55 Pa. Code § 255.1 - Restitution and disqualification policy
(a) This chapter applies to AFDC, GA and SBP,
except as modified in subsections (c)-(e) and in Chapter 451 (relating to State
Blind Pension) and MA. This chapter does not apply to overpayments resulting
from the forged endorsement of assistance checks. Recovery of overpayments is
described in §
231.24(c)
(relating to procedures).
(b) The
general restitution policy of the Department will be as follows:
(1) The course of action of the Department in
respect to overpayments will be directly related to the cause or reason
underlying the client's receipt of assistance for which the client was not
eligible. When the overpayment appears due to fraud, the Public Welfare Code
(62
P. S. §§
101-1412) will set the course of
action to be taken.
(2) The
decision as to whether or not fraud is suspected will be an administrative
decision which will place on the Department the responsibility of
distinguishing between overpayments due to fraud, and those due to error. To
carry out this responsibility, the Department has developed certain objective
criteria which will be used in deciding the appropriate action for an
overpayment.
(3) Assistance
regulations, including this chapter, are aimed at reducing and preventing the
incidence of overpayment. Accomplishment of this objective will depend to a
large extent on the degree to which the respective responsibilities of the
client and the worker are understood and developed. These responsibilities are
given in detail in other sections of this title but essential elements are
repeated here because of their importance.
(4) A person applying for or receiving
assistance has an obligation to report his resources and changes in
circumstances. An adult applicant and recipient will be responsible for
reporting these facts as they apply to him and to other persons in his
assistance unit.
(5) The worker
will have an obligation to explain eligibility requirements in terms that fit
the situation of the client. The worker will be responsible for being alert to
the possibility of resources or changes in the circumstances of the client and
for setting up with the client definite and specific reporting requirements
appropriate to the situation. The plan for reporting will be entered in the
case record.
(c) In
addition to being subject to other civil or criminal penalties, an AFDC or GA
recipient who has been found by a Federal or State court or by the Department,
following an administrative disqualification hearing-as described in Chapter
275 (relating to appeal and fair hearing and administrative disqualification
hearings)-to have committed an intentional program violation shall be
disqualified from receiving Cash Assistance for 6 months for the first offense,
12 months for the second offense and permanently for the third offense. The
Department will not take the disqualified individual's needs into account when
determining the budget group's need for and amount of assistance. The
Department will consider available to the budget group countable income and
resources of the disqualified individual.
(d) The Department will provide an applicant
for GA and AFDC, at the time of application or reapplication for aid, with
written notice of the penalties for intentional program violation which are
provided in subsection (c).
(e) The
Department will provide current recipients of GA and AFDC with a one-time
written notice of the penalties which are provided for in subsection (c) prior
to imposition of disqualification.
(f) If the individual is eligible for
benefits under the program in which the intentional program violation occurred,
the Department will impose the disqualification within 45 days of the date of
the finding of the court, administrative disqualification hearing final order
or signing of a consent agreement or waiver of administrative disqualification
hearing as set forth in Chapter 275, Subchapter B (relating to administrative
disqualification hearings). If the individual, who is found to have committed
an intentional program violation or who signs a consent agreement or waiver of
administrative disqualification hearing is not eligible for benefits under the
assistance program in which the intentional program violation occurred, the
Department will impose the disqualification effective on the date of the
finding of the court, administrative disqualification hearing final order or
signing of a consent agreement or waiver of administrative disqualification
hearing. Once the Department imposes the disqualification, the disqualification
period shall continue uninterrupted.
Notes
The amendment made to this section at 21 Pa.B. 1557 (April 13, 1991) was promulgated under section 6(b) of the Regulatory Review Act (71 P. S. § 745.6(b)).
The provisions of this § 255.1 amended under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§ 201(2) and 403(b)).
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