The CAO will send a Confirming Notice to advise the individual that an action has been taken when:
The individual's payment toward the cost of LTC facility services decreases.
NOTE: A notice is not required if there is no change in the individual's payment toward the cost of LTC facility services or for changes in medical expenses which are verified by the LTC facility and adjusted by the facility through the billing process.
MA LTC facility services payments are discontinued or the individual's payment toward the cost of LTC facility services increases because:
factual information known to the CAO, such as receipt of a LTC Admission and Discharge Transmittal (MA 103) from the LTC facility or a newspaper obituary, confirms the death of the individual. The effective date of discontinuance is the date of death.
the CAO receives an MA 103 from the LTC facility indicating that the individual no longer requires LTC facility services.
the CAO receives an MA 103 from the LTC facility reporting the individual's discharge from the facility either to the community or to another facility. For a move to a facility in another county, the CAO will complete an inter-county transfer. See Chapter 423.6, Changes in Residence/ Discharge/ Transfers.
the CAO receives a statement signed by the individual or someone acting on the individual's behalf requesting the decrease or termination of continued LTC facility services payments. The statement must be a consent for that specific action, not blanket consent for all changes.
the individual's whereabouts are unknown and DPW mail, such as CAO correspondence, client messages, or ACCESS cards have been returned.
NOTE: The CAO will contact the LTC Service Provider to determine the reason for the returned mail. An individual could be hospitalized. Caution should be exercised before closing a case due to returned mail. 55 Pa. Code § 133.4(c)
Because the LTC facility does not submit its billing for a calendar month until the following month, the CAO may send the Confirming Notice at any time during the month the change is effective.
Example: On 4/10 an individual's representative reports a decrease in the person's income beginning in April. The CAO sends a Confirming Notice on 4/19 with an effective date of 4/1. The LTC facility will submit its billing in May for the calendar month of April.
MA and/or HCBS are discontinued because:
factual information known to the CAO, such as receipt of a Home and Community Based Services Eligibility/ Ineligibility Change Form (PA 1768) from the HCBS provider or a newspaper obituary, confirms the death of an individual. The effective date of discontinuance is the date of death;
the CAO receives a PA 1768 indicating that the individual no longer requires HCBS;
the CAO receives a PA 1768 reporting the individual's transfer to another HCBS waiver or a transfer to another county. For a change of address to another county in PA, the CAO will complete an inter-county transfer. See Chapter 423.6, Changes in Residence/ Discharge/ Transfers;
the CAO receives a statement signed by the individual or someone acting on the individual's behalf requesting the decrease or termination of continued HCBS. The statement must be a consent for that specific action, not blanket consent for all changes; or
the individual's whereabouts are unknown and DPW mail, such as CAO correspondence, client messages, or ACCESS cards have been returned.
NOTE: The CAO will contact the HCBS provider to determine the reason for the returned mail. An individual could be hospitalized. Caution should be exercised before closing a case due to returned mail.
Issued May 1, 2012