Pennsylvania Code & Bulletin

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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 § 52.14. Ongoing responsibilities of providers.

§ 52.14. Ongoing responsibilities of providers.

 (a)  An applicant is not a provider until the following are met:

   (1)  The Department approves the applicant’s MA application.

   (2)  An MA provider agreement including a waiver addendum is signed.

 (b)  Within 180 days from the date of enrollment, a provider shall attend new provider training provided by the Department.

 (c)  A provider shall implement the policies under §  52.11(a)(5) (relating to prerequisites for participation).

 (d)  In addition to meeting the participation requirements under Chapter 1101 (relating to general provisions), a provider shall update and submit to the Department the provider qualifications under §  52.11(a)(3)—(7) at least every 2 years.

 (e)  In addition to meeting the requirements in §  1101.68 (relating to invoicing for services), the provider shall meet the requirements in the MA HCBS Provider Handbook, available on the Department’s web site.

 (f)  A provider shall maintain appropriate licenses and certifications as required by State and Federal requirements. The provider shall submit a copy of a valid license or certification, or both, to the Department at the beginning of each applicable licensure period.

 (g)  The provider shall ensure the following prior to rendering services to a participant:

   (1)  The service plan is approved by the Department.

   (2)  The type, scope, amount, duration and frequency of the service to be rendered are listed in the service plan that the provider is assigned to implement.

 (h)  A provider shall ensure a participant is eligible to receive a service prior to rendering the service to the participant.

 (i)  A provider shall comply with the applicable approved waiver, including approved waiver amendments.

 (j)  The provider shall notify the Department at least 30 business days prior to any of the following occurrences:

   (1)  Changes in the provider’s address, telephone number, fax number, e-mail address, provider name change or provider’s designated contact person.

   (2)  Creation, changes or revocation of the provider’s articles of incorporation or partnership agreements.

   (3)  Revisions to an audit previously submitted to the Department under §  52.11(a).

   (4)  Revocation or provisional status of a license or certification.

   (5)  Cancellation of the following insurances:

     (i)   Commercial general liability insurance.

     (ii)   Workers’ compensation insurance.

     (iii)   Professional liability insurance if the profession authorized to provide a service requires professional liability insurance.

 (k)  If the provider is unable to notify the Department due to an emergency prior to a change occurring as stated under subsection (j), the provider shall notify the Department within 2 business days of the change.

 (l)  A provider shall ensure that each employee possesses a valid Social Security Number.

 (m)  A provider may not render a service when the participant is unavailable to receive the service.

 (n)  A provider may not bill for a service when the participant is unavailable to receive the service.

 (o)  A provider which is not an SCE shall cooperate with the participant, the SCE and the Department to resolve delays in service provision.

 (p)  A provider shall complete and comply with a CAP as required by the Department or other Federal or State agency.

 (q)  A provider shall implement and provide services to the participant in the type, scope, amount, duration and frequency as specified in the service plan.

 (r)  A provider shall document the participant’s progress towards outcomes and goals in the Department’s designated information system.

 (s)  The provider shall comply with the terms of the MA provider agreement, including waiver addendum.

 (t)  A provider shall participate in Department-mandated trainings.

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