Subchapter B. PROVIDER QUALIFICATIONS AND PARTICIPATION
Sec.
52.11. Prerequisites for participation.
52.12. Prerequisites for existing provider enrolling in a new service.
52.13. Review of application.
52.14. Ongoing responsibilities of providers.
52.15. Provider records.
52.16. Abuse.
52.17. Critical incident and risk management.
52.18. Complaint management.
52.19. Criminal history checks.
52.20. Provisional hiring.
52.21. Staff training.
52.22. Provider monitoring.
52.23. Corrective action plan.
52.24. Quality management.
52.25. Service plan.
52.26. Service coordination services.
52.27. Service coordinator qualifications and training.
52.28. Conflict free service coordination.
52.29. Confidentiality of records.
52.30. Waiver of a program qualification.§ 52.11. Prerequisites for participation.
(a) As a condition of participation in a waiver or Act 150 program, an applicant shall meet the following qualifications:
(1) Complete and submit an MA application including a waiver addendum to that application.
(2) Complete and submit a signed MA provider agreement including the waiver addendum to that agreement.
(3) Verify fiscal solvency by submitting a copy of the following:
(i) Applicant’s most recent corporate or nonprofit tax return. If an applicant does not have a corporate or nonprofit tax return, then the applicant shall submit the most recent individual tax return for the owner of the entity which is applying for enrollment.
(ii) Applicant’s most recent monthly balance sheet. If an applicant does not have a balance sheet, then an applicant shall submit a copy of the business plan indicating assets, liabilities, and anticipated costs and revenues for the next fiscal year.
(iii) Articles of incorporation, if the applicant is incorporated.
(iv) Partnership agreement, if the applicant is a partnership.
(v) Most recent audit or financial review if the applicant has completed an audit or financial review within the previous 5 years.
(4) Area Agencies on Aging that are units of county government are not required to submit documentation under paragraph (3).
(5) Create and follow policies and procedures relating to the following:
(i) Compliance with this chapter.
(ii) Provision of services in a nondiscriminatory manner.
(iii) Compliance with the Americans with Disabilities Act of 1990 (42 U.S.C.A. § § 12101—12213).
(iv) Compliance with the Healthcare Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191).
(v) Staff member training. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.
(vi) Participant complaint management process.
(vii) Critical incident management. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.
(viii) Quality management. The policy must be in accordance with this chapter and licensing requirements that the applicant is required to meet.
(ix) Staff member screening for criminal history.
(x) Employee Social Security Number verification.
(xi) Initial and continued screening for staff members and contractors to determine if they have been excluded from participation in Federal health care programs by reviewing the LEIE, EPLS and Medicheck.
(xii) Process for participants with limited English proficiency to access language services.
(6) Obtain and maintain appropriate licenses and certifications from other State or Federal agencies as required.
(7) Obtain the following insurances:
(i) Commercial general liability insurance.
(ii) Worker’s compensation insurance.
(iii) Professional liability insurance if required by a profession.
(8) Comply with the applicable approved waiver, including approved waiver amendments as posted on the Department’s publicly accessible web site.
(b) An applicant shall submit verification of compliance with subsection (a) to the Department.
(c) Application materials shall be submitted to the Department in a form and manner as prescribed by the Department.
(d) An applicant may apply to become a provider of more than one service as long as the provision of multiple services is not prohibited by this chapter or Federal or State requirement.
Cross References This section cited in 55 Pa. Code § 52.13 (relating to review of application); and 55 Pa. Code § 52.14 (relating to ongoing responsibilities of providers).
§ 52.12. Prerequisites for existing provider enrolling in a new service.
(a) If an existing provider enrolled in a waiver program wants to enroll to provide an additional waiver service, the provider shall submit the following to the Department:
(1) A written request to enroll as a provider of the additional service.
(2) A copy of the license required to provide the service if the service requires licensure.
(3) A completed and signed waiver addendum to the MA provider agreement for the new service.
(b) The provider shall submit the written request to enroll in an additional service to the Department in a form and manner prescribed by the Department.
§ 52.13. Review of application.
(a) The Department will only review complete application materials.
(b) The Department will review the application materials submitted under § 52.11 (relating to prerequisites for participation).
(c) The Department may request additional information from an applicant to verify the applicant is qualified to provide services in accordance with this chapter or other Federal or State requirements.
(d) Incomplete application materials are void after 30 days of receipt.
(e) The Department will notify the applicant if the applicant’s application is incomplete.
(f) The Department is not required to return application materials to an applicant.
§ 52.14. Ongoing responsibilities of providers.
(a) An applicant is not a provider until the following are met:
(1) The Department approves the applicant’s MA application.
(2) An MA provider agreement including a waiver addendum is signed.
(b) Within 180 days from the date of enrollment, a provider shall attend new provider training provided by the Department.
(c) A provider shall implement the policies under § 52.11(a)(5) (relating to prerequisites for participation).
(d) In addition to meeting the participation requirements under Chapter 1101 (relating to general provisions), a provider shall update and submit to the Department the provider qualifications under § 52.11(a)(3)—(7) at least every 2 years.
(e) In addition to meeting the requirements in § 1101.68 (relating to invoicing for services), the provider shall meet the requirements in the MA HCBS Provider Handbook, available on the Department’s web site.
(f) A provider shall maintain appropriate licenses and certifications as required by State and Federal requirements. The provider shall submit a copy of a valid license or certification, or both, to the Department at the beginning of each applicable licensure period.
(g) The provider shall ensure the following prior to rendering services to a participant:
(1) The service plan is approved by the Department.
(2) The type, scope, amount, duration and frequency of the service to be rendered are listed in the service plan that the provider is assigned to implement.
(h) A provider shall ensure a participant is eligible to receive a service prior to rendering the service to the participant.
(i) A provider shall comply with the applicable approved waiver, including approved waiver amendments.
(j) The provider shall notify the Department at least 30 business days prior to any of the following occurrences:
(1) Changes in the provider’s address, telephone number, fax number, e-mail address, provider name change or provider’s designated contact person.
(2) Creation, changes or revocation of the provider’s articles of incorporation or partnership agreements.
(3) Revisions to an audit previously submitted to the Department under § 52.11(a).
(4) Revocation or provisional status of a license or certification.
(5) Cancellation of the following insurances:
(i) Commercial general liability insurance.
(ii) Workers’ compensation insurance.
(iii) Professional liability insurance if the profession authorized to provide a service requires professional liability insurance.
(k) If the provider is unable to notify the Department due to an emergency prior to a change occurring as stated under subsection (j), the provider shall notify the Department within 2 business days of the change.
(l) A provider shall ensure that each employee possesses a valid Social Security Number.
(m) A provider may not render a service when the participant is unavailable to receive the service.
(n) A provider may not bill for a service when the participant is unavailable to receive the service.
(o) A provider which is not an SCE shall cooperate with the participant, the SCE and the Department to resolve delays in service provision.
(p) A provider shall complete and comply with a CAP as required by the Department or other Federal or State agency.
(q) A provider shall implement and provide services to the participant in the type, scope, amount, duration and frequency as specified in the service plan.
(r) A provider shall document the participant’s progress towards outcomes and goals in the Department’s designated information system.
(s) The provider shall comply with the terms of the MA provider agreement, including waiver addendum.
(t) A provider shall participate in Department-mandated trainings.
§ 52.15. Provider records.
(a) The following requirements are in addition to the recordkeeping provisions under § 1101.51(d) and (e) (relating to ongoing responsibilities of providers):
(1) A provider shall use the Department’s designated information system to record service plan information regarding the participant as required under § 52.25 (relating to service plan).
(2) A provider shall complete and maintain documentation on service delivery.
(b) Electronic records are acceptable documentation when the provider meets the following:
(1) The electronic format conforms to Federal and State requirements.
(2) The electronic record is the original record and has not been altered or if altered shows the original and altered versions, dates of creation and the creator.
(3) The electronic record is readily accessible to the Department, the Department’s designee and State and Federal agencies.
(4) The provider creates and implements an electronic record retention policy.
(5) Electronic imaging of paper documentation must result in an exact reproduction of the original record and conform to the provider’s electronic record retention policy.
(c) The provider shall ensure records are compliant with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191).
(d) The requirements of this section are in addition to the recordkeeping provisions in Chapters 2380 and 2390 (relating to adult training facilities; and vocational facilities), 6 Pa. Code Chapter 11 (relating to older adult daily living centers) and 28 Pa. Code Chapters 601 and 611 (relating to home health care agencies; and home care agencies and home care registries).
Cross References This section cited in 55 Pa. Code § 52.19 (relating to criminal history checks); and 55 Pa. Code § 52.43 (relating to audit requirements).
§ 52.16. Abuse.
(a) Abuse is an act or omission that willfully deprives a participant of rights or human dignity, or which may cause or causes actual physical injury or emotional harm to a participant including a critical incident and one or more of the following:
(1) Sexual harassment of a participant.
(2) Sexual contact between a staff member and a participant.
(3) Restraining a participant.
(4) Financial exploitation of a participant.
(5) Humiliating a participant.
(6) Withholding regularly scheduled meals from a participant.
(b) Abuse of a participant is prohibited.
§ 52.17. Critical incident and risk management.
(a) The requirements in this chapter are in addition to the reporting requirements under Chapter 2380 or 2390 (relating to adult training facilities; and vocational facilities), 6 Pa. Code Chapter 11 (relating to older adult daily living centers) and 28 Pa. Code Chapters 601 and 611 (relating to home health care agencies; and home care agencies and home care registries).
(b) A provider shall report a critical incident involving a participant to the Department or the SCE, or both, on a form prescribed by the Department.
(c) A provider shall develop and implement written policies and procedures on the prevention, reporting, notification, investigation and management of critical incidents.
(d) A provider shall meet the risk management requirements as specified in the approved applicable waivers, including approved waiver amendments.
(e) If the Department requires additional follow-up information to a critical incident, then the provider shall submit additional information as requested to the Department.
(f) A provider shall reduce the number of preventable incidents. The methods used by the provider to reduce the number of preventable incidents shall be documented on the provider’s QMP.
§ 52.18. Complaint management.
(a) The provider shall implement a system to record, respond and resolve a participant’s complaint.
(b) The provider complaint system must contain the following:
(1) The name of the participant.
(2) The nature of the complaint.
(3) The date of the complaint.
(4) The provider’s actions to resolve the complaint.
(5) The participant’s satisfaction to the resolution of the complaint.
(c) The provider shall review the complaint system at least quarterly to:
(1) Analyze the number of complaints resolved to the participant’s satisfaction.
(2) Analyze the number of complaints not resolved to the participant’s satisfaction.
(3) Measure the number of complaints referred to the Department for resolution.
(d) The provider shall develop a QMP when the numbers of complaints resolved to a participant’s satisfaction are less than the number of complaints not resolved to a participant’s satisfaction.
(e) The provider shall submit a copy of the provider’s complaint system procedures to the Department upon request.
(f) The provider shall submit the information under subsection (c) to the Department upon request.
§ 52.19. Criminal history checks.
(a) The criminal history requirements in this section are in addition to the requirements in Chapter 2380 or 2390 (relating to adult training facilities; and vocational facilities), 6 Pa. Code Chapter 11 (relating to older adult daily living centers) and 28 Pa. Code Chapters 601 and 611 (relating to home health care agencies; and home care agencies and home care registries) for providers licensed under these chapters.
(b) Prior to hiring an employee, a provider shall obtain a criminal history check which is in compliance with the following for each employee who may have contact with a participant:
(1) A report of criminal history record information from the Pennsylvania State Police or a statement from the Pennsylvania State Police that the Pennsylvania State Police Central Repository does not contain information relating to that person, under 18 Pa.C.S. Chapter 91 (relating to Criminal History Record Information Act), if the employee has been a resident of this Commonwealth for the 2 years immediately preceding the date of application.
(2) A report of Federal criminal history record information under the Federal Bureau of Investigation appropriation of Title II of the act of October 25, 1972 (Pub. L. No. 92-544, 86 Stat. 1109) if the employee has not been a resident of this Commonwealth for the 2 years immediately preceding the date of application.
(c) Criminal history checks shall be in accordance with the Older Adults Protective Services Act (35 P. S. § § 10225.101—10225.5102) and 6 Pa. Code Chapter 15 (relating to protective services for older adults).
(d) The hiring policies shall be in accordance with the Department of Aging’s Older Adults Protective Services Act policy as posted on the Department of Aging’s web site at http://www.portal.state.pa.us/portal/server.pt?open=514&objID=616725&mode=2.
(e) A copy of the final report received from the Pennsylvania State Police or the Federal Bureau of Investigation, as applicable, shall be kept in accordance with § 52.15 (relating to provider records).
Cross References This section cited in 55 Pa. Code § 52.20 (relating to provisional hiring).
§ 52.20. Provisional hiring.
(a) A provider may hire a person for employment on a provisional basis, pending receipt of a criminal history check, provided that the following are met:
(1) The provider is in the process of obtaining a criminal history check as required under § 52.19 (relating to criminal history checks).
(2) A provider may not hire a person provisionally if the provider has knowledge that the person would be disqualified for employment under 18 Pa.C.S. § 4911 (relating to tampering with public records or information).
(3) A provisionally-hired employee shall swear or affirm in writing that he is not disqualified from employment under this chapter.
(4) A provider shall monitor the provisionally-hired person awaiting a criminal history check through random, direct observation and participant feedback. The results of monitoring must be documented in the person’s employment file.
(5) The period of provisional hire may not exceed 30 days for a person who has been a resident of this Commonwealth for at least 2 years.
(6) The period of provisional hire may not exceed 90 days for a person who has been a resident of this Commonwealth for less than 2 years.
(b) If the information obtained from the criminal history check reveals that the person is disqualified from employment under § 52.19, the provider shall terminate the provisionally-hired person immediately.
(c) When subsection (a) conflicts with Chapters 2380 and 2390 (relating to adult training facilities; and vocational facilities), 6 Pa. Code Chapter 11 (relating to older adult daily living centers) or 28 Pa. Code Chapters 601 and 611 (relating to home health care agencies; and home care agencies and home care registries), subsection (a) is not applicable.
Source The provisions of this § 52.20 corrected February 8, 2013, effective May 19, 2012, 43 Pa.B. 833. Immediately preceding text appears at serial pages (361347) to (361348).
§ 52.21. Staff training.
(a) A provider shall meet the training requirements necessary to maintain appropriate licensure or certification, or both, in addition to meeting the training requirements of this chapter.
(b) Prior to providing a service to a participant, a staff member shall be trained on how to provide the service in accordance with the participant’s service plan.
(c) A provider shall maintain documentation for the following:
(1) Staff member attendance at trainings.
(2) Content of trainings.
(d) A provider shall implement standard annual training for staff members providing services which contains at least the following:
(1) Prevention of abuse and exploitation of participants.
(2) Reporting critical incidents.
(3) Participant complaint resolution.
(4) Department-issued policies and procedures.
(5) Provider’s quality management plan.
(6) Fraud and financial abuse prevention.
§ 52.22. Provider monitoring.
(a) The Department will monitor a provider at least once every 2 years.
(b) Monitoring may be announced or unannounced.
(c) A provider shall submit documentation as requested by the Department that the provider is in compliance with the following:
(1) This chapter.
(2) The MA provider agreement, including the waiver addendum.
(3) Chapter 1101 (relating to general provisions).
(4) The approved applicable waiver, including approved waiver amendments.
(5) A State or Federal requirement.
(d) The Department will issue a written statement of findings if the provider has not complied with subsection (c).
Cross References This section cited in 55 Pa. Code § 52.23 (relating to corrective action plan).
§ 52.23. Corrective action plan.
(a) The provider shall respond to the written statement of findings under § 52.22 (relating to provider monitoring) with a CAP when requested by the Department.
(b) The provider shall submit a CAP to the Department on a form prescribed by the Department.
(c) The CAP must contain at least the following:
(1) The provider’s name.
(2) The provider’s address.
(3) The provider’s MA identification number.
(4) The action steps to address a specific finding.
(5) The dates action steps will be completed.
(6) An explanation on how the action steps will remediate the finding.
(7) The date when a finding will be remediated.
(8) The provider’s signature indicating the provider will implement the CAP.
(d) The Department will review and monitor a provider-drafted CAP to ensure each finding is corrected.
(e) The Department may reject a provider-drafted CAP and request the provider to revise the CAP so the CAP is in compliance with this section.
(f) The Department may develop a CAP for a provider to implement in response to the statement of findings.
(g) The provider shall implement a Department-approved CAP.
(h) The Department may conduct a follow-up monitoring to ensure the provider is implementing the CAP.
§ 52.24. Quality management.
(a) The provider shall create and implement a QMP to ensure the provider meets the requirements of this chapter and Chapter 1101 (relating to general provisions).
(b) The QMP must contain at least the following:
(1) Measureable goals to ensure compliance with this chapter, Chapter 1101 and other chapters in this title under which the provider is licensed.
(2) Data-driven outcomes to achieve compliance with this chapter, Chapter 1101 and other chapters in this title which the provider is licensed.
(3) The current Department-approved CAP, if the provider has a CAP.
(c) The provider may add additional items to the QMP to address self-identified areas of quality improvement.
(d) The QMP must be updated at least annually by the provider.
(e) The Department may request a provider to update the provider’s QMP if the provider receives a CAP.
(f) The provider shall submit a copy of the QMP to the Department upon request.
§ 52.25. Service plan.
(a) A service plan must be developed for each participant that contains the following:
(1) The participant need as identified on a standardized needs assessment provided by the Department.
(2) The participant goal.
(3) The participant outcome.
(4) Service, TPR or informal community support that meets the participant need, participant goal or participant outcome.
(5) The type, scope, amount, duration and frequency of services needed by the participant.
(6) The provider of each service.
(7) The participant’s signature.
(8) Risk mitigation strategies.
(9) The participant’s back-up plan.
(b) The participant’s back-up plan must contain an individualized back-up plan and an emergency back-up plan.
(c) Each participant need must be addressed by an informal community support, TPR or service unless the participant chooses for a need to not be addressed.
(d) If a participant refuses to have a need addressed, then the SCE shall document when the participant refused to have the need addressed and why the participant chose for the need to remain unaddressed.
(e) The following services require a physician’s prescription prior to being added to a participant’s service plan:
(1) Physical therapy.
(2) Occupational therapy.
(3) Speech and language therapy.
(4) Nursing services.
(5) Telecare health status and monitoring services.
(6) Durable medical equipment.
(f) An SCE or the Department’s designee shall use a person-centered approach to develop the participant’s service plan.
(g) An SCE or the Department’s designee shall use the Department’s person-centered assessment and risk assessment to develop the participant’s service plan.
(h) An SCE or the Department’s designee shall complete the participant’s service plan on a format prescribed by the Department and enter the service plan into the Department’s designated information system.
(i) The Department will approve the participant’s service plan prior to service provision.
(j) An SCE or the Department’s designee shall review the participant need, participant goal and participant outcome documented on the service plan at least annually with the participant.
(k) An SCE or the Department’s designee shall review and modify, if necessary, the participant need, participant goal and participant outcome each time a participant has a significant change in medical or social condition.
(l) If there has been a significant change in the medical or social condition of a participant, an SCE or the Department’s designee shall use the Department’s person-centered assessment and risk assessment to determine if changes are needed in the participant’s service plan.
Cross References This section cited in 55 Pa. Code § 52.15 (relating to provider records).
§ 52.26. Service coordination services.
(a) To be paid for rendering service coordination services, an SCE shall:
(1) Complete a person-centered assessment.
(2) Complete a level of care re-evaluation at least annually.
(3) Develop a service plan for each participant for whom the SCE renders service coordination services. The provider shall complete the following:
(i) Develop and modify the participant’s service plan at least annually.
(ii) Modify the participant’s service plan, if necessary, when the participant has a significant medical or social change.
(4) Review the participant need, the participant goal and participant outcome with the participant and other persons that the participant requests to be part of the review as required by conducting the following:
(i) At least one telephone call or face-to-face visit per calendar quarter. At least two face-to-face visits are required per calendar year.
(ii) More frequent calls or visits if the service coordinator or the Department determines more frequent calls or visits are necessary to ensure the participant’s health and safety.
(5) Coordinate a service, TPR and informal community supports with the participant to ensure the participant need, the participant goal and the participant outcome are met.
(6) Provide the participant with a list of providers in the participant’s service location area that are enrolled to render the service that meet the participant needs.
(7) Inform the participant of the participant’s right to choose any willing and qualified provider to provide a service on the participant’s service plan.
(8) Confirm with the participant’s selected provider that the provider is able to provide the service in the type, scope, amount, duration and frequency as listed on the participant’s service plan.
(9) Provide information regarding the authorized type, scope, amount, duration and frequency of services as listed in the participant’s service plan to the provider rendering the service.
(10) Ensure and document at least on a quarterly basis that the participant’s services are being delivered in the type, scope, amount, duration and frequency as required by the participant’s service plan.
(11) Evaluate if the participant need, participant goal and participant outcome are being met by the service.
(12) Ensure a participant exercising participant-directed budget authority does not exceed the number of service hours approved in the participant’s service plan.
(b) If additional information is necessary to ensure that services are provided to a participant in the type, scope, amount, duration or frequency as required by the participant’s service plan, the SCE shall convey the additional information to a provider.
(c) The SCE shall ensure a waiver or Act 150 service assigned to a participant is a service offered under the waiver or Act 150 service in which the participant is enrolled.
(d) If a participant is available to receive only a portion of the service coordination services in subsection (a), the Department will pay for those portions of the services rendered to the participant.
(e) If the SCE is an OHCDS, then the SCE shall be a direct service provider of at least one vendor good or service.
(f) If services are not being delivered by a provider to a participant in the type, scope, amount, duration or frequency as required by the participant’s service plan, then the SCE shall work with the provider to do either of the following:
(1) Ensure that services are being delivered to the participant in the type, scope, amount, duration and frequency required by the participant’s service plan.
(2) Transition the participant to a provider who is willing and qualified to provide services to the participant in accordance with the participant’s service plan.
(g) The Department may limit the number of service coordination units available to participants as provided in the approved applicable waiver, including approved waiver amendments.
(h) A provider may not bill for more units of service coordination services for a participant than provided for in the participant’s service plan.
(i) If a participant requires more units of service coordination services than provided for in the participant’s service plan, then the SCE shall submit:
(1) A request to increase the number of service coordination units for the participant to the Department.
(2) Justification for why the participant requires more units of service.
(3) The number of service coordination units the participant is assessed to need.
(j) If the service is also offered as a Medicaid State Plan service, then the Medicaid State Plan service shall be accessed prior to another Departmental program to provide the service.
(k) The SCE or the Department’s designee shall assist a participant to collect and send information to the Department to determine the participant’s continued eligibility for the waiver or Act 150 program, including financial eligibility.
Source The provisions of this § 52.26(g) and (i) effective June 27, 2012, 42 Pa.B. 4545. Immediately preceding text appears at serial pages (361351) to (361353).
§ 52.27. Service coordinator qualifications and training.
(a) To provide service coordination services, a service coordinator shall meet either of the following:
(1) Have a bachelor’s degree including or supplemented by at least 12 college-level credit hours in sociology, social welfare, psychology, gerontology or another behavioral science.
(2) A combination of experience and training which adds up to 4 years of experience, and education which includes at least 12 semester hours of college-level courses in sociology, social work, social welfare, psychology, gerontology or other social science.
(i) Experience includes:
(A) Coordinating assigned services as part of an individual’s treatment plans.
(B) Teaching individuals living skills.
(C) Aiding in therapeutic activities.
(D) Providing socialization opportunities for individuals.
(ii) Experience does not include:
(A) Providing hands-on personal care for people with disabilities or individuals over 60 years of age.
(B) Maintenance of the individual’s home, room or environment.
(C) Aiding in adapting the physical facilities of the individual’s home.
(b) To supervise staff providing service coordination services, a service coordinator supervisor shall meet either of the following:
(1) Have at least 3 years of experience in public or private social work and a bachelor’s degree.
(2) Have an equivalent to paragraph (1) of experience and training including completion of 12 semester hours of college-level courses in sociology, social work, social welfare, psychology, gerontology or other related social sciences. Graduate coursework in the behavioral sciences may be substituted for up to 2 years of the required experience. Behavioral sciences include anthropology, counseling, criminology, gerontology, human behavior, psychology, social work, social welfare, sociology and special education.
(c) A service coordinator shall have at least 40 hours of training within the first year of employment. The training shall include at least the following:
(1) Conducting a person-centered assessment.
(2) Developing and modifying a participant’s service plan.
(3) Utilizing the Department’s data systems.
(4) Improving communication skills.
(5) Acquiring conflict resolution skills.
(6) Completing documentation.
(7) Understanding the disabilities of participants served.
(d) A service coordinator shall have at least 20 hours of training annually that includes the training topics under subsection (c).
§ 52.28. Conflict free service coordination.
(a) An SCE may not provide other waiver or Act 150 services if the SCE provides service coordination services unless one of the following is applicable:
(1) The SCE is providing the service as an OHCDS under § 52.53 (relating to organized health care delivery system).
(2) The SCE is providing community transition services to a participant transitioning from a nursing facility or an ICF/ORC.
(3) The SCE is providing financial management services to a participant.
(b) If an SCE operates as an OHCDS, then the SCE may not require a participant to use that OHCDS as a condition to receive the service coordination services of the SCE.
(c) An SCE may not require a participant to choose the SCE as the participant’s community transition service provider as a condition to receive service coordination services.
(d) An SCE and a provider of a service other than service coordination may not share any of the following:
(1) Chief executive officer or equivalent.
(2) Executive board.
(3) Bank account.
(4) Supervisory staff.
(5) Tax identification number.
(6) MA provider agreement.
(7) Master provider index number.
Source The provisions of this § 52.28 effective June 27, 2012, 42 Pa.B. 4545. Immediately preceding text appears at serial pages (361354) to (361355).
§ 52.29. Confidentiality of records.
Participant records must be kept confidential and, except in emergencies, may not be accessible to anyone without the written consent of the participant or if a court orders disclosure other than the following:
(1) The participant.
(2) The participant’s legal guardian.
(3) The provider staff for the purpose of providing a service to the participant.
(4) An agent of the Department.
(5) An individual holding the participant’s power of attorney for health care or health care proxy.
§ 52.30. Waiver of a program qualification.
(a) The Department may grant a waiver to a provision of this chapter which is not otherwise required by Federal and State law and does not jeopardize the health, safety or well-being of a participant.
(b) The waiver request must be on a form prescribed by the Department.
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