To be eligible, households meeting certain conditions must complete and turn in a reporting form every six months. A semiannual reporting (SAR) form is sent to the households and information from the form is used to decide on a household’s continued eligibility for the next semiannual (six-month) period or the next renewal, whichever is sooner.
NOTE: See Appendix A for information on how often a renewal is needed and whether a semiannual review (SAR) is needed for each MA program category.
A SAR review is required for the following categories:
Nonmoney Payment (NMP) categories - PD00, PD21, PD22.
Medical Assistance for Workers with Disabilities (MAWD) - PW00, PW66, PW80, PI00, PI80.
Medically Needy Only (MNO) categories TD00, TD22, TA00, TA22, TA66, TA80, TJ00, TJ22, TJ66, TJ80, TC00, TC22, TU00, TU22.
Exceptions: TA65, TA67, TJ65, TJ67 and Long-Term Care and Home and Community Based Services categories (TAN, TJN, TAW, TJW).
CIS or eCIS will set the SAR review date for six months or six months from the last renewal, whichever is sooner. The SAR form will serve as:
55 Pa. Code § 133.83(a)(1)(ii)
The complete renewal for TD budgets.
The partial renewal for TA, TJ, and TC budgets.
The premium review for MAWD budgets.
eCIS will set the next SAR review for six months or the next complete renewal, whichever occurs first.
When an MNO budget with a patient pay liability or a retroactive period is opened with another SAR budget, a SAR period for each SAR budget may be needed at first to fit the program rules.
An MNO budget with a patient pay liability cannot be set with any other SAR budgets in the record until the patient pay liability period has ended.
All SAR reviews must be processed through a Partial Reapplication workflow in eCIS. To set a new SAR period for any category, the CAO must first process only that particular category through a Partial Reapplication workflow.
Enrollment in SAR does not change the need for the client to report changes that affect continued eligibility. A reported change must also be included on the next SAR form. The CAO must take timely action on information provided, no matter how it is reported.
The SAR system controls what benefits are given to budget groups that are enrolled in SAR. The CAO must enter data into the system to show whether the SAR form is complete or incomplete. Updating of the system is called tracking.
The SAR form requests a signature in the “certification” area. There is no policy or federal regulation that requires a signature to be in a specific area. If the signature on the form is outside of the certification area, track the form as complete and contact the client to determine if they are claiming good cause or filing an appeal. Results on the contact should be recorded in the case narrative. No signature is required if an ex-parte review can be completed and the SAR/LIN can be processed.
NOTE: If the SAR/LIN is processed electronically and the signature is located outside of the certification area, the system validations will fail and a work item will be created and assigned to the IMCW to review the form and contact the client.
If the SAR form is not received or there is information missing, it is tracked as incomplete. The system creates a late/incomplete notice (L/IN). If the L/IN is not received by the due date or it is received incomplete, the CAO must complete an ex parte review. If all necessary verification is available through electronic data sources and/or the case record, process the Partial Reapplication workflow in eCIS. If all necessary verification is not available through electronic data sources and/or the record, the CAO must send an advance notice and discontinue benefits.
Reminder: If data source income will result in a reduction in benefits or budget closure, the SAR cannot be completed ex parte and must be closed 042.
MA benefits subject to SAR must be closed if the client does not meet the semiannual reporting rules.
MA benefits that are not subject to SAR must not be closed if a SAR or L/IN form is not received for other benefits (MA benefits subject to SAR, SNAP, TANF).
1. Complete an ex parte review (See Section 376.22, Ex Parte Review).
Note: A signature is not required for MA if an ex parte review can be completed and the SAR or L/IN can be processed.
2. If verification is available from data sources and the case record, track the SAR as complete and process the SAR. If verification is not available, continue to step 3.
3. If verification is not available through data sources or the case record, track the SAR as incomplete and send the L/IN form.
4. When the L/IN form is received, review for completeness. If all necessary information was provided, process the Partial Reapplication workflow in eCIS. If all necessary information is not provided, or if the L/IN was not received by the due date, continue to step 5.
5. Complete an ex parte review. If all necessary verification is available through data sources and/or the case record, process the Partial Reapplication workflow in eCIS. If all necessary verification is not available through electronic data sources and/or the record, continue to step 6.
6. Complete the supervisory checklist, close MA with reason code 042 and complete a narrative.
If the SAR form is not received, track as not received and generate a L/IN form. Begin at step 4 in the instructions above.
If a SAR or L/IN is generated for a case with a combination of benefits (MA with SNAP and/ TANF), and all necessary verification is not returned with the form, complete the following steps:
Review the form and determine if any reported change that may affect MA eligibility.
If there is a reported change that affects MA eligibility, complete an ex parte review for all MA budgets (See Section 376.22, Ex Parte Review).
If the reported change can be verified using electronic data sources or information in the case record, process the SAR or L/IN form via a Partial Reapplication workflow. Narrate all case actions.
If the reported change cannot be verified using electronic data sources or information in the case record, complete the MA Closure Checklist and close MA with reason code 042 and send a 15-day advanced notice.
If the reported change does not affect MA eligibility, continue MA benefits.
If a SAR or L/IN is generated for a case with a combination of benefits (MA with SNAP and/ TANF), and is not returned, the CAO must complete an ex parte review before the MA can be closed (See Section 376.22, Ex Parte Review).
Note: If a SAR or L/IN is generated for a combination case containing MA budgets that are not subject to SAR, the CAO must take no action on the MA budget, regardless of whether the SAR is returned.
Updated January 23, 2020, Replacing July 2, 2019