55 Pa. Code § 258.4 - Request for statement of claim

(a) The personal representative has a duty to ascertain whether the decedent received MA services during the 5 years preceding death and, if so, give notice to the Department requesting a statement of claim. The 5-year time frame is for notification purposes only and does not limit the Department's claim. Effective August 15, 1994, the amount of MA paid for services rendered after August 15, 1994, to an individual 55 years of age or older is subject to the Department's claim. The notice shall be sent by certified mail return receipt, facsimile machine or electronic mail to the address of the Department specified in § 258.14 (relating to service on the Department). The notice shall include the following:

(1) A statement that the personal representative is requesting a statement of claim against the estate of the decedent.

(2) The decedent's name.

(3) The decedent's last address.

(4) The decedent's date of birth.

(5) The decedent's date of death.

(6) The decedent's Social Security Number.

(7) The personal representative's name, address and telephone number.

(8) Written documentation of the gross value of the decedent's estate.

(b) The Department will submit a statement of claim to the personal representative within the response period of 45-calendar days in accordance with section 1412(b) of the Public Welfare Code (62 P. S. § 1412(b)) relating to repayment from probate estates. If the notice from the personal representative is mailed to the incorrect address, or does not otherwise fully comply with subsection (a), the response period shall be suspended until a fully complying notice is received. If the Department fails to submit a statement of claim to the personal representative within the response period, the Department's claim is forfeited.

(c) The certified mail receipt date, facsimile receipt date or the electronic mail receipt date verifies the receipt date of the notice from the personal representative.

(d) The Department will date the statements of claim. The date on the statement of claim shall establish the Department's issuance date of the statement of claim.

(e) A personal representative may extend the Department's response period. Additionally, if the last date of the response period falls on a weekend, Commonwealth holiday or other day that the offices of the Department are closed, the response period shall end on the next business day.

(f) The Department may amend a statement of claim after the response period has elapsed if there is new or updated information relating to the statement of claim. The amended statement of claim shall relate back to the date of the original statement of claim.

Notes

55 Pa. Code § 258.4

This section cited in 55 Pa. Code § 258.8 (relating to liability of personal representative).