§ 1181.45. Ongoing responsibilities of providers.
(a) In addition to the ongoing responsibilities established in Chapter 1101 (relating to general provisions), a nursing facility shall, as a condition of participation:
(1) Submit a Utilization Review Plan to the Office of MA for approval.
(2) Have in operation a system for managing patients’ funds that, at a minimum, fully complies with the Medicare long term care certification requirements established at 42 CFR 405.1121(k)(6) (relating to conditions of participation—governing body and management).
(i) The facility in which a qualified Medical Assistance recipient dies may, under the circumstances described in this subparagraph, make payment of funds, if any remain in the patient’s care account, for the decedent’s burial expenses. Payment may be made only to a qualified funeral director and may not exceed $1,000. The payment may be made whether or not a personal representative has been appointed.
(ii) Subparagraph (i) applies only in circumstances where there is no will, if this is ascertainable, and if no relative or friend of the deceased patient takes responsibility for the burial. Under 20 Pa.C.S. (relating to Probate, Estates and Fiduciaries Code) a facility making such a payment is released from responsibility to the same extent as if payment had been made to an appointed personal representative of the decedent and the facility is not required to oversee the manner in which the funeral director applies the payment.
(3) File an acceptable cost report with the Department within the time limit specified in § 1181.64 (relating to cost reporting) if the facility is continuing its participation in the MA Program or within the time limit specified in § 1181.73 (relating to final reporting) if the facility is sold, transferred by merger or consolidation, terminated or withdraws from participation in the MA Program. An acceptable cost report is one that meets the requirements of § 1181.66(a)(1)(i)—(iv) (relating to setting ceilings on allowable net operating costs).
(4) Except for non-State operated intermediate care facilities for the mentally retarded, if making initial application for participation, submit a projected MA 11 cost report to the Bureau of Long Term Care Programs for the purpose of establishing an interim per diem rate.
(5) Undergo at least an annual onsite inspection of care by the Department’s Inspection of Care Team and within 30 days of receipt of the team’s report, submit a written response, if required by the Department.
(6) Submit to the Bureau of Long Term Care Programs changes in ownership of persons having a direct or indirect interest of 5% or more in the nursing facility and, if a corporation, changes in the name or address of corporate officers.
(7) Have a written transfer agreement with one or more general hospitals to provide needed diagnostic and other medical services to patients of the nursing facility, and under which acutely ill patients may be transferred to ensure timely admission. Hospital based units are exempt from this requirement.
(b) If the facility changes ownership and the new owner wishes the facility to participate in MA, the facility shall submit a written request for participation to the Bureau of Long Term Care Programs. The agreement in effect at the time of the ownership change will be assigned to the new owner subject to applicable statutes and regulations and to the terms and conditions under which it was originally issued.
Source The provisions of this § 1181.45 codified July 24, 1981, effective July 25, 1981, 11 Pa.B. 2610; amended May 3, 1985, effective retroactively to July 1, 1984, 15 Pa.B. 1629; amended March 10, 1989, effective immediately and applies retroactively to January 1, 1989, 19 Pa.B. 1005. Immediately preceding text appears at serial pages (117415) to (117417).
Notes of Decisions Nursing care facilities must file a ‘‘cost report’’ with the Department within 90 days of the close of each fiscal year in order to be eligible for cost reimbursement. Harston Hall Nursing and Convalescent Home, Inc. v. Department of Public Welfare, 513 A.2d 1097, 1099 (Pa. Commw. 1986).
Cross References This section cited in 55 Pa. Code § 1181.42 (relating to additional participation requirements for hospital-based nursing units); 55 Pa. Code § 1181.43 (relating to additional participation requirements for intermediate care facilities for the mentally retarded); and 55 Pa. Code § 1181.44 (relating to additional participation requirements for State-operated nursing facilities other than intermediate care facilities for the mentally retarded).
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