55 Pa. Code § 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. (1) A written request to enroll as a provider of the additional service.
2. (2) A copy of the license required to provide the service if the service requires licensure.
3. (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.