An individual who is eligible for payment of Long Term Care (LTC) facility services will receive certain medical, rehabilitative, and social services in return for a specified per MA LTC rate of payment to the LTC service provider. The Department of Public Welfare (DPW) will determine the MA LTC rate for each LTC service provider. Each LTC service provider will have its own MA LTC rate. The LTC service provider may only charge the MA LTC rate for services provided.
Exception: An LTC service provider may charge the private rate if a individual does not qualify for payment of LTC services because a penalty period has been imposed for the transfer of assets for less than FMV. See Chapter 440.8, Disposition of Assets for less than FMV.
The individual must pay for services which are not included in the MA LTC rate or are not covered by MA. 55 Pa. Code § 1181.51
The LTC service provider is subject to an audit of its billing by DPW. 55 Pa. Code § 1187.71.(g)
The CAO will issue an MA identification card, called the Pennsylvania ACCESS card, to the following individuals receiving MA LTC:
Individuals who qualify for Supplemental Security Income (SSI) or Categorically Needy Non-money Payment (NMP) MA LTC.
Individuals who qualify for Medically Needy Only (MNO) MA LTC.
See the Medical Assistance Eligibility Handbook, Chapter 338, MA Benefits, for information about the medical benefits available to individuals.
Issued March 12, 2012