If AAA decides that the individual is functionally disabled and the application is complete, the CAO must send a Notice to Applicant with Your Right to Appeal and to a Fair Heading. The CAO must forward the PA 747 to the SSA to approve payment of the Personal Care Supplement. 55 Pa Code 299.36 (2)(iv)(A)
If the individual is receiving SSI, the SSA will add the supplement to the federal benefit and let the individual and the CAO know of the change in the benefit amount.
If the individual is not getting SSI benefits or has not been found eligible, the CAO must send the PA 747 to the SSA. SSA must determine financial eligibility for SSI using the higher income limit of the combined federal benefit level and personal care supplement. The SSA will determine the amount of the payment and inform the individual.
When the individual's SSI eligibility is determined, the CAO must send a copy of the Notice to Applicant and the PA 747 to AAA.
For the effective date on the PA 747, the CAO must use one of the following dates, whichever is later:
The date that AAA stamps the application with the date (Section 4 of the PA 761).
The date of placement in the PCH or Dom Care Home.
The SSA sets the effective date that the supplement must be paid by using the date the CAO enters on thePA 747 and the following rules:
If the individual is getting SSI, the effective date is the first day of the month in which the application is received and stamped with the date by the assessment agency.
If the individual is approved for SSI but is not yet getting SSI benefits, the effective date is one of the following:
The date SSI began if the PA 761 or PA 1-D is dated after the SSI begin date and in the same month as the SSI begin date.
The date SSI began if the PA 761 or PA 1-D is dated in a month prior to the SSI begin date.
The first day of the calendar month in which the PA 761 or PA 1-D is dated if it is dated in a calendar month following the month SSI began.
NOTE: The SSI begin date is based on the date the SSA accepts an application either by telephone, in person, at the SSA office or the date the application is date-stamped in the SSA. There is no retroactive eligibility for the Personal Care Supplement . The CAO should not authorize the Personal Care Supplement prior to the date SSI began.
The CAO must assign category A, J, or M to the recipient of SSI and the Personal Care Home or Domiciliary Care Facility supplement. See Chapter 387, Supplemental Security Income, for a description of each category.
When an alert on Exchange #6 of IEVS shows that SSI has been opened or that the supplement has been added to an existing SSI benefit, the CAO must open the SSI case on CIS (if it is already open) and enter the right Program Status Code on CACOMP and the Facility Code on CAIFAC.
Program Status Codes
60—Individual receiving Domiciliary Care Supplement
62—Individual receiving PCBH supplement
Facility Codes
75—Domiciliary Care Facility
76—Personal Care Home
The State Living Arrangement Code (SLAC) found on the Basic Information tab on SDX Data Exchange 6, verifies the individual's living arrangement. A "G" designates the individual is residing in a Dom Care Home. An "H" designates a PCH.
NOTE: When justified by the level of care determination reported on a PA 1768, Dom Care and PCH residents could require concurrent entry of facility and waiver codes.
A Notice to Applicant (PA/FS 162) and the most current version of Your Right to Appeal and to a Fair Hearing (PS/FS 162F) found in Docushare, must be sent to the individual as soon as the CAO gets the application from AAA.
The CAO must write "Personal Care Supplement" in the "Other" benefit block on page one of the PA/FS 162 found in Docushare and use the language and regulations shown in Appendix B to explain to the individual the action that was taken.
Advance notice on the PS/FS 162A with the PS/FS 162F must be sent with the appropriate language and current regulations when a change in PCH supplement eligibility is being communicated with a recipient.
NOTE: The MA Non Money Payment (PA/162MN) is never appropriate to use for PCH supplement notification.
Updated April 8, 2016 Replacing May 7, 2015