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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 § 6100.3. Definitions.

§ 6100.3. Definitions.

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

   Allowable cost—Expenses considered reasonable, necessary and related to the service provided.

   Applicant—An entity that is in the process of enrolling in the Medical Assistance program as a provider of HCBS.

   Base-funding—Reimbursement provided exclusively by a grant to a county under the Mental Health and Intellectual Disability Act of 1966 (50 P.S. § §  4101—4704) or Article XIV-B of the Human Services Code (62 P.S. § §  1401-B—1410-B).

   Corrective action plan—A document that specifies the following:

     (i)   Action steps to be taken to achieve and sustain regulatory compliance.

     (ii)   The time frame by which corrections will be made.

     (iii)   The person responsible for taking the action step.

     (iv)   The person responsible for monitoring compliance with the corrective action plan.

   Cost report—A data collection tool issued by the Department to collect expense and utilization information from a provider that may include supplemental schedules or addenda as requested by the Department.

   Department—The Department of Human Services of the Commonwealth.

   Designated managing entity—An entity that enters into an agreement with the Department to perform administrative functions delegated by the Department, as the Department’s designee. For base-funding, this includes the county mental health and intellectual disability program.

   Fixed asset—A major item, excluding real estate, which is expected to have a useful life of more than 1 year or that can be used repeatedly without materially changing or impairing its physical condition through normal repairs, maintenance or replacement of components.

   HCBS—Home and community-based service—An activity, assistance or product provided to an individual that is funded through a Federally-approved waiver program or the State plan.

   Health care practitioner—A person who is authorized to prescribe medications under a license, registration or certification by the Department of State.

   Individual—A woman, man or child who receives a home and community-based service or base-funding service.

   Individual plan—A coordinated and integrated description of person-centered activities, including services and supports for an individual.

   Life sharer—An employee or a contracted person who shares a common home and daily life experience with an individual, providing service and support as needed in both the home and the community.

   Provider—The person, entity or agency that is contracted or authorized to deliver the service to the individual.

   Restraint—A physical, chemical or mechanical intervention used to control acute, episodic behavior that restricts the movement or function of the individual or a portion of the individual’s body, including an intervention approved as part of the individual plan or used on an emergency basis.

   SSI—Supplemental security income.

   State plan—The Commonwealth’s approved Title XIX State Plan.

   Service—An activity, assistance or product provided to an individual and paid through a Federally-approved waiver program, the State plan or base-funding. A service includes an HCBS, support coordination, TSM, agency with choice, organized health care delivery system, and vendor goods and services, unless specifically exempted in this chapter.

   Support—An unpaid activity or assistance provided to an individual that is not planned or arranged by a provider.

   TSM—Targeted support management.

   Vacancy factor—An adjustment to the full capacity rate to account for days when the residential service provider cannot bill due to an individual not receiving services.

   Volunteer—A person who is an organized and scheduled component of the service system and who does not receive compensation, but who provides a service through the provider that recruits, plans and organizes duties and assignments.

Cross References

   This section cited in 55 Pa. Code §  6100.43 (relating to regulatory waiver); 55 Pa. Code §  6100.801 (relating to agency with choice); 55 Pa. Code §  6100.804 (relating to base-funding); and 55 Pa. Code §  6100.805 (relating to vendor goods and services).

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