55 Pa. Code § 133.4 - Procedures
(a)
Notice. A notice to recipients is required whenever an action
is taken or the CAO has decided that an action should be taken. The single
exception to individual notification is mass grant increases in which
recipients are notified by inserts with their assistance checks.
(b)
Advance notice. Use of
Advance Notice shall conform with the following:
(1)
General. In situations
other than when the confirming notice is used the client shall be provided with
an Advance Notice whenever the CAO proposes to do one of the following:
(i) Decrease, suspend or discontinue a
monthly assistance payment.
(ii)
Reduce or terminate MA payments.
(iii) Reduce or terminate a
service.
(iv) Change the category
of assistance from TANF to GA; from PA, PC or PJ to PD; from TA, TC or TJ to
TD.
(2)
Use requirements. Use requirements are as follows:
(i) Advance notice is used to provide the
client with timely and adequate advance notice of a proposed action, as
specified in this section, so that the client has the opportunity either to
provide or to clarify information needed to establish the client's continued
eligibility or to appeal the decision. It is not used for general or
miscellaneous communications such as scheduling interviews or redetermination
appointments.
(ii) In addition to
the necessary information required, the Advance Notice shall contain the date
an appeal shall be received or post-marked if the client wants to appeal the
decision and have a determination made whether assistance will continue pending
the hearing. The date to be specified will be 10-calendar days from the date
the Advance Notice is mailed.
(iii)
The original of the Advance Notice shall be mailed to the client. A copy will
be retained by the Department for 120 days from the date of the notice or until
the point in question is resolved.
(3)
Timing and effect on
decision. The Advance Notice shall be mailed at least 10 days before
the proposed action is taken. This means that the following shall occur:
(i) For cash assistance, the Advance Notice
shall be sent to the client promptly, but no later than 10-calendar days before
the telephone hold deadline of the payment date for the action decided on by
the CAO.
(ii) For MA or medical
services, the Advance Notice shall be sent at least 10-calendar days before the
effective date for the proposed action.
(iii) If the Advance Notice cannot be sent
within the set time limits in this paragraph for cash assistance, the effective
date for the proposed action is the next regular payment date or issuance
date.
(4)
Follow-up. Follow-up requirements are as follows:
(i) The CAO shall take its proposed action
when the client does not request a hearing by returning a completed and signed
copy of the Advance Notice, or by another means as set forth in Chapter 275
(relating to appeal and fair hearing and administrative disqualification
hearings) to the CAO within the specified 10-calendar day period.
(ii) If the client does respond to the
Advance Notice by requesting a hearing within the specified 10-calendar day
period or later, the CAO shall proceed under §
275.4(a)(3)(i)
(relating to procedures).
(c)
Confirming notice. The
confirming notice is used to provide the client with confirmation of an action
that has been taken. The original shall be mailed to the client. A copy will be
retained by the Department for 120 days from the date of the notice or until
the point in question is resolved, whichever is later. If the action to
decrease or discontinue a budget results from information provided on a Monthly
Reporting Form, and the client appeals within 10 days of the date on the
notice, the CAO shall proceed under §
275.4(a)(3)(v)(C)(I).
The CAO shall take its action and provide the client with a confirming notice
whenever one of the following changes occur:
(1) An increase in a monthly assistance
payment, MA benefits or services.
(2) A decrease or discontinuance of a monthly
assistance payment, MA benefits or services resulting from one of the
following:
(i) A written request signed by the
client or someone acting on his behalf.
(ii) Notice of the death of a client, such as
an obituary notice in the newspaper, except when the client lived
alone.
(iii) Mass closings due to
the end of a strike, lockout and the like.
(iv) An official notice that a client has
been institutionalized or otherwise removed from the home, such as notification
from a child welfare agency that a child has been removed from the home of a
parent.
(v) A report from a client,
or someone acting on his behalf, that the client has moved permanently to
another county.
(vi) The
whereabouts of the client are unknown and agency mail, such as correspondence
or assistance check directed to him has been returned by the post office
indicating no known forwarding address. If the client makes his whereabouts
known prior to the next payment date, the check shall be made available to the
client; but if the client has not contacted the CAO prior to the next payment
date, then the budget is closed.
(vii) Notice that the recipient has been
placed in skilled nursing care, intermediate care or long-term
hospitalization.
(viii) A recipient
has been accepted for assistance in a new county following an intercounty
transfer.
(ix) A change in level of
medical care as prescribed by the physician of the recipient.
(x) Notification that a recipient of interim
assistance has received his initial SSI payment.
(xi) Information provided on a Monthly
Reporting Form.
(xii) Removal of a
special allowance for child care from the grant.
(d)
Form PA 564-A (Late/Incomplete
Notice Monthly Reporting Form). This notice is sent to the recipient
if the Monthly Reporting Form is not received by the due date, or is received
by the due date but is incomplete. The notice is mailed so that it arrives no
later than the regular payment date and shall advise the recipient of the
following:
(1) The Monthly Reporting Form was
not received by the due date or was incomplete.
(2) The date of the affected check and the
following stipulations:
(i) If the Monthly
Reporting Form was not received by the due date, the check will be
late.
(ii) If the Monthly Reporting
Form was received by the due date but was incomplete, the check may be
late.
(iii) If the complete
Late/Incomplete Notice Monthly Reporting Form is received in the CAO by the due
date indicated on the form, eligibility for that check is determined based on
the information provided on the form.
(3) If the recipient has earned income and
does not provide good cause for not reporting the income timely or completely,
the earned income disregard, deductions and dependent care expenses under §§
183.94 and
183.95 (relating to eligibility
for TANF earned income deductions; and GA earned income deductions) are not
allowed for the payment month affected.
(4) If the complete Late/Incomplete Notice
Monthly Reporting Form is not received in the CAO by the due date indicated on
the form, that assistance will be terminated for the payment month. The
appropriate manual reference is cited.
(5) If an appeal is filed within 10 days,
benefits will continue at the current level pending a hearing
decision.
(6) The right to appeal
an action within 30 days and to have a fair hearing.
(e)
Content of notices. The
notice shall contain the following:
(1) A
statement of the action taken or to be taken and the effective date.
(2) The reasons for the action, including the
facts on which the action is based in as much detail as possible.
(3) A statement of the information needed to
establish continued eligibility when applicable.
(4) A citation and brief explanation of
regulations used as the basis for the action.
(5) The name and address of the legal
services agency available in the county.
Notes
The provisions of this § 133.4 issued under: sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§ 201(2) and 403(b)); amended under: section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
This section cited in 55 Pa. Code § 108.12 (relating to notice of good cause waiver determinations based on domestic violence); 55 Pa. Code § 133.74 (relating to procedures); 55 Pa. Code § 133.84 (relating to MA redetermining eligibility procedures); 55 Pa. Code § 142.23 (relating to requirements); 55 Pa. Code § 147.24 (relating to procedure); 55 Pa. Code § 165.44 (relating to verification for special allowances for supportive services); 55 Pa. Code § 168.41 (relating to verification requirements); 55 Pa. Code § 183.104a (relating to additions to or deletions from a budget group-statement of policy); 55 Pa. Code § 183.105 (relating to increases in income); 55 Pa. Code § 255.4 (relating to procedures); 55 Pa. Code § 275.4 (relating to procedures); and 55 Pa. Code § 291.23 (relating to requirements).
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