A new application (electronic or paper) is not required when MA LTC services were closed because the individual did not complete the renewal process and the individual requests reconsideration, asks for a new application, and/or submits required verification within 90 days of the date of benefits closure.
Exception: If an individual did not submit the PA 600L renewal before LTC/HCBS closed, give the individual or the individual’s representative a PA 600L and have them complete and submit it within 30 days.
The CAO must determine continuing eligibility using all available paperwork and information in the case record when an individual requests reconsideration, submits required documents, and it is within 90 days of benefit closure. Always review information available through electronic data sources. If eligible, reopen benefits effective the day after benefits closure.
Example: LTC/HCBS budget closed for failure to complete the renewal on March 15, 20xx and the appropriate ineligibility notice was sent. Request for reconsideration is received with all necessary renewal information within 90 days but no later than June 12, 20xx.
Reminder: Timely appeal of a closure notice will ensure continuous coverage. Appeals and reconsiderations can be requested concurrently and if resolved, unnecessary appeals will be withdrawn.
A new application is required if the benefits were closed because the applicant(s) was over the income and/or resource limit unless the applicant(s) subsequently provides verification that they were within the allowed income and/or resource limits at the time of closure. Although a new application is not required for reconsideration, the CAO must still register a non-application in e-CIS when the individual submits all required verification.
NOTE: If the individual provides some but not all of the pending information and the closure was appealed, the CAO must continue to work with the individual to obtain the necessary information. New information provided will be reviewed prior to an appeal hearing.
479.31 Procedures for Retroactive CHC Authorizations Due to Reconsideration at Renewal
When the caseworker authorizes HCBS or LTC facility services retroactively for CHC recipients, the caseworker will provide the Office of Medical Assistance Programs (OMAP) with the information required to ensure accurate provider billing and to avoid any gap in coverage. The caseworker is to follow the steps below after opening benefits retroactively:
· Email RA-PWEnrollmentUnit@pa.gov with the following information:
o Master Client Index (MCI) number of the recipient
o First and last name of the recipient
o Retroactive effective date of opening.
o Date data entry was completed by the CAO.
Updated October 14, 2020, Replacing December 4, 2015