Verbal or written information provided to the funeral director from the CAO is not an authorization of payment. OMAP has final approval authority. OMAP reviews the completed Burial Payment Request (PA 118) and approves payment only after all of this chapter’s eligibility requirements are met. DHS pays the funeral director.
55 Pa. Code § 283.3 55 Pa. Code § 283.6
When the written or oral request for payment is received, the CAO will:
1. Determine if the request meets the requirements in Section 890.11, Who Qualifies for Payment and Section 890.2, Receiving a Request for Payment. If not, deny payment, record the decision in the case record and notify the person making the request of ineligibility.
2. If necessary, discuss the available funeral directors who are enrolled as providers and find out which one will be used.
3. Determine if countable resources equal $1,500 or more. If so, deny payment, record the decision in the case record and notify the person making the request of ineligibility.
4. Calculate DHS’s payment for burial or cremation, or both. See Section 890.3, Determining The Amount Of The Payment.
NOTE: DHS’s payment will not exceed $750.
If the request meets requirements and DHS will be making a burial payment, complete the blocks at the top of the PA 118 with the case identifying information and send the form to the requestor to complete Section I.
NOTE:For multiple deaths, prepare one copy of the PA 118 and include the name and line number of each deceased person.
NOTE: The requestor may have the funeral director help in the completion of the form.
5. Make three copies when the form is returned to the CAO and the funeral director did not complete the back of the form.
Send two copies of the PA 118 to the funeral director along with a statement listing any resources available to reduce DHS’s burial payment.
6. Keep one copy of the PA 118 for the case record.
When the funeral director receives the PA 118 from the CAO or the requestor, the funeral director will:
1. Complete side 2 and the certification section of the PA 118.
2. Return both copies of the PA 118 and any accompanying material to the CAO within 30 days of death.
Exception: Extend the 30 days when:
There are unusual circumstances and the funeral director submits valid reasons for delay.
A request is approved after burial. In this case, the funeral director must submit the PA 118 within 30 days of the date of request.
Information on Worker’s Compensation, OASDI, or RR lump sum benefits is pending.
NOTE: The funeral director will submit verification of the notification of benefits decision from Workers' Compensation, OASDI, or RR Retirement, along with the PA 118 to the CAO within 15 days of receiving the decision.
If the funeral director does not return the PA 118, the CAO takes no further action.
When the CAO receives the completed PA 118 from the funeral director, the CAO will:
1. Review for correctness and completeness.
2. Review the resources listed in Section I and compare them to those listed on the Invoice (side 2).
NOTE: Return both copies of the PA 118 to the funeral director to correct or clarify if:
There are omissions or errors on the form or attached material,
The provider identification code is missing,
The charges are questionable, or
Resources not identified on the form are subsequently identified or collected before the form is forwarded for payment.
3. Check the computation on the invoice to be sure the net amount to be paid by DHS is correct and does not exceed the maximum payment.
NOTE: If the deceased is a stillborn child or a person who is not included in the Client Information System (eCIS), the CAO must provide a recipient number so payment can be made. Follow these steps:
Open or add the deceased person to eCIS for the date of death.
Authorize a noncontinuous eligibility (NCE) opening and closing of medical assistance on the date of death.
Enter nine zeros for the newborn’s Social Security number with SSN code O.
4. Complete Section II if countable resources are less than $1,500.
5. Deny payment if the total countable resources alone or combined with the DHS maximum allowable payment exceed $1,500. Notify the requestor of the ineligibility.
6. If total countable resources plus the DHS maximum allowable payment do not exceed $1,500, send the original correct, completed PA 118 and attachments to:
Department of Human Services
Office of Medical Assistance Programs
Burial Request Unit/HP
PO Box 60273
Harrisburg PA 17106-0273
EMAIL: RA-PWPA118_REFERENCE@pa.gov
7. Notify the requestor that the request has been approved and forwarded for payment.
If additional resources become available after the PA 118 is submitted, the CAO will Contact the OMAP, Bureau of Data and Claims Management by EMAIL: RA-PWPA118_REFERENCE@pa.gov
to check the status of the PA 118.
If the form has not been processed for payment, submit a corrected copy of the PA 118 and notify the requestor of any change in payment.
NOTE: The CAO may enter corrections on its copy of the PA 118. Mark the form “Corrected Copy.” Note the date it was corrected. The CAO is not required to have the funeral director complete and sign a new PA 118.
If the PA 118 has been processed:
Advise the funeral director that he or she may reimburse the amount overpaid by check made payable to the Pennsylvania Department of Human Services.
Give the funeral director a Receipt of Payment (PA/CS 175-M).
Complete a corrected copy of the PA 118 (see above note).
Attach the check and the receipt copies.
Send to the OMAP, Fee-for-Services.
If the funeral director declines to make repayment through the CAO, complete a Reimbursement Referral (OIG 173-S) to the OSIG advising them of the available resources. Attach a copy of the PA 118 to the referral.
If the Office of Medical Assistance Programs (OMAP) Bureau of Data and Claims Management identifies errors or omissions on the Burial Payment Request PA 118, the form is returned to the CAO with a memo explaining the action required.
If necessary, the CAO will return the forms to the funeral director for correction.
When corrections are made, the CAO returns the forms and all attached material to the OMAP Bureau of Data and Claims Management.
If the CAO learns that a funeral director may be violating regulations, it will immediately send a memo explaining the situation to:
Department of Human Services
Office of Medical Assistance Programs
Bureau of Program Integrity
P.O. Box 2675
Harrisburg, PA 17105-2675
Phone 1-866-379-8477
Evidence submitted by the CAO may include:
Receipts showing additional payments made to the funeral director;
Bills or letters sent by the funeral director requesting additional payment; or
Proof that DHS was charged for services not provided.
The Bureau of Program Integrity determines what action will be taken, including collection, prosecution, or termination of provider approval.
Updated July 25, 2024, Replacing April 16, 2021