Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 7346 (November 25, 2023).

55 Pa. Code § 1130.52. Ongoing responsibilities of hospice providers.

§ 1130.52. Ongoing responsibilities of hospice providers.

 (a)  To retain the right to participate in the MA Program, a provider of hospice services shall:

   (1)  Be Medicare certified and continue to meet the Medicare conditions for participation as a hospice as set forth at 42 CFR Part 418, Subpart C (relating to conditions of participation).

   (2)  Fulfill the applicable requirements of § §  1101.42, 1101.43(b)(1) and (5) and 1101.51 (relating to prerequisites for participation; enrollment and ownership reporting requirements; and ongoing responsibilities of providers).

   (3)  Fully inform each recipient or representative, in writing prior to admission to the hospice, regarding the following:

     (i)   Conditions the hospice imposes.

     (ii)   What services the hospice provides.

     (iii)   The names of other facilities such as hospitals and nursing facilities with which the hospice has agreements for general inpatient or respite care.

     (iv)   The recipient’s rights under the MA Program with respect to changing the designated hospice, revoking hospice care and receiving care from a physician of the patient’s choice.

     (v)   The fact that the recipient may be notified by the CAO that he is required to pay a specific amount towards hospice care, with respect to a recipient residing in a nursing facility.

   (4)  Ensure that enrollment of MA recipients in a hospice is without regard to age, race, creed, sex, physical or mental handicap, national origin, marital status or sexual preference.

   (5)  Not contract or otherwise arrange for hospice service to be provided either directly or indirectly to a MA recipient by a provider who has been suspended or terminated from participation in the MA Program.

 (b)  The hospice organization elected by the recipient is considered by the Department to be the responsible provider of hospice services and will be held ultimately responsible for the quality of services rendered.

 (c)  The hospice is responsible for notifying, in writing, the CAO, within 7 calendar days, when a MA recipient elects hospice care, revokes hospice care, changes to a different hospice or dies.



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