Section 51.62. Vendor goods and services reimbursement

(a) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:

Vendor—A company that sells goods and services to the general public that also agrees to sell those goods or services to a participant at the same cost they charge to the general public.

Vendor goods and services—A type of service that is offered to the general public and a participant.

(b) In accordance with the approved applicable waiver, including approved waiver amendments, vendor goods and services include the following in the Consolidated and P/FDS Waiver:

(1) Public and mile transportation.

(2) Education support.

(3) Home accessibility adaptations.

(4) Vehicle accessibility adaptations.

(5) Assistive technology.

(6) Respite camp.

(7) Specialized supplies

(c) In accordance with the approved applicable waiver, including approved waiver amendments, vendor goods and services include the following in the Adult Autism Waiver:

(1) Community transition.

(2) Assistive technology.

(3) Environmental modification.

(d) The Department will publish changes to vendor goods and services as a notice in the Pennsylvania Bulletin.

(e) For a provider of a vendor goods and services to receive payment directly from the Department, the vendor shall meet the requirements in § § 51.11 and 51.13 (relating to prerequisites for participation; and ongoing responsibilities of providers).

(f) A provider of a vendor goods and services may only include administrative expenses in the cost of the vendor goods and services when the following are met:

(1) The amount does not exceed $25 or 15% of the cost of the good or service, whichever is less.

(2) The administrative activity performed must be required for the provider to deliver the vendor goods or services to a participant.

(3) A provider of a vendor goods and services shall document the activity that supports the administrative expense included in the cost of the vendor goods and services.

(g) A provider of vendor goods and services may not be reimbursed for rendering vendor goods and services if it contracts with an entity or participant who is listed on the LEIE, EPLS or Medicheck list.

(h) A provider of vendor goods and services may not be reimbursed for rendering vendor goods and services if it contracts with a provider or individual who employs staff that are listed on the LEIE or EPLS.

(i) A provider of vendor goods and services is responsible for ensuring that each subcontractor with which it contracts meets the applicable provisions of this chapter and the HCBS is rendered in accordance with the approved applicable waiver, including approved waiver amendments.

(j) A vendor shall provide the SCO, the Department or the Department’s designee with a signed statement that attests that the:

(1) Cost of the vendor goods or services is the same cost charged to the general public.

(2) Amount added to the cost for administration expenses is in accordance with the Department’s requirements in subsection (f)(1)—(3).

(k) The Department or the Department’s designee may review documentation of a provider of vendor goods and services at any time.

(l) Subsections (b) and (f) do not apply to a provider of HCBS in the Adult Autism Waiver.

(m) Subsection (c) does not apply to a provider of HCBS in the Consolidated and P/FDS Waivers.

Notation

Cross References

This section cited in 55 Pa. Code § 51.43 (relating to Department rates and HCBS classification); and 55 Pa. Code § 51.61 (relating to vendor goods and services applicability).