§ 6100.642. Assignment of rate.
(a) The provider will be assigned a cost-based rate for an existing HCBS at the location where the HCBS is delivered, with an approved cost report and audit, as necessary.
(b) If the provider seeks to provide a new HCBS, the provider will be assigned the area adjusted average rate of approved provider cost-based rates.
(c) A new provider with no historical experience will be assigned the area adjusted average rate of approved provider cost-based rates.
(d) If the provider fails to comply with the cost reporting requirements specified in this chapter after consultation with the Department, the provider will be assigned the lowest rate calculated Statewide based on all provider cost-based rates for an HCBS.
(e) Compliance with cost reporting requirements will be verified by the Department through a designated managing entity review or an audit, as necessary.
This section cited in 55 Pa. Code § 6100.641 (relating to cost-based rate); 55 Pa. Code § 6100.802 (relating to support coordination, targeted support management and base-funding support coordination); and 55 Pa. Code § 6100.803 (relating to organized health care delivery system).
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