|SUBJECT: Personal Care Supplement Application Process|
|TO: Executive Directors|
|FROM: Christine M. Bowser, Director, Bureau of Operations|
To provide information on changes to the application process for the Personal Care Supplement (PCS).
Staff from the Department of Aging (DOA), and the Department of Public Welfare's (DPW) Office of Social Programs and Office of Income Maintenance met with representatives of the Personal Care Home (PCH) industry to resolve complaints about delays and lost benefits to the PCH residents who apply for the PCS.
The complaints include the apparent inconsistency of the application process throughout the state and the confusion regarding how to lock-in a date of application for the PCS versus establishing the date of application for Supplemental Security Income (SSI), since both dates affect when the SSI and PCS payment begins. Additionally, the PCH representatives are concerned that often there is no means of following the progress of an application and no one agency to contact regarding the entire application process. They also indicate that there is no official notification from DPW when an application has been denied because of failure by the applicant to provide all necessary documentation and no way to file an appeal if the date of application for the PCS is in dispute.
Although many OPTIONS offices have procedures in place to keep the applicant advised of the disposition of every application for the PCH submitted to their offices, this practice is not followed statewide. The obligation to officially notify the applicant of the state eligibility requirements for the PCS and whether the individual has met them or not has always rested with DPW.
In the past, an applicant or provider submitted a PA 761 or PA 1-D to OPTIONS but did not always have the MA 51 attached. OPTIONS would not date-stamp the PA 761 or PA 1-D until the completed MA 51 was submitted. As a result, some providers did not submit the PA 761 or PA 1-D until the MA 51 was completed and attached. In both cases, the date of application was delayed and this resulted in lost benefits for the applicant and lost payments to the provider.
In cases where the PA 761 or PA 1-D was submitted but the MA 51 was never received, OPTIONS would not process this as an application and, therefore, no client notice was sent. The applicant often had no idea about the disposition of the application.
As a resolution to the problems listed and to prevent possible lost benefits, the following application procedure was established:
1. The applicant or provider will submit the PA 761 or PA 1-D to OPTIONS as soon as possible to lock-in an application date. It was agreed by both DPW and DOA that OPTIONS may accept a FAXed copy of the PA 761 or PA 1-D as long as both the FAXed copy and the original are sent to the County Assistance Office (CAO).
2. If the MA 51 is not provided at the time that the PA 176 or PA 1-D is submitted, then OPTIONS will notify the applicant in writing of a deadline for submission. However, the PA 761 or PA 1-D will still be date- stamped on the day it is received.
3. The PA 761 or PA 1-D will be held by OPTIONS for at least 60 days pending receipt of the MA 51. PCH licensing regulations mandate that a resident of a PCH (whether an SSI recipient or not) must have a medical evaluation completed and signed by a physician within 60 days prior to or within 30 days after admission. OPTIONS will determine the length of time to allow for submission of the MA 51 based on this PCH licensing requirement.
4. If all documentation is provided as requested by OPTIONS and OPTIONS completes their assessment and determines that the applicant is in need of the level of care required by the Domiciliary Care Facility or licensed PCH, the documents will then be forwarded to the CAO. The CAO will forward the PA 747 to the Social Security Administration to authorize payment of the appropriate supplement and will insert the date of eligibility as either the date stamp on the application or the date the applicant moved into the home, whichever is later.
5. If the application for the supplement cannot be processed because the applicant either failed to provide the MA 51 or did not follow through on the application for another reason, then OPTIONS will forward to the CAO the PA 761 or PA 1-D and a copy of any related correspondence to the applicant, e.g., a letter establishing a plan to provide the MA 51 by a certain date.
The CAO will send a Notice to Applicant as outlined in Medical Assistance Eligibility Handbook Chapter 391. The notice will explain why the application is denied based on the information provided by OPTIONS and may include a statement that the applicant must reapply for the State supplement. See Appendix B-1 for the proper regulatory citation.
1. Review this information with appropriate staff.
2. Provide client notices as outlined in Medical Assistance Eligibility Handbook Chapter 391.
3. Contact Ms. Donna Roe at (717) 772-7924 with any questions.
4. Maintain this Operations Memorandum until the appropriate Cash Assistance Handbook pages are released.