A timely and adequate Advance Notice is required prior to taking any of the following actions: 55 Pa. Code § 133.4(b)
When authorizing each month of monthly Categorically Needy Nonmoney Payment (NMP) Spend-Down. The notice will indicate the spend-down amount and the beginning and ending date of eligibility.
Decreasing or discontinuing MA.
Changing the MA category from NMP to Medically Needy Only (MNO).
Changing the MA category from a TANF-related or SSI-related category (federally funded) to a GA-related category (state funded).
Example: For NMP: PH, PW, PI, PS, PC, PU, PA, PM or PJ to PD;
OR
For MNO: TA, TJ, TC or TU to TD.
Discontinuing Healthy Beginnings for a child who reaches the age limit. 55 Pa. Code § 140.127
Discontinuing Healthy Beginnings at the end of the postpartum period for the mother.
Discontinuing a budget which is actively transferred from one county to another. 55 Pa. Code § 133.4
NOTE: The Advance Notice is sent by the county that the individuals are leaving.
In addition to the information listed in Section 377.1 which is contained on all notices, the Advance Notice will contain:
An explanation of the reason for the action, and the basis on which the decision was made.
The availability of continuing benefits if an action is appealed.
An explanation that the Department will no longer pay the health insurance premium for an individual enrolled in the HIPP Program or Medicare Premium (Buy-In) when MA benefits are discontinued. See Section 338.22, Health Insurance Premium Payment (HIPP) Program.
An explanation that eligibility for services under the Medical Assistance Transportation Program (MATP) will end on the date the MA ends.
NOTE: A Late/Incomplete Notice does not serve as advance notice for those MA budgets enrolled in Semi-Annual Reporting (SAR). For any changes or closings resulting from SAR, an advance notice is required for MA.
A budget closed with an Advance Notice will be closed effective the 15th day from the processing date of the transaction.
Example: The CAO processes the closure of an MA budget on May 1st. The closure date is May 16th.
The CAO will not use the Advance Notice as the first notice to the recipient that has a scheduled appointment or is to provide information to the CAO. The Advance Notice is used only after the recipient has failed to keep the scheduled appointment or failed to provide information within an established time period.
Updated February 14, 2012, Replacing April 22, 2011