The individual (or an individual's representative) must let the CAO know of changes that might affect the individual's eligibility for the Personal Care Supplement. 55 Pa Code 299.22
Exception: Changes in the individual's income and resources must be reported to the SSA. The SSA decides on the individual's continued eligibility for SSI benefits. The SSA must use (Notice of SSI Eligibility)SSA 8036 to report changes in SSI eligibility to the CAO.
Changes that might affect an individual's eligibility include, but are not limited to, the following:
The individual is permanently discharged from the PCH or Dom Care Home. This does not include a short stay in a hospital or a Long Term Care (LTC) facility. It may be necessary to contact the SSA to see whether they have confirmed that the stay is temporary. ( Long Term Care Handbook, Section 405.2, SSI Category), for an explanation of continued SSI payments while in a LTC facility.
The individual passed away. The operator of the PCH or Dom Care Home must report the death.
The individual moves from a PCH to a Dom Care Home or from a Dom Care Home to a PCH.
The individual's functional disability changes, and so he or she no longer needs to be in a PCH or Dom Care Home. The CAO must ask the home operator to have the individual's physician fill out a new MA 51. The operator must forward the MA 51 to AAA for review. AAA will let the individual, the operator of the home, and the CAO know of its decision on the AAA Level II Client Determination Report.
NOTE: AAA must let the individual know that he or she is no longer eligible for the supplement within 10 days of the date the decision is made. The CAO must also send the individual an advance notice to let the individual know he or she is no longer eligible for the supplement.
If the individual is no longer eligible for the supplement because of the change, the CAO must send a Termination: State Supplement for Domiciliary Care (PA 746) to the SSA.
NOTE: If the supplement was for a PCH, the CAO must write "PERSONAL CARE HOME" in the upper-right corner of the PA 746.
The CAO must provide a notice of a change in eligibility to the individual as it would for any other SSI recipient. ( Chapter 387, Supplemental Security Income.) The CAO must send a copy of the notice to AAA.
If the individual is ineligible for SSI benefits because of unreported income or resources, the CAO must complete an Overpayment Referral (FAIR 189). ( Supplemental Handbook, Chapter 910, Restitution and Disqualification.)
Updated February 14, 2012, Replacing February 8, 2002