Section 51.31. Transition of participants

(a) When a participant selects another willing and qualified provider to replace the current provider, both providers shall cooperate with the Department or the Department’s designee, the participant and the participant’s SCO or SCA during the transition between providers.

(b) The current provider shall ensure the following:

(1) Participation in transition planning meetings to aid in the successful transition to the new willing provider.

(2) Cooperation with visitation schedules identified during the transition meeting.

(3) Arrangement for transportation of the participant to support the visitation schedule.

(4) Closing of open incidents in HCSIS.

(5) Undue influence is not exerted when the participant is making the choice to a new willing and qualified provider.

(c) A provider that is no longer willing to provide an HCBS to a participant shall provide written notice at least 30 days prior to the date of discharge to the participant, the Department, the Department’s designee and the SC when the provider is not the SCO or SCA.

(d) The provider shall provide written notification that includes the following:

(1) The HCBS the provider is unwilling or unable to provide.

(2) The HCBS location where the HCBS is currently provided.

(3) The reason the provider is no longer willing to provide the HCBS to the participant.

(4) A description of the efforts made to address or resolve the issue that has led to the provider becoming unwilling or unable to deliver the HCBS to the participant.

(5) Suggested time frames for transitioning the delivery of the HCBS to a selected willing and qualified provider.

(6) The current provider name and Master Provider Index number.

(e) A provider shall continue to provide the authorized HCBS during the transition period to ensure continuity of care until a willing and qualified provider is selected unless otherwise directed by the Department or the Department’s designee.

(f) A provider shall provide written notification to the Department or the Department’s designee if the provider cannot continue to provide the HCBS until another willing provider is selected due to emergency circumstances.

(g) A selected willing provider shall cooperate with transition planning activities including participation in transition planning meetings.

(h) A current SCO provider shall cooperate with transition planning activities including utilization of HCSIS transfer functionality and participation in all transition planning meetings that occur during the transition period.

(i) A provider shall provide available records to the selected willing provider within 7 days of the date of transfer.

(j) This section does not apply to an SSW provider and an AWC/FMS provider.

Notation

Cross References

This section cited in 55 Pa. Code § 51.13 (relating to ongoing responsibilites of providers); 55 Pa. Code § 51.155 (relating to provider closure requirements).