55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL)

What this rule requires your agency to do

• 1A provider must attend new-provider training within 180 days of enrollment, update and submit provider qualifications under § 52.11(a)(3)-(7) to the Department at least every 2 years, and notify the Department at least 30 business days before changes such as address, incorporation, license status, or insurance cancellation (§ 52.14).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 2As a condition of participation, a provider must create and follow written policies and procedures covering compliance, nondiscrimination, ADA, HIPAA, staff training, complaint management, critical incident management, quality management, criminal-history screening, SSN verification, exclusion screening (LEIE/EPLS/Medicheck), and language access, and must carry commercial general liability, workers' compensation, and (if required) professional liability insurance (§ 52.11).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 3A provider must retain books, records, and documents supporting service provision for at least 5 years after the provider's fiscal year-end (longer if litigation, investigation, or unresolved questions exist), and must report a change in ownership or 5%-or-more controlling interest in writing at least 30 days before the effective date (§ 52.43, § 52.44).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 4A provisional hire pending a criminal history check may not exceed 30 days (2-year-plus PA residents) or 90 days (others), the person must swear in writing they are not disqualified, must be monitored through random direct observation and participant feedback documented in the file, and must be terminated immediately if the check reveals disqualification (§ 52.20).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 5Prior to hiring any employee who may have contact with a participant, a provider must obtain a criminal history check (PA State Police for 2-year-plus residents; FBI for others) in accordance with the Older Adults Protective Services Act, and keep the final report in the provider's records (§ 52.19).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 6A provider must implement standard annual staff training covering prevention of abuse/exploitation, reporting critical incidents, complaint resolution, Department-issued policies, the provider's quality management plan, and fraud/financial abuse prevention, and must maintain documentation of attendance and training content (§ 52.21).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 7A provider must use the Department's designated information system to record service plan information and complete and maintain documentation on service delivery, keeping records HIPAA-compliant (§ 52.15).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 8A provider must report critical incidents to the Department or SCE on the prescribed form, develop and implement written critical-incident policies and procedures, and implement a complaint-management system reviewed at least quarterly (§ 52.17, § 52.18).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 9A provider must render and bill services only in the type, scope, amount, duration, and frequency specified in the participant's Department-approved service plan, and may not bill for services when the participant is unavailable (§ 52.14, § 52.42).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))
• 10A service coordinator must meet the education/experience qualifications, complete at least 40 hours of training in the first year of employment and at least 20 hours of training annually thereafter (§ 52.27).(55 Pa. Code Chapter 52 — Home and Community-Based Services (OLTL))