PMN-21273-489 - Revised PA 1768 - Home and Community-Based Services (HCBS) Eligibility/Ineligibility/Change Form, March 21, 2023
PMN-20929-489 Procedure for entering Medicare Part B Premiums on Living Independence for the Elderly (LIFE) Waiver Cases when the Recipient Resides in a Long-Term Care (LTC) Facility, June 13, 2022
PMN-20796-489 How to Process Community HealthChoices (CHC) Waiver Cases with the Correct Enrollment Date after Encountering a TIPR Error, March 10, 2022
PMN-20564-489 - Living Independence for the Elderly (LIFE) County Assistance Office (CAO) Processing Error and Creation of the LIFE Issues Desk Guide, June 28, 2021
PMN-20427-489 - Statewide Living Independence for the Elderly (LIFE) Enrollment by the Independent Enrollment Broker (IEB), April 12, 2021
PMN-20129-489 - Updated Hearings and Appeals Procedure for Nursing Facility Ineligible (NFI) Determinations, August 25, 2020
PMN-19874-489 - Changes to Processing Procedures for Home and Community-Based Services (HCBS) Eligibility/Ineligibility/Change (PA 1768) Forms Received for the Living Independence for the Elderly (LIFE) Program with An Assessment Date, April 13 2020
PMN-19665-489 - End Dating Waiver Screens in eCIS With a Future Date, October 30, 2019
PMN-19521-489 - Individuals Receiving Home and Community-Based Services (HCBS) in Modified Adjusted Gross Income (MAGI) Budget Categories, August 13, 2019
PMN-19278-489 - OBRA Waiver Recipient Re-Assessments, February 26, 2019
PMN-18898-489 - OBRA Waiver Recipient Re-Assessments, May 1, 2018
PMN-18894-489 - Address for correspondence and notices for LIFE participants, April 30, 2018
PMN-18673-489 - End Dating Waiver Discharge Codes, August 31, 2017
PMN-18583-489 - Home and Community Based Services (HCBS) in a Medical Assistance for Workers with Disabilities (MAWD) Category, July 17, 2017
PMN-18478-489 - Capitated Rates Paid to LIFE Program Providers, May 10, 2017
PMN-18176-404 - Transfer from Act 150 Program to the Attendant Care Waiver, August 25, 2016
PMN-18079-489 - Overlapping 902Z and 903Q TPLs on Long Term Care (LTC) records of recipients, June 27, 2016
The Federal government permits states to waive certain Medical Assistance (MA) program requirements in order to provide Home and Community Based Services (HCBS) to specific groups of clients. HCBS Programs are an alternative to institutional or extended inpatient hospital care.
HCBS Programs are sometimes called Waiver Programs. Both terms mean the same thing. All HCBS Programs are made available through one of the Department's various Program Offices.
HCBS Programs allow the Department to provide medical benefits to an individual who may not otherwise qualify for MA. HCBS Programs may also provide services which are not normally covered by MA. HCBS Programs are available to an individual as long as the estimated cost does not exceed the cost of institutional or inpatient care.
The Department of Human Services (DHS) will make a payment towards the cost of Long-Term Care (LTC) services for an individual who is eligible for MA LTC. An individual must be both medically and financially eligible to receive payment.
A HCBS provider agency, Independent Enrollment Broker (IEB), local Area Agency on Aging (AAA) office,or County Mental Health for Individuals with Intellectual disabilities (MH/ID) program is responsible for determining an individual’s medical eligibility for services.
The County Assistance Office (CAO) is responsible for determining financial eligibility for MA LTC services.
The determination of financial eligibility is a two step process. Throughout the LTC Handbook there are references to STEP 1 and STEP 2. In STEP 1, the CAO will determine eligibility for MA/LTC for both LTC facility services and HCBS. In STEP 2, the CAO will determine the amount of the individual’s payment towards the cost of LTC facility services. There is no payment from the individual towards the cost of HCBS.
See LTC Handbook Chapter 404, Application, and Chapter 479, Reconsidering Denied Applications and Reopening Benefits, for policy and procedures regarding application and reconsideration for HCBS programs. The policy and procedures in these chapters apply to the HCBS programs listed here as well as to MA LTC services provided in a facility.
See LTC Handbook Chapter 440, Resources, Chapter 450, Income, and Chapter 468 Eligibility and Payment when determining eligibility for HCBS programs. The policies and procedures in these chapters apply to the HCBS programs listed here as well as to MA LTC services provided in a facility.
In addition to the requirements of the LTC Handbook, the requirements of the following chapters of the Medical Assistance Handbook apply to an individual in a HCBS Program:
The Commonwealth of Pennsylvania offers the following HCBS programs:
Adult Community Autism Program (ACAP) (Waiver Code 51)
Aging Waiver (Waiver Code 38)
Attendant Care Waiver (Waiver Code 40)
Autism Waiver (Waiver Code 52)
Community HealthChoices Waiver (Waiver Code 20)
Community Living Waiver (Waiver Code 81)
Consolidated Waiver (Waiver Code 77)
Independence Waiver (Waiver Code 42)
Infants, Toddlers and Families Waiver (Waiver Code 70)
LIFE (Living Independence for the Elderly) (Waiver Code 96)
OBRA Waiver (Waiver Code 79)
Person/Family Directed Support Waiver (Waiver Code 68)
NOTE: The TFAC and TWAI tables within CIS Systems Reference Table Inquiry list Waiver codes.
42 U.S.C. § 1396n(i)(1)
Updated March 30, 2020, Replacing February 6, 2020