Section 51.11. Prerequisites for participation

(a) In addition to the requirements under Chapter 1101 (relating to general provisions) to become an enrolled provider, the provider shall:

(1) Complete the provider enrollment application on a form prescribed by the Department.

(2) Sign an MA provider agreement and an HCBS waiver provider agreement.

(3) Submit supporting qualification documents identified on the Department’s web site to the Department or the Department’s designee.

(4) Comply with the approved applicable waiver, including approved waiver amendments, and any other applicable licensing requirements as identified in § 51.4 (relating to incorporation by reference).

(5) Send a complete enrollment package to the Department or the Department’s designee.

(b) New providers shall complete and submit the provider monitoring documentation designated for new providers before being authorized to provide HCBS.

(c) A provider shall be qualified by the Department for each HCBS the provider intends to provide prior to rendering the HCBS.

(d) The provider shall submit any missing supporting qualification documentation materials requested by the Department or Department’s designee within 30 days of notification by the Department.

(e) If missing supporting qualification documentation is not submitted within 30 days of notification, the enrollment application will be considered withdrawn by the Department and will not be processed.

(f) A provider may submit a new enrollment application after the previous enrollment application is withdrawn by the Department.

(g) A provider will not be paid until the provider is qualified and authorized by the Department or the Department’s designee to provide an HCBS.

(h) A provider shall comply with the training requirements as specified in § 51.23 (relating to provider training).

(i) A provider may not influence a participant’s freedom of choice in selecting a new provider.

(j) Subsection (b) does not apply to a provider of HCBS in the Adult Autism Waiver.

(k) This section does not apply to an SSW provider.

Notation

Cross References

This section cited in 55 Pa. Code § 51.62 (relating to vendor goods and services applicability).