A nursing facility shall meet the following admission or MA conversion requirements:

1. (1) Prescreening. The nursing facility shall ensure that individuals applying for admission to the facility are prescreened by the Department as required by section 1919 of the Social Security Act (42 U.S.C.A. § 1396r(e)(7)) and 42 CFR Part 483 Subpart C (relating to preadmission screening and annual review of mentally ill and mentally retarded individuals).

2. (2) Preadmission or MA conversion evaluation and determination.

   1. (i) The nursing facility shall ensure that before an MA applicant or recipient is admitted to a nursing facility, or before authorization for MA payment for nursing facility services in the case of a resident, the MA applicant, recipient or resident has been evaluated by the Department or an independent assessor and found to need nursing facility services.
   2. (ii) The nursing facility shall maintain a copy of the Department’s or the independent assessor’s notification of eligibility in the business office.

3. (3) Notification to the Department.

   1. (i) The nursing facility shall notify the Department on forms designated by the Department whenever an MA applicant or recipient is admitted to the nursing facility or whenever a resident is determined eligible for MA.
   2. (ii) The nursing facility shall submit information regarding target residents to the Department on forms designated by the Department within 48 hours of the admission of a target resident to the nursing facility.
4. (4) Physician certification. Within 48 hours of admission of a resident to a nursing facility or, if a resident applies for MA while in the nursing facility before the Department authorizes payment for nursing facility services, the nursing facility shall ensure that a resident’s attending physician certifies in writing in the resident’s clinical record that the resident requires nursing facility services.

Authority

The provisions of this § 1187.31 amended under sections 201(2), 206(2), 403(b) and 443.1(5) of the Human Services Code (62 P.S. § § 201(2), 206(2), 403(b) and 443.1(5)).

Source

The provisions of this § 1187.31 amended June 23, 2006, effective July 1, 2006, 36 Pa.B. 3207. Immediately preceding text appears at serial pages (287009) to (287010).