Pennsylvania Administrative Code

§ 21.55. AAA placement activities. (a) Limitation. (1) In a home which is certified on or after January 6, 1990 or which had a certified capacity of three or fewer clients under a certification or recertification made prior to January 6, 1990, the AAA shall conduct its placement …

§ 21.56. Central registry of certified homes. (a) The AAA shall develop and maintain a registry of certified domiciliary care homes within the PSA. (b) The registry shall contain the following information for each home: (1) The name, address and telephone number of each provider.…

§ 21.57. Domiciliary care review team. (a) A domiciliary care review team shall be established by the AAA which shall consist of at least one person from the AAA, one person from the CAO and one person from the county mental health/mental retardation program. A representative fro…

§ 21.58. Staffing responsibilities for AAAs providing domiciliary care. (a) The AAA shall have paid staff sufficient in number and qualifications to carry out the responsibilities required by this chapter. These responsibilities shall include, but not be limited to, the following…

§ 21.59. Training requirements. The AAA shall assure that its staff receives periodic training in job-related areas.

§ 21.60. Recordkeeping. (a) Confidentiality. (1) Client record information is confidential and may not be disclosed or made use of, directly or indirectly, except in the legitimate performance of domiciliary care services, and in monitoring and evaluation of the service by State …

§ 21.61. Domiciliary care service’s relationship to service management. The AAA shall determine how domiciliary care service interrelates with service management and specify that interrelationship in a written statement to be kept on file for review by the Department.

§ 21.62. Facility ownership. The AAA may not own or directly operate a domiciliary care facility.

PROVIDER RIGHTS ANDRESPONSIBILITIES § 21.71. General provisions. A domiciliary care home provider shall operate in accordance with applicable provisions of this chapter to assure a safe, supportive, homelike setting for clients. Cross References This section cited in 6 Pa. Code §…

§ 21.72. Staff qualifications. The provider shall ensure that the following basic qualifications are met for the staff persons involved in home provider services. A staff person: (1) Shall be 18 years of age or older. (2) Shall be capable of performing home provider services in a…

§ 21.73. Staffing. (a) At least one provider or staff person shall be present and available on the premises when one or more clients are present in the home. (b) The AAA may waive the requirements in subsection (a), if the clients are independently mobile and the provider or staf…

§ 21.74. Basic furnishings. A provider is responsible for furnishing to a client or, if appropriate, paying for the full cost of, the following basic items: (1) Adequate housing in accordance with the standards in § § 21.27 and 21.80 (relating to domiciliary care home certificati…

§ 21.75. Client and provider agreement. (a) There shall be a written agreement between the provider and the client, specifying the monthly charge for domiciliary care provider services in accordance with the amounts established by the Department. The agreement, to be completed on…

§ 21.76. Personal care responsibilities. (a) The provider shall help the client in developing or maintaining self-help skills, personal hygiene skills and other skills relating to activities of daily living in accordance with the care plan established under § 21.54 (relating to A…

§ 21.77. Provider and AAA related activities. (a) The provider, in cooperation with the AAA, shall: (1) Assure that each client visits or is seen by his physician at least annually or more frequently if indicated by the client’s health needs. (2) Obtain emergency medical care whe…

§ 21.78. Nutrition responsibilities of providers. The provider shall assure that: (1) A client is served daily at least three well-balanced meals which are designed to meet the daily nutritional requirements of the client and which are prepared either by the provider, or as indic…

§ 21.79. Fire and safety activities. The provider shall assure that: (1) First aid supplies such as bandages, adhesive tape, bandaids, slings, cotton, sterile dressings, antiseptics, safety pins and scissors, are available in the home. (2) The telephone number of the local fire d…

§ 21.80. Domiciliary care home maintenance activities. The provider shall assure that: (1) The atmosphere and routine of the domiciliary care home enables clients to spend the majority of their hours outside of their bedrooms. (2) Furnishings and housekeeping standards are of a s…

§ 21.81. Provider financial accountability. (a) The provider shall maintain accurate financial records regarding the operation of the domiciliary care home. The records shall include, but not be limited to, records of payments made to utilities and mortgage-holders, and records o…

§ 21.82. Other provider responsibilities. (a) The provider shall pay a client for work performed which is of a consequential economic benefit to the provider. This work shall be paid for under 29 CFR Part 529 (relating to employment of patient workers in hospitals and institution…

§ 21.83. Provider rights. A domiciliary care provider shall be afforded the following rights: (1) The right to appeal an adverse action by the Department or the AAA and receive a fair hearing under Chapter 3 (relating to fair hearings and appeals). (2) The right to prompt action …

CLIENT RIGHTS AND RESPONSIBILITIES § 21.91. Client rights. A client residing in a domiciliary care home shall be afforded the following basic rights: (1) The client may not be restricted in the right to leave and return to the domiciliary care home at reasonable times consistent …

§ 21.92. Client responsibilities. A client residing in a domiciliary care home is responsible for the following: (1) Paying the monthly domiciliary care provider fee as established by the Department under § 21.41(6) (relating to Departmental responsibilities) to the provider in a…

GENERAL PROVISIONS § 22.1. Scope and authority. (a) This chapter sets forth regulations governing the administration, provision and receipt of prescription drug benefits available to older Pennsylvanians under the Pharmaceutical Assistance Contract for the Elderly (PACE) Program.…

PROVIDER HEARINGS AND APPEALS § 22.101. Provider appeals. (a) Appealable actions. Providers shall have the right to appeal the following adverse actions taken by the Department: (1) The rejection of an application for enrollment in the PACE Program when the provider believes the …

§ 22.102. Notification of adverse action and right to appeal. (a) The Department will provide written notice of any adverse action it has decided to take against a provider. (b) The notice of adverse action will be given in a timely manner and in no event will the notice be given…

§ 22.103. Filing of appeals. (a) Appeals shall be filed within 30 days of the date of a notice of adverse action and shall be submitted to the Department. (b) The form and content of provider appeals shall be under 1 Pa. Code § 35.10 (relating to form and content of formal compla…

§ 22.104. The handling of appeals. Appeals or complaints shall be handled as formal complaints under 1 Pa. Code Part II (relating to general rules of administrative practice and procedure). Source The provisions of this § 22.104 adopted June 15, 1984, effective June 16, 1984, 14 …

GENERAL PAYMENT PRINCIPLES § 22.11. General payment principles. (a) Provider billing. A provider is required to bill the Department at the usual charge for the drug dispensed. (b) Payment elements. A payment to an enrolled provider under the PACE Program shall consist of the foll…

OTHER ADMINISTRATIVE PROVISIONS § 22.111. Forms, handbooks and other materials. The Department may supplement or interpret this chapter by developing and issuing forms, handbooks or other materials necessary to the effective administration of the program. Source The provisions of…

§ 22.2. Definitions. The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise: Act—Chapter 5 of the State Lottery Law (72 P.S. § § 3761-501—3761-537), regarding pharmaceutical assistance for the elderly.…

CLAIMANT ELIGIBILITY § 22.21. General claimant eligibility policy. To be eligible to participate in PACE, an applicant shall be a resident of this Commonwealth, be 65 years of age or older, have annual income less than the maximum annual income and not be qualified for payment fo…

§ 22.22. Residence provisions. (a) Residence criteria. Except as set forth in subsection (d), a resident is a person who has lived within this Commonwealth, under color of law, for a period of at least 90 consecutive days immediately preceding the date the applicant’s application…

§ 22.23. Age provisions. (a) Age limit. An applicant shall be 65 years of age or older to participate in the PACE Program. (b) Early application. An applicant may, in order to assist in the timely determination of eligibility, submit a completed application to participate in PACE…

§ 22.24. Income provisions. (a) Income limits. Applicants shall have an annual income of $11,999.99 or less in the case of a single individual, or $14,999.99 or less combined income in the case of married couples, with the following exceptions: (1) Married applicants will be subj…

§ 22.25. Other third-party benefits. (a) Applicants who are qualified for coverage of payments for prescription drugs under a public assistance program are ineligible for PACE as long as they are so qualified. (b) Applicants who are qualified for full coverage of payments for pre…

§ 22.26. PACE eligibility. (a) Eligibility for PACE is established during a calendar year when a valid PACE application is approved, and remains in effect until the expiration date stated on the PACE identification card, unless there is cause for earlier termination. (b) The PACE…

APPLICATION PROCESS § 22.31. General provisions. The application process includes all activity relating to a request for eligibility determination. It begins with the receipt by the Department of an eligibility application and continues until there is an official disposition of t…

§ 22.32. Initiating the application process. An applicant requests a determination of eligibility to participate in the PACE Program by completing a PACE application form and submitting it to the Department. Source The provisions of this § 22.32 adopted June 15, 1984, effective J…

§ 22.33. Responsibilities of the applicant in the application process. The applicant has the responsibility to conform to the following: (1) Complete the PACE application form legibly and accurately. (i) Answer questions fully. (ii) Present necessary evidentiary documents under t…

§ 22.34. Authorized agent. (a) Adjudicated incompetency. When the applicant is adjudicated incompetent, the Department will accept the court-appointed guardian as an authorized agent for the purpose of initiating an application on behalf of the applicant. (b) Incapacity. If the a…

§ 22.35. Certification. The applicant shall certify that the answers to the questions and items on the application form are true and accurate to the best of the applicant’s knowledge. Before the application can be processed, the certificate shall be dated and signed by the applic…

§ 22.36. Authorization. By signing/marking the certification and authorization statement on the application form, the applicant authorizes: (1) The Department to verify any information on the form by contacting the Social Security Administration, the Internal Revenue Service, the…

§ 22.37. Right of appeal. Departmental actions against an applicant which relate to the application process are subject to the right of appeal under § § 22.91—22.95 (relating to claimant hearings and appeals). Source The provisions of this § 22.37 adopted June 15, 1984, effective…

ELIGIBILITY REDETERMINATION PROCESS § 22.41. General provisions. A claimant requests a redetermination of eligibility to participate in the PACE Program each year by completing a PACE application form and submitting it to the Department. Eligibility will continue without interrup…

§ 22.42. Responsibilities of the claimant in the eligibility redetermination process. The claimant has the responsibility to conform to the following: (1) Complete the PACE application form legibly and accurately. (i) Answer questions fully. (ii) Present necessary evidentiary doc…

§ 22.43. Authorized agent. In those instances when the claimant is either adjudicated incompetent or is incapable of filing an application form on the claimant’s own behalf, the Department will accept as authorized agents the persons designated in § 22.34(a) and (b) (relating to …