Section 1187.175. Criteria for the approval of bed transfer requests

(a) Upon consideration of the information specified in § 1187.174 (relating to information and data relevant to bed requests), the Department may approve a bed transfer request only if the following are satisfied:

(1) The bed transfer request contains the information required under § 1187.172(a) (relating to contents and submission of bed requests).

(2) The receiving provider agrees to achieve and maintain an MA day-one admission rate that is equal to or greater than the surrendering provider’s MA day-one admission rate or another MA day-one admission rate as may be agreed to by the Department.

(3) The change in the bed complements of the receiving and surrendering providers will maintain or improve access to medically necessary nursing facility services for MA recipients.

(4) Neither provider will receive an increase in reimbursement as a result of a change in its peer group if the bed transfer request is approved.

(5) If the proposed bed transfer will result in a change in peer group assignments under this chapter for the surrendering or receiving provider, the change will not have a negative effect on the MA Program, on MA recipients or on other facilities which are members of the affected peer group.

(6) Approval of the bed transfer request will not result in increased costs to the MA Program.

(7) None of the circumstances specified in § 1187.172(a)(4) applies.

(8) Both the surrendering provider and the receiving provider agree that the new or additional beds at the receiving provider shall be licensed, MA-certified and available for immediate occupancy before the surrendering provider decertifies and closes a bed.

(b) The Department may deny a bed transfer request even if the conditions specified in subsection (a) are satisfied if the Department determines one of the following:

(1) Approval of the request would negatively affect the Department’s goal to rebalance the Commonwealth’s publicly-funded long-term living system to create a fuller array of service options for MA recipients.

(2) There are alternatives to the transfer of beds, such as an increase in home and community-based services, that would be less costly, more efficient or more appropriate in assuring that long-term living care and services will be provided under the MA Program in a manner consistent with applicable Federal and State law.

(c) Approval of a bed transfer request is not a determination that additional MA-certified beds are needed to maintain or improve MA recipients’ access to medically necessary services in the primary service area or county in which the receiving provider is located.

Notation

Cross References

This section cited in 55 Pa. Code § 1187.172 (relating to contents and submission of bed requests).