State regulations that contain requirements of participation and rate setting provisions for non-public nursing facilities participating in Medicaid.

State regulations that contain requirements of participation and rate setting provisions for county nursing facilities participating in Medicaid.

COMPASS is an online application for Pennsylvanians to apply for many health and human services programs – Medicaid is among the programs. Nursing facilities can sign up to be a Community Partner in the COMPASS system and apply for Medicaid for their residents.

The Office of Income Maintenance oversees all County Assistance Offices which, among other things, process financial eligibility applications for individuals in need of long-term care services. This handbook outlines the policies that are used in the determination process.

Claims for all health care services with dates of service on or after October 1, 2015, and all hospital inpatient claims with discharge dates on or after October 1, 2015, must use the ICD-10 code sets. This webpage provides information and resources related to this code set.

The PROMISe system is the system MA participating nursing facility providers use to submit claims for services provided to MA residents.

Provides a block-by-block reference guide to assist nursing facilities in successfully completing the UB-04 claim form to receive payment for MA residents

On December 30, 2015, the Commonwealth Court held in Peake v. Commonwealth of Pennsylvania, (Peake) that the “lifetime employment ban” contained in the Older Adults Protective Services Act (OAPSA), violates due process guarantees under the Pennsylvania Constitution and is therefore not enforceable. The Court also held that the Department of Aging’s (DOA) previously posted “Interim Policy” (pertaining to the employment of individuals with certain criminal convictions caring for older adults) is invalid.

An Act relating to the protection of the abused, neglected, exploited or abandoned elderly; establishing a uniform Statewide reporting and investigative system for suspected abuse, neglect, exploitation or abandonment of the elderly; providing protective services; providing for funding; and making repeals.

The Pennsylvania State Police Pennsylvania Access to Criminal History website. Its purpose is to better enable the public to obtain criminal history record checks.

The Older Adults Protective Services Act (OAPSA) mandates employees or applicants hired after July 1, 1998, in covered facilities (which includes nursing facilities), to obtain a report of criminal history information from the Pennsylvania State Police (PSP) PATCH Program. If this is not available, a statement from the PSP stating that they are not on record in the central repository must be obtained. If an employee or applicant has not been a resident of Pennsylvania for the two years immediately preceding the employment application, a federal criminal history record must also be obtained. In addition, an FBI check must be submitted to the Pennsylvania Department of Aging (PDA). The FBI will send the results to the PDA. PDA will analyze the results and a letter of employment determination will be sent to the applicant and facility.

The Nursing Facility Report Portal is a secure site for use by Pennsylvania Medical Assistance nursing facilities. Supported processes include CMI Reports; and MA-11 Cost Reports and Supporting Documentation.

An Assessed Nursing Facility must submit resident day data for each Resident Day Quarter using the on-line RDR Form developed by the Department at http://www.PANFsubmit.com. The portal used for this submission is a web site developed to electronically submit this data. This web site and the features that it contains are called the PA NF Submission System.

An MA nursing facility that wants to add beds to their existing bed complement or transfer beds from one MA nursing facility to another is required to seek approval from the Department of Human Services through the Participation Review Bed Request process, prior to the implementation of the project. Additionally a nursing facility that is receiving capital payment for their MA beds and wants to replace all or a portion of the beds is required to seek approval from the Department through the replacement bed process. This webpage provides information on the process and contains the public notices relating to bed requests.

The Omnibus Budget Reconciliation Act requires all individuals seeking admission to a Medicaid certified nursing facility regardless of payor source to be subject to Preadmission Screening Resident Review (PASRR) process. The PASRR is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care. PASRR requires that 1) all applicants to a Medicaid-certified nursing facility be evaluated for mental illness and/or intellectual disability; 2) be offered the most appropriate setting for their needs (in the community, a nursing facility, or acute care settings); and 3) receive the services they need in those settings. This link provides access to the PASRR forms; recent training provided by the Department and the PASRR Bulletins.

This webpage contains information for Medical Assistance participating nursing facility providers regarding the case mix payment system, payment rates and the underlying documents and notices used in the rate setting system. Additionally, information related to payments made outside the case mix system, the MDS, CMIs, PSAEs, NF Assessment, Field Operations, OBRA Training, Participation Review and Waivers are made available.

The Department of Human Services issues MA Bulletins to providers participating in the MA Program to clarify existing policies and procedures, and establish new policies and procedures. This link can be used to search for MA Bulletins issued by all DHS program offices, including OMAP and OLTL. MA Bulletins of critical importance to Skilled Nursing Facilities may be found on the MA Bulletins page of the PHCA website.

The Affordable Care Act requires the Department to revalidate all Medical Assistance providers at least every five years. As a result all providers who enrolled as an MA provider on or before March 25, 2011 must revalidate their enrollment information no later than March 24, 2016. This can be accomplished by completing a new enrollment application including all revalidation requirements. The application can be found on this webpage.

The Department provides Quick Tips to assist MA providers with claims billing issues. On the bottom of this webpage is a list of Quick Tips specifically for Long-Term Care Providers.

The Office of Medical Assistance Programs (OMAP) produces and distributes over 70 forms and envelopes for provider use at no charge to the provider. Providers can order forms using this webpage or the MA 300X order form.