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 § 6210.107. Recipient right of appeal of alternate care determinations.

§ 6210.107. Recipient right of appeal of alternate care determinations.

 (a)  The recipient or the person or the facility acting on the behalf of the recipient, in accordance with Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings), has 30 days in which to appeal the Inspection of Care Team’s alternate care determination.

 (b)  Neither the facility, the facility’s utilization review committee, nor the recipient’s attending physician has the right to appeal the alternate care determination on its own behalf.

 (c)  If the recipient or the person or the facility acting on behalf of the recipient appeals the decision within 10 calendar days from the date the CAO issues the advance notice, payment for the present level of care will continue pending the outcome of the hearing subject to §  6210.52 (relating to payment pending appeal).

Cross References

   This section cited in 55 Pa. Code §  6210.101 (relating to scope of claims review procedures).



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