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COMMONWEALTH OF PENNSYLVANIA

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Pennsylvania Code



Subchapter A. GENERAL PROVISIONS


Sec.


1189.1.    Policy.
1189.2.    Definitions.
1189.3.    Compliance with regulations governing noncounty nursing facilities.

§ 1189.1. Policy.

 (a)  This chapter applies to county nursing facilities.

 (b)  This chapter sets forth conditions of participation for county nursing facilities, identifies the costs incurred by county nursing facilities to provide nursing facility services that will be recognized as allowable MA Program expenditures and specifies the methodology by which rates will be set and payments made to county nursing facilities for services provided to MA residents.

 (c)  Payment for nursing facility services provided by county nursing facilities is made subject to this chapter and Chapter 1101 (relating to general provisions).

 (d)  Extensions of time will be as follows:

   (1)  The time limits established by this chapter for the filing of a cost report, resident assessment data and picture date reporting, or other document or submission to the Department cannot be extended, except as provided in this section.

   (2)  Extensions of time in addition to the time otherwise prescribed by this chapter may be permitted only upon a showing of fraud, breakdown in the Department’s administrative process or an intervening natural disaster making timely compliance impossible or unsafe.

   (3)  This subsection supersedes 1 Pa. Code §  31.15 (relating to extensions of time).

Cross References

   This section cited in 55 Pa. Code §  1189.71 (relating to cost reporting).

§ 1189.2. Definitions.

 (a)  Except for those terms defined in subsection (b), the defined words and terms set forth in §  1187.2 (relating to definitions), have the same meanings when used in this chapter, unless the context clearly indicates otherwise.

 (b)  The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

   Allowable MA Program Expenditure—A cost incurred by a county nursing facility to provide nursing facility services to MA residents that is allowable under this chapter and that is reported and certified by the county nursing facility in a form and manner specified by the Department.

   MA Cost Report—The package of certifications, schedules and instructions designated by the Department which county nursing facilities shall use to record and report the costs that they incur to provide nursing facility services during a calendar year.

   New county nursing facility

     (i)   One of the following:

       (A)   A newly constructed, licensed and certified county nursing facility.

       (B)   An existing nursing facility that through a change of ownership, is controlled by the county institution district or by county government if no county institution district exists.

     (ii)   For the purposes of this definition, ‘‘controlled’’ in clause (B) means the power to direct or cause to direct the management and policies of the nursing facility, whether through equitable ownership of voting securities or otherwise.

   Per diem rate—The amount established under this chapter at which the Department makes payment to a county nursing facility for a resident day of care provided to an MA resident.

Authority

   The provisions of this §  1189.2 amended under sections 201(2), 206(2), 403(b) and 443.1 of the Public Welfare Code (62 P. S. § §  201(2), 206(2), 403(b) and 443.1).

Source

   The provisions of this §  1189.2 amended July 18, 2014, effective July 19, 2014, 44 Pa.B. 4498. Immediately preceding text appears at serial page (361700).

§ 1189.3. Compliance with regulations governing noncounty nursing facilities.

 (a)  Unless a specific provision of this chapter provides to the contrary, the following subchapters of Chapter 1187 (relating to nursing facility services) are applicable to county nursing facilities:

   (1)  Subchapter B (relating to scope of benefits).

   (2)  Subchapter C (relating to nursing facility participation).

   (3)  Subchapter D (relating to data requirements for nursing facility applicants and residents), except for §  1187.33(b) (relating to resident data and picture data reporting requirements).

   (4)  Subchapter I (relating to enforcement of compliance for nursing facilities with deficiencies).

   (5)  Subchapter K (relating to exceptional payment for nursing facility services).

   (6)  Subchapter L (relating to nursing facility participation requirements and review process).

 (b)  If a provision of Chapter 1187 is made applicable to county nursing facilities by subsection (a) or other provision of this chapter, and the provision of Chapter 1187 uses the term ‘‘nursing facility,’’ that term shall be understood to mean ‘‘county nursing facility,’’ unless the context clearly indicates otherwise.

Source

   The provisions of this §  1189.3 amended June 29, 2012, effective June 30, 2012, 42 Pa.B. 3733. Immediately preceding text appears at serial pages (353364) and (32079).



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