55 Pa. Code § 165.44 - Verification for special allowances for supportive services

Current through Register Vol. 51, No. 40, October 2, 2021

(a) Verification needed to authorize special allowances for supportive services.
(1) Before authorizing the special allowance for supportive services, the Department will determine the following:
(i) Whether the supportive service requested is required to enable the participant to engage in an approved work or work-related activity.
(ii) The expected charge for the service or item requested.
(iii) The date the service or item is needed by the participant.
(iv) The date that payment for the service or item is required under the provider's usual payment policy or practice.
(v) The Department will not pay for or provide a special allowance for items and services already paid for or obtained unless required under Federal law.
(2) Verification, including collateral contact, that the special allowances for supportive services is required will be provided prior to authorization.
(3) Acceptable verification consists of collateral contacts, written statements or completed Departmental forms, obtained from sources such as employers, prospective employers, school officials, employment and training providers or providers of supportive services. If collateral contacts are used, the information will be documented in the participant's file.
(4) The Department will use collateral contacts whenever necessary to ensure that payment is made in advance of the date that payment is required.
(b) Verification needed for reoccurring and nonrecurring special allowances for supportive services.
(1) The individual's eligibility for a special allowance for a supportive service is reviewed monthly, or more often if expenses are likely to change, at each redetermination or recertification, whenever a change in employment or training is reported by the individual or the employment and training provider, and whenever the AMR or EDP is revised.
(i) A participant shall verify the actual costs incurred by the participant for the supportive service and the participant's attendance at the approved work or work-related activity. The Department may require that the participant or provider of the supportive service, or both, verify that the participant received the approved special allowance for supportive services and that the provider received payment for the amount the participant was eligible to receive.
(ii) When verification provided indicates a change in eligibility, payment of the special allowance to the participant shall be reduced, terminated or increased, as appropriate, upon issuance of a confirming notice to the participant, in accordance with § 133.4(c) (relating to procedures).
(iii) The individual shall provide verification of expenditure of the special allowance within the time frame specified on the AMR or EDP.
(2) The Department will process an overpayment referral to recover a special allowance for supportive services to the extent of the misuse in accordance with § 165.91 (relating to restitution) and Chapter 255 (relating to restitution). Circumstances for which a referral may be appropriate include the following:
(i) The participant was ineligible for cash assistance or SNAP only benefits in the month the Department issued a special allowance for supportive services.
(ii) The participant did not use the special allowance for supportive services for its intended purpose.
(iii) The actual cost of the supportive service was less than the estimated cost of the service.
(iv) The participant provided falsified or erroneous documentation to obtain a special allowance for supportive services.
(v) The participant received a reoccurring special allowance for supportive services when the need no longer existed.
(vi) The participant or provider of supportive services, or both, did not provide verification, such as a receipt, that the supportive services requested were obtained using the special allowance payment.
(vii) The participant did not participate in or comply with RESET, including meeting hourly and other work and work-related requirements as specified on the AMR or EDP.

Notes

55 Pa. Code § 165.44
The provisions of this § 165.44 adopted October 2, 1992, effective October 3, 1992, 22 Pa.B. 4875; amended January 8, 1999, effective February 1, 1999, 29 Pa.B. 271; amended November 19, 2010, effective November 20, 2010, 40 Pa.B. 6665; amended April 13, 2012, effective April 14, 2012, 42 Pa.B. 1992.

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