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 § 52.11. Prerequisites for participation.

§ 52.11. Prerequisites for participation.

 (a)  As a condition of participation in a waiver or Act 150 program, an applicant shall meet the following qualifications:

   (1)  Complete and submit an MA application including a waiver addendum to that application.

   (2)  Complete and submit a signed MA provider agreement including the waiver addendum to that agreement.

   (3)  Verify fiscal solvency by submitting a copy of the following:

     (i)   Applicant’s most recent corporate or nonprofit tax return. If an applicant does not have a corporate or nonprofit tax return, then the applicant shall submit the most recent individual tax return for the owner of the entity which is applying for enrollment.

     (ii)   Applicant’s most recent monthly balance sheet. If an applicant does not have a balance sheet, then an applicant shall submit a copy of the business plan indicating assets, liabilities, and anticipated costs and revenues for the next fiscal year.

     (iii)   Articles of incorporation, if the applicant is incorporated.

     (iv)   Partnership agreement, if the applicant is a partnership.

     (v)   Most recent audit or financial review if the applicant has completed an audit or financial review within the previous 5 years.

   (4)  Area Agencies on Aging that are units of county government are not required to submit documentation under paragraph (3).

   (5)  Create and follow policies and procedures relating to the following:

     (i)   Compliance with this chapter.

     (ii)   Provision of services in a nondiscriminatory manner.

     (iii)   Compliance with the Americans with Disabilities Act of 1990 (42 U.S.C.A. § §  12101—12213).

     (iv)   Compliance with the Healthcare Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191).

     (v)   Staff member training. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.

     (vi)   Participant complaint management process.

     (vii)   Critical incident management. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.

     (viii)   Quality management. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.

     (ix)   Staff member screening for criminal history.

     (x)   Employee Social Security Number verification.

     (xi)   Initial and continued screening for staff members and contractors to determine if they have been excluded from participation in Federal health care programs by reviewing the LEIE, EPLS and Medicheck.

     (xii)   Process for participants with limited English proficiency to access language services.

   (6)  Obtain and maintain appropriate licenses and certifications from other State or Federal agencies as required.

   (7)  Obtain the following insurances:

     (i)   Commercial general liability insurance.

     (ii)   Worker’s compensation insurance.

     (iii)   Professional liability insurance if required by a profession.

   (8)  Comply with the applicable approved waiver, including approved waiver amendments as posted on the Department’s publicly accessible web site.

 (b)  An applicant shall submit verification of compliance with subsection (a) to the Department.

 (c)  Application materials shall be submitted to the Department in a form and manner as prescribed by the Department.

 (d)  An applicant may apply to become a provider of more than one service as long as the provision of multiple services is not prohibited by this chapter or Federal or State requirement.

Cross References

   This section cited in 55 Pa. Code §  52.13 (relating to review of application); and 55 Pa. Code §  52.14 (relating to ongoing responsibilities of providers).



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