The County Assistance Office (CAO) will send a notice to the individual when it takes or plans to take an action regarding eligibility for Medical Assistance (MA) Long Term Care (LTC) facility or Home and Community Based Services (HCBS). In addition to the notice to the individual, the CAO will send copies of all notices to:
55 Pa. Code §125.1(k)
55 Pa. Code § 133.4(a)
the individual's representative, if someone else applied on behalf of the individual;
the spouse or dependent in the community (if different from the individual's representative) when there is a change in the community spouse maintenance allowance;
the LTC facility;
the LTC Service Provider; and
the agency that determined functional need of the individual when a decision is made on initial eligibility for HCBS or LTC facility services following a Level of Care Assessment (LOCA), also known as the assessing agency. For the 0192, Attendant Care, Independence, COMMCARE and OBRA Waivers an independent enrollment broker, Maximus, determines a HCBS consumer's clinical eligibility.
NOTE: By entering the names of the representative, LTC facility, LTC Service Provider, and assessing agency or independent enrollment broker on the Provider Screen the CAO will ensure that all involved parties will receive copies of the notices generated.
The notice will contain the following information in language that is easily understood:
A statement of action taken or to be taken.
The reason for the action and the effective date.
A citation of the regulations used as a basis for the action.
When applicable, the information needed to establish eligibility or continued eligibility.
The right to appeal any action and the right to a fair hearing.
The name of the CAO worker and the telephone number of the CAO.
A listing of individuals or organizations that provide free legal services.
When one type of notice is specified for a particular action, another notice is not required. For example, a Confirming Notice is not sent to confirm that the action proposed by an Advance Notice was actually taken.
NOTE: System generated notices should be sent when available because the system generated notices contain the appropriate citations and all pertinent information in language that is easily understood. Unlike manual notices, the date system generated notices were processed and mailed is easily documented. . Reprints of system generated notices are available in e-CIS by accessing the 'Correspondence' tab.
Issued May 1, 2012