Pennsylvania Code
Title 55 - HUMAN SERVICES
Part II - Public Assistance Manual
Subpart B - Intake and Redetermination
Chapter 133 - REDETERMINING ELIGIBILITY
GENERAL PROVISIONS
Section 133.4 - Procedures

Universal Citation: 55 PA Code ยง 133.4

Current through Register Vol. 54, No. 44, November 2, 2024

(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.

(v) Establish a protective or vendor payment under §§ 291.23 and 291.24 (relating to requirements; and procedures).

(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.

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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