§ 1101.43. Enrollment and ownership reporting requirements.
(a) Request for approval. Written requests to participate in the MA Program should be sent to the Department’s Office of MA, Bureau of Hospital and Outpatient Programs. The Bureau of Hospital and Outpatient Programs will forward an enrollment form and provider agreement to the applicant to be completed and returned to the Department.
(b) Ownership reporting requirements.
(1) Medical facilities. A medical facility shall disclose to the Department, upon execution of a provider agreement or renewal thereof, the name and social security number of a person who has a direct or indirect ownership or control interest of 5% or more in the facility. Disclosure shall include the identity of a person who has been convicted of a criminal offense under section 1407 of the Public Welfare Code (62 P. S. § 1407) and the specific nature of the offense. A change in ownership or control interest of 5% or more shall be reported to the Department within 30 days of the date the change occurs. Failure to submit a complete and accurate report constitutes a deceptive practice under section 1407(a)(1) of the Public Welfare Code (62 P. S. § 1407(a)(1)) and justifies a termination of the provider agreement by the Department.
(2) Additional reporting requirements for nursing facilities. In addition to the reporting requirements specified in paragraph (1), nursing facilities shall meet the requirements of this paragraph.
(i) If a provider enters into an agreement of sale that will result in a change of ownership of its nursing facility, the provider shall notify the Department of the sale no less than 30 days prior to the effective date of the sale.
(ii) The provider shall include in the notice of the agreement of sale the effective date of the sale and a copy of the sales agreement. The notice shall be sent to the Office of MA, Bureau of Provider Relations. The notice requirement shall be deemed met on the date it is received by the Department, not the date of mailing.
(iii) If a provider fails to notify the Department as specified in subparagraphs (i) and (ii), the provider forfeits all reimbursement for nursing care services for each day that the notice is overdue.
(3) The effect of change in ownership of a nursing facility. When there is a change in ownership of a nursing facility, the Department will enter into a provider agreement with the buyer or transfer the current provider agreement to the buyer subject to the terms and conditions under which it was originally issued, if:
(i) Applicable State and Federal statutes and regulations are met.
(ii) The buyer has applied to the Division of Provider Enrollment, Bureau of Provider Relations, Office of MA, Department of Human Services, and has been determined to be eligible to participate in the MA Program.
(iii) The seller has repaid to the Department monies owed by the seller to the Department as determined by the Comptroller, Department of Human Services.
(4) Additional reporting requirements for a shared health facility. In addition to the reporting requirements specified in paragraph (1), a shared health facility shall meet the requirements of section 1403 of the Public Welfare Code (62 P. S. § 1403) and Chapter 1102 (relating to shared health facilities).
(5) Providers. Providers shall meet the reporting requirements specified in § 1101.71(b) (relating to utilization control).
(c) Notification by the Department. The Department will notify applicants in writing either that they have been approved or disapproved to participate in the program. A provider who has been approved is eligible to be reimbursed only for those services furnished on or after the effective date on the provider agreement and only for services the provider is eligible to render subject to limitations in this chapter and the applicable provider regulations. An applicant may appeal under 2 Pa.C.S. § § 501—508 and 701—704 (relating to Administrative Agency Law), if the Department denies enrollment in the program.
Source The provisions of this § 1101.43 amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3653. Immediately preceding text appears at serial pages (75055) and (75056).
Cross References This section cited in 55 Pa. Code § 1121.41 (relating to participation requirements); 55 Pa. Code § 1123.41 (relating to participation requirements); 55 Pa. Code § 1127.41 (relating to participation requirements); 55 Pa. Code § 1128.41 (relating to participation requirements); 55 Pa. Code § 1130.51 (relating to provider enrollment requirements); 55 Pa. Code § 1130.52 (relating to ongoing responsibilities of hospice providers); 55 Pa. Code § 1141.41 (relating to participation requirements); 55 Pa. Code § 1142.41 (relating to participation requirements); 55 Pa. Code § 1143.41 (relating to participation requirements); 55 Pa. Code § 1144.41 (relating to participation requirements); 55 Pa. Code § 1149.41 (relating to participation requirements); 55 Pa. Code § 1187.22 (relating to ongoing responsibilities of nursing facilities); and 55 Pa. Code § 1251.41 (relating to participation requirements).
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