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 § 52.28. Conflict free service coordination.

§ 52.28. Conflict free service coordination.

 (a)  An SCE may not provide other waiver or Act 150 services if the SCE provides service coordination services unless one of the following is applicable:

   (1)  The SCE is providing the service as an OHCDS under §  52.53 (relating to organized health care delivery system).

   (2)  The SCE is providing community transition services to a participant transitioning from a nursing facility or an ICF/ORC.

   (3)  The SCE is providing financial management services to a participant.

 (b)  If an SCE operates as an OHCDS, then the SCE may not require a participant to use that OHCDS as a condition to receive the service coordination services of the SCE.

 (c)  An SCE may not require a participant to choose the SCE as the participant’s community transition service provider as a condition to receive service coordination services.

 (d)  An SCE and a provider of a service other than service coordination may not share any of the following:

   (1)  Chief executive officer or equivalent.

   (2)  Executive board.

   (3)  Bank account.

   (4)  Supervisory staff.

   (5)  Tax identification number.

   (6)  MA provider agreement.

   (7)  Master provider index number.

Source

   The provisions of this §  52.28 effective June 27, 2012, 42 Pa.B. 4545. Immediately preceding text appears at serial pages (361354) to (361355).



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