PROVIDER PARTICIPATION

In addition to the participation requirements established in Chapter 1101 (relating to general provisions), nursing facilities shall meet the following requirements:

1. (1) Skilled nursing care and intermediate care facilities shall be licensed by the Department of Health.
2. (2) Intermediate care facilities for the mentally retarded shall be licensed by the Department.
3. (3) Nursing facilities shall abide by applicable Federal, State and local statutes and regulations, including, but not limited to, Title XIX of the Social Security Act (42 U.S.C.A. § § 1396—1396q), sections 443.1—443.6 of the Public Welfare Code (62 P. S. § § 443.1—443.6) and applicable licensing statutes. Nursing facilities shall conform with the requirements specified in Title XIX of the Social Security Act and the regulations promulgated thereunder which are necessary for the Department to receive Federal financial participation for nursing services rendered by the facilities.
4. (4) A facility with more than 60 licensed beds shall be enrolled and participating in the Medicare Program. This paragraph does not apply to a facility that has no beds certified to provide skilled care.

Source

The provisions of this § 1181.41 codified July 24, 1981, effective July 25, 1981, 11 Pa.B. 2610; amended March 10, 1989, effective immediately and applies retroactively to January 1, 1989, 19 Pa.B. 1005. Immediately preceding text appears at serial pages (133589) to (133590).

Notes of Decisions

Court rejected petitioner’s contention that Department of Public Welfare’s regulations regarding classification of nursing care as skilled or intermediate were inconsistent with Department of Health’s regulations. The Department of Public Welfare has been named as the single state agency to administer and supervise the medicard program and the Department of Health is merely in charge of licensing skilled and intermediate care facilities. Barnett v. Department of Public Welfare, 491 A.2d 320 (Pa. Cmwlth. 1985).

Cross References

This section cited in 55 Pa. Code § 1181.41a (relating to dual participation requirements for Medicare and MA Programs—statement of policy); 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); 55 Pa. Code § 1181.44 (relating to additional participation requirements for State-operated nursing facilities other than intermediate care facilities for the mentally retarded); 55 Pa. Code § 1181.504 (relating to background); 55 Pa. Code § 1181.511 (relating to provider conditions of participation); and 55 Pa. Code Chapter 1181 Appendix O (relating to OBRA sanctions).