§ 1181.41a. Dual participation requirements for Medicare and MA Programs—statement of policy.
(a) As a result of the multiple changes to § 1181.41(4) (relating to provider participation requirements), a facility providing skilled care, enrolled in the MA Program with more than 60 licensed beds, shall also be enrolled in the Medicare program to the extent that it has sufficient beds to accommodate Medicare eligible residents. This does not preclude a facility with a bed complement of under 60 beds from enrolling in the Medicare program.
(b) A facility certified to participate in the Medicare program shall have sufficient beds to accommodate its Medicare eligible residents. Payment will be based on criteria found in § 1181.51(b) (relating to general payment policy).
(c) If a facility has a total bed complement of more than 60 licensed beds and is not enrolled in the Medicare Program, the Department of Health should be contacted to enroll the skilled beds. Medicare enrollment forms may be requested from and returned to: Department of Health, Division of Long Term Care, Room 526, Health and Welfare Building, Harrisburg, Pennsylvania 17108, (717) 787-1816.
(d) Failure to be enrolled and certified in the Medicare Program will result in denial of claims for a recipient with both Medicare and MA coverage.
Source The provisions of this § 1181.41a adopted April 20, 1990, effective July 1, 1990, 20 Pa.B. 2200; amended October 5, 1990, effective October 6, 1990, and apply retroactively to July 1, 1990, 20 Pa.B. 5054; corrected October 19, 1990, effective July 1, 1990, 20 Pa.B. 5296. Immediately preceding text appears at serial page (146849).
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