pa.R.C.P.
-Pennsylvania Rules of Civil
						Procedure.
Party
-A provider, a program office or an
						intervener.
Person
-An individual, partnership,
						association, corporation, political subdivision, municipal authority or other
						entity.
Petition for relief
-A document filed
						under 1 Pa. Code §
												35.17, §
												35.18 or §
												35.19 (relating to petitions
						generally; petitions for issuance, amendment, waiver or deletion of
						regulations; and petitions for declaratory orders) of the GRAPP.
Pleading
-A request for hearing,
						including amendments thereto.
Presiding officer
-A member of the
						agency, or one or more trial examiners appointed according to law and
						designated, to preside at hearings or conferences, or other officers specially
						provided for and designated under statute to conduct specified classes of
						proceedings, but not including the agency head when sitting as such.
Program office
-
(i) An office within the Department that is
					 managed and operated by an individual who reports directly to the Secretary,
					 including a deputy secretary, or a bureau or other administrative unit of an
					 office within the Department that is managed and operated by an individual who
					 reports directly to a deputy secretary.
(ii) The term does not include the
					 Bureau.
Provider
-One of the following:
(i) A person currently enrolled in the MA
					 Program as a provider of services.
(ii) A person who has applied for enrollment
					 in the MA Program as a provider of services.
(iii) A person whose enrollment in the MA
					 Program as a provider of services has been suspended or terminated by the
					 Department.
Provider appeal
-A proceeding to obtain
						review of an agency action that is commenced by a provider by filing a request
						for hearing.
Request for hearing
-The pleading filed
						by a provider in order to commence a provider appeal.
Secretary
-The Secretary of Public
						Welfare.
Senior Department official
-the
						Comptroller, the Chief Counsel of the Department, a nonclerical individual who
						works in the office of the Secretary or who reports directly to the Secretary,
						including a deputy secretary, or a director of a bureau within a program
						office.
Supersedeas
-An order suspending the
						effect of an agency action pending the Bureau's determination in a provider
						appeal.
Waiver request
-A request that the
						Secretary waive the application of a provision set forth in a Department
						regulation.