PAYMENT FOR NURSING FACILITY CARE
§ 1181.51. General payment policy.
(a) Payment for nursing facility care is subject to the following conditions and limitations:
(1) This chapter and Chapter 1101 (relating to general provisions).
(2) The applicable per diem ceilings established under § 1181.66 (relating to setting ceilings on allowable net operating costs) and announced by the submission of a notice for recommended publication in the Pennsylvania Bulletin and suggested codification in the Pennsylvania Code as an annex to § 1181.66 for the location of the facility, level of care, type of facility and date of service involved. Heavy care/intermediate services shall be paid at the higher of a facility’s applicable rates for skilled or intermediate care, as limited by the ceilings.
(b) Payment will not be made for long term care if full payment, at the medical assistance interim per diem rate, is available from another public agency, another insurance or health program, or the patient’s resources.
Authority The provisions of this § 1181.51 amended under sections 201 and 443.1(2) of the Public Welfare Code (62 P. S. § § 201 and 443.1(2)).
Source The provisions of this § 1181.51 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 September 6, 1985, effective September 7, 1985, except that the groups and ceilings shall be effective and apply at audit to costs of services rendered from July 1, 1984 through December 31, 1985, 15 Pa.B. 3181; amended March 10, 1989, effective immediately and applies retroactively to February 23, 1988, 19 Pa.B. 999. Immediately preceding text appears at serial pages (117417) to (117418).
Cross References This section cited in 55 Pa. Code § 1181.41a (relating to dual participation requirements for Medicare and MA Programs—statement of policy); and 55 Pa. Code § 1181.52 (relating to payment conditions).
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