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Nursing Facility Care | Midpage
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Pennsylvania Code
Title 55
Part III
Chapter 1181
Nursing Facility Care
Nursing Facility Care
1181.1
Policy.
1181.2
Definitions.
1181.21
Scope of benefits for the categorically needy.
1181.22
Scope of benefits for the medically needy.
1181.23
Scope of benefits for State Blind Pension recipients.
1181.24
Scope of benefits for qualified Medicare beneficiaries.
1181.25
Scope of benefits for General Assistance recipients.
1181.41
Provider participation requirements.
1181.41a
Dual participation requirements for Medicare and MA Programs—statement of policy.
1181.42
Additional participation requirements for hospital-based nursing units.
1181.43
Additional participation requirements for intermediate care facilities for the mentally retarded.
1181.44
Additional participation requirements for State-operated nursing facilities other than intermediate care facilities for the mentally retarded.
1181.45
Ongoing responsibilities of providers.
1181.51
General payment policy.
1181.52
Payment conditions.
1181.53
Payment conditions related to the recipient’s initial need for care.
1181.54
Payment conditions related to the recipient’s continued need for care.
1181.55
General limitations on payment.
1181.56
Limitations on payment for reserved beds.
1181.56a
Limitations on payment for reserved beds—statement of policy.
1181.56b
Charges for bed hold days—statement of policy.
1181.56c
Reimbursement for hospital reserved bed days during a Medicare benefit period—statement of policy.
1181.57
Limitations on payment for prescription drugs.
1181.58
Limitations on payment during strike or disaster situations requiring patient evacuation.
1181.58a
[Reserved].
1181.59
Payment to a nursing facility for heavy care/intermediate services or intermediate care provided in a dually certified skilled bed.
1181.60
Utilizing Medicare as a resource.
1181.61
Services included in the interim per diem rate.
1181.61a
Nurse-aide programs—statement of policy.
1181.62
Noncompensable services.
1181.63
Method of payment.
1181.64
Cost reporting.
1181.65
Cost-finding.
1181.66
Setting ceilings on allowable net operating costs.
1181.67
Setting interim per diem rates.
1181.68
Upper limits of payment.
1181.69
Annual adjustment.
1181.71
Annual reporting.
1181.72
Interim reporting.
1181.73
Final reporting.
1181.74
Auditing requirements related to cost reports.
1181.75
Auditing requirements related to patient fund management.
1181.81
Scope of claims review procedures.
1181.82
Review of need for admission.
1181.83
Inspections of care.
1181.84
Facility course of action.
1181.85
Facility utilization review requirements.
1181.86
Provider misutilization.
1181.91
Failure to file a cost report.
1181.92
Failure to maintain adequate records.
1181.93
Failure to correct deficiencies.
1181.94
Failure to adhere to certification requirements.
1181.95
Failure to adhere to medical evaluation requirements.
1181.96
Failure to comply with requirements of maintaining patient’s funds.
1181.101
Facility’s right to a hearing.