870.81 Processing Interim Assistance (IA) Requests
When a final decision has not been handed down from BHA within the appropriate time limit, either BHA, an individual, or the the individual's representative may request the CAO to authorize IA (also known as interim relief or IR) benefits. Once requested, the CAO will review the case to see if interim benefits should be authorized while awaiting a BHA decision. If eligible, an individual will receive interim benefits from the first day after the BHA decision deadline (the IA date) expires until the date the decision is received. IA benefits are paid out of state funds and require special action by the Office of the Budget so CAOs must report IA requests to BHA.
IA is appropriate in the following circumstances:
An individual has appealed an action described on an advance or confirming notice, and benefits have not been continued; or
An individual has appealed an action described on an ineligible notice, and benefits were not authorized; or
BHA has provided the name of the individual who must be reviewed for IA (see Section 870.811); and
BHA has not provided a decision within the following time frames:
90 days for MA, including LTC and HCBS
60 days for SNAP
90 days for TANF Cash
IA is not appropriate in the following circumstances:
the appeal is about a nonrecurring special allowance
the appeal is for an undocumented non-citizen
NOTE: IA is appropriate for all other citizenship statuses to include lawful permanent residents (even if under the five-year bar), temporary residents and refugees.
the deadline for the final decision to be provided has not been reached. The deadlines are as follows:
90 days for MA, including LTC and HCBS
60 days for SNAP
90 days for TANF Cash
The individual delayed the appeal process by asking that the hearing be rescheduled or by agreeing to extend the appeal process and it has not been more than the applicable time frame for the benefit plus the delay caused by or agreed to by the individual.
Example: John appealed the decision that he was not eligible for MA benefits due to excess income on 11/1. John requested an extension from BHA to provide verification. BHA granted the extension for 10 days. On 1/30 John requests interim assistance. IA benefits cannot be granted on 1/30 because John requested an extension which was provided for 10 days. IA would not be applicable until the 101st day after the appeal was requested (91 days for MA plus the 10-day extension given per John’s request) which would be 2/9.
The individual is ineligible for continuing SNAP benefits due to failure to complete the redetermination or recertification process or comply with seminannual reporting (SAR) requirements.
NOTE: IA is appropriate when a MA or TANF recipient fails to complete a MA or TANF redetermination or comply with a MA or TANF SAR requirement.
870.811 Requests for IA Made by BHA
BHA will provide a weekly report of cases that are potentially eligible to receive IA to the Office of Income Maintenance (OIM) Liaison at headquarters every Wednesday. The “OIM Weekly Report” will include the following information from BHA in the “Information from BHA” section of the spreadsheet:
An internal SharePoint link has been provided to Area Managers and CAOs. It includes the following folders and Excel spreadsheets:
The OIM Liaison will distribute the “OIM Weekly Report” via Share Point to the Area Managers who will then assign to their team to evaluate each case for IA. Area Managers or their designee will fill out the green columns marked as “Information for CAO to complete” - columns V through Z of the report and report back to the OIM Liaison within two business days of reviewing the report, when the report has been updated.
The Area Managers or their designee will then take the following actions:
Area Managers will inform the OIM Liaison when IA benefits are processed in eCIS.
870.812 Requests for IA made by the Individual or Individual's Representative
When IA benefits are requested by the individual or individual’s representative, the CAO will:
NOTE: Current BHA site administrators can be found at BHA’s webpage at OA-Bureau of Hearings and Appeals. See Section 870.83 for more information.
NOTE: When IA benefits are requested by the individual directly to BHA, BHA will provide the CAO with the case record information, date the appeal was filed, issue on appeal and the IR date via the Interim Relief letter. The CAO will take the actions listed in steps 2-7 above and will also complete the Interim Relief letter and mail it to the BHA site administrator.
Once BHA provides the individual and CAO with the final administrative decision the CAO will either continue benefits if the appeal was sustained or end benefits if the individual’s appeal was denied.
If sustained, the CAO will continue benefits and narrate the outcome of the appeal. No additional notice needs issued unless the Final Administrative Action Order calls for one.
If denied, the CAO will discontinue benefits in eCIS based on the reason the individual is not eligible (ex. excess income or resources) included in the Final Administrative Action Order. No additional notice is required, the BHA final Administrative Action notice is sufficient. Narrate the action.
NOTE: Individuals do not have the right to appeal the closure of interim assistance. Notices terminating IA are unnecessary because the IA approval notices contain a statement that IA benefits will continue until the date that the Final Administrative Action Order is issued.
7 eCFR § 273.15(c)(1) 55 Pa. Code § 275.4(d)
The CAO must report all IA benefit requests and determinations to BHA, whether IA is approved or denied. The CAO will complete columns V, W and Z of the “OIM Weekly Report” once IA benefits are authorized or denied. If the individual requested IA benefits from BHA and BHA sent the CAO the Interim Relief Letter, then once interim benefits are processed the CAO will email the regional BHA site administrator the information listed below and send the completed Interim Relief letter back to the BHA site administrator.
The following information must be emailed to the BHA site administrator anytime the CAO receives an Interim Relief letter from BHA:
· Case record number
· Appellant’s name
· Appeal number
· Date of IA request
· Name of individual making the IA request
· Decision to approve or deny IA benefits
· If IA was approved:
o Date IA was approved
o Name of caseworker who authorized IA and sent a manual notice
o Benefit type approved (MA, LTC, HCBS, SNAP, TANF)
o Monetary amount of IA benefit approved, if applicable
Reminder: Regional BHA site administrators can be found at OA-Bureau of Hearings and Appeals. Email addresses for the CAO’s regional site administrator can be found in the CWOPA global address book.
870.84 Additional Instructions for Authorizing Long-Term Care (LTC) and Home and Community-Based Services (HCBS) IA Benefits
When a LTC or HCBS applicant/recipient is due IA benefits, the CAO must follow the procedures outlined in this Chapter for reviewing and processing IA benefits. The CAO must also review fair consideration provisions outlined in LTCH 440.8 when authorizing IA for both LTC and HCBS and make a cost of care determination for LTC facility applicants as explained in LTCH 468.
Fair Consideration:
If a LTC or HCBS applicant/recipient is due IA benefits, the CAO must verify whether fair consideration was received.
If an individual appeals the establishment of the fair consideration ineligibility period and IA benefits are due, then the CAO will remove the 903Q ineligibility period until the Final Administrative Action Order is received. Once received, the CAO will re-enter the 903Q if the appellant loses the appeal.
Example: Bob was authorized for MA effective 5/15 with an ineligibility period for payment of LTC benefits from 5/15 -11/20. He appealed the penalty period timely, on 6/1. A Final Administrative Action Order was not issued by the 90th day so IA benefits must be issued starting 8/30. The CAO must remove the 903Q TPL so that the LTC facility provider will receive payment beginning 8/30. If BHA sustains the CAOs eligibility decision, then the CAO will re-enter the 903Q TPL effective the date the decision is made. If BHA decides on 10/10 that the CAO acted correctly then Bob received payment of LTC facility services from 8/30 through 10/9 when he was not eligible. Unless fraud was committed Bob is not subject to an overpayment.
Cost of Care Determination:
If a LTC applicant/recipient is due IA benefits, the CAO must use all verified income to determine the monthly cost of care applied during the IA period. For any income sources/amounts that are not verified, the CAO will use the self-attested income.
Example: Alan applied for LTC facility services on 1/28. On the application, Alan reports monthly gross income of $1,296.40 from the Social Security Administration, $200 from a pension and $300 from an annuity. Alan provides verification of his monthly gross pension income, and the CAO verifies his Social Security via the BENDEX Exchange 3. The CAO rejects Alan’s application for failure to provide the annuity income. Alan appeals the rejection on 3/1. A Final Administrative Action Order was not issued by the 90th day so IA benefits must be issued starting 5/30. The CAO will determine the cost of care during the interim assistance period based on monthly gross income of $1,796.40.
Updated September 19, 2024, replacing June 13, 2024