391.3 Application for the Supplement

The individual applying for a Personal Care Supplement (or someone acting for the individual) must complete and sign one of the following applications:

55 Pa. Code § 299.22

If the individual is not receiving SSI or is not eligible for SSI, he or she must also:

NOTE:  For the date of the SSI application, the SSA uses the date that the first contact for SSI benefits is made.  The SSA must be told at that time that the individual is also applying for a Personal Care Supplement.  If the individual's income is more than the regular SSI limit, AAA may need to call the SSA to confirm that the individual is functionally disabled.

391.31 Duties of the PCH or Dom Care Home Operator

When the application process begins with the PCH or Dom Care Home, the operator of the home must take the following actions:    55 Pa Code § 2600.141  

NOTE:  If the individual is not getting SSI and needs Medical Assistance (MA) to pay for the exam, AAA must tell the individual to submit a completed PA 600 to the CAO.

391.32 Duties of the Area Agency on Aging (AAA)

When AAA receives an application for a personal care supplement, it must take the following actions:

NOTE:  If the individual does not turn in the needed forms, notify the individual that the application cannot be processed   until he or she does so.

NOTE:  If the individual is not an SSI recipient needs Medical Assistance (MA) to cover the cost of the exam, AAA will refer the individual to the CAO for an application for MA.  A PA 600 is required.

NOTE:  AAA has a list of Dom Care Homes, but, generally, it is the individual's (or their representative’s) duty to find a PCH. A list of licensed PCH providers is available from the Department’s regional licensing offices. See Appendix C for the addresses and telephone numbers of the regional offices.       

391.33 Duties of the CAO

When the CAO receives the application and completed forms, the CAO must take the following actions:

NOTE:  The Department maintains a Personal Care Home Directory of all licensed PCHs in the State. If a certificate of compliance is not included with the application it can be found by accessing the PCH Directory online at the Department’s website, www.dpw.state.pa.us. A copy should be made for the case record.

NOTE:  The Notice to Applicant is the formal notice of the individual's right to ask for a fair hearing.   If the individual appeals the AAA decision, notify AAA of the request and the date and time of the hearing. An individual from the Area Agency on Aging must attend the hearing to explain the decision, if an explanation is needed.       55 Pa. Code § 299.22 (d)

NOTE:  If the PA 747 is being used to authorize the personal care supplement in a PCH, write “PERSONAL CARE HOME” in the upper-right corner.

NOTE:  The Client Information System (CIS) will not allow entry of a program status code designating eligibility for the personal care supplement (60 or 62) until eligibility for the supplement is showing on Data Exchange 6. The CAO must wait until the SDX Data Exchange shows the Personal Care Supplement as being received before  Program Status Code 60 or 62 can be entered into CIS.

NOTE:  The Client Information System (CIS) will not allow authorization in an SSI category (A, J, M) until the SSA determines eligibility for SSI benefits. The CAO cannot authorize MA in an SSI category until eligibility for SSI is verified on the SDX Data Exchange.

If the SSA determines that the individual is not eligible for SSI benefits, the SSA will return the PA 747 to the CAO. Notify AAA of the SSA’s decision.  If the individual needs or requests MA before the SSA makes its decision, explain the application process and give him or her a PA 600.

391.34 Referral to SSA

If an applicant for a PCH or Dom Care Supplement is being referred to SSA for a determination of SSI eligibility, the home operator and/or AAA will help the individual or representative with the application, if help is needed.  SSA determines the date of the SSI application based on the date the initial contact regarding SSI was made.  The first contact should be a telephone call to SSA requesting benefits

It is important for the individual or representative to tell SSA that an application is also being submitted for the Personal Care Supplement.  If the individual's income exceeds the normal SSI eligibility limit, AAA may need to contact SSA by phone on the individual's behalf, to verify the individual's determination of functional disability.  If a request is not made by phone, the date of initial contact is the date SSA receives the application.  To avoid a loss of benefits, the CAO should advise the individual to make the request by phone.

NOTE: The individual must enter the facility within 30 days of  SSA’s decision.

If the individual's countable net income is more than the federal SSI benefit rate but less than the federal benefit rate plus the Supplement, SSA will issue an SSI check for the amount of the supplemental benefits for which the individual is eligible.  SSA allows a $20 income disregard.

 

Updated February 14, 2012, Replacing February 8, 2002