A written notice to the applicant or recipient is required when an action is proposed or taken regarding eligibility for Medical Assistance (MA). If a representative applies on an individual’s behalf, a copy of all notices is also sent to the representative. 55 Pa. Code § 125.1 55 Pa. Code § 133.4(a)
The CAO must send a copy of the notice to the LTC Service Provider, including any agencies that assess, enroll, and disenroll individuals in Home and Community Based Services (HCBS) when:
Eligibility is determined.
A change occurs in the MA LTC benefit.
MA LTC eligibility is discontinued.
To ensure a notice is sent to the LTC Service Provider, the following steps must be taken:
Enter a “Y” to “CC Notices” on CACASE to queue CAPROV.
Enter the provider number or the provider name and address on CAPROV.
Pressing the “F6” function key will schedule additional provider screens if needed.
Ensure a “Y” is populated on the “Copy Provider” field on CACNAN.
Enter a “Y” to copy each provider on CANOCA.
NOTE: Steps to follow in e-CIS
Enter a "Y" in "Add/Modify Provider" field on the household page.
Complete all required fields on the "Vendor/Provider" screen.
Click "Add More" button to add additional providers.
The provider information will be saved in CIS; however, a notice will not automatically go to the provider when a future change is made. When a change requiring a notice occurs during case maintenance, the CAO must enter a “Y” on CANOCA to generate a notice to the provider.
NOTE: For individuals enrolling in an HCBS program, the CAO may need to contact the assessment agency if the address is not provided on the HCBS Eligibility/Ineligibility/Change form (PA 1768).
The notice will contain the following information in language that is easily understood by the applicant or recipient:
A statement of the action taken or to be taken.
When applicable, the information needed to establish eligibility or continued eligibility.
The reason for the action and the effective date.
A citation of the regulations used as a basis for the action.
Information regarding the right to appeal any action and the right to a fair hearing.
NOTE: Individuals have 30 days from the mailing date on the notice to submit an oral or written request for an appeal. If the request for an appeal is postmarked or received orally or in writing 15 days from the processing date, benefits will continue unchanged pending the hearing decision.
A listing of an individual or organization that provides free legal services.
The name of the County Assistance Office (CAO) worker and the telephone number of the CAO.
Mailing date:
The mailing date must be included on all notices.
The mailing date for all notices (manual or system-generated) is the next business day after the transaction processing date.
Example: On Friday May 23rd, the CAO processes a change that results in the discontinuance of MA benefits. Monday, May 26th is a holiday. The mailing date is Tuesday, May 27th.
CAOs are to utilize system-generated notices whenever possible. If a situation occurs in which a system-generated notice cannot be sent, the CAO will send the most current manual notice available on DocuShare.
While CIS sends separate system-generated notices for Cash Assistance, SNAP, and MA, the CAO may include information about Cash Assistance, SNAP and MA budgets on a single manual notice (PA162), if appropriate. Notice text may be found in the CIS Systems Reference Table: TNRT.
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.
Updated May 19, 2017, Replacing February 14, 2012