Pennsylvania Code
Title 55 - HUMAN SERVICES
Part II - Public Assistance Manual
Subpart K - Blind Persons
Chapter 451 - STATE BLIND PENSION
GENERAL PROVISIONS
Section 451.4 - Procedures
Universal Citation: 55 PA Code ยง 451.4
Current through Register Vol. 54, No. 52, December 28, 2024
(a) Computing income. Computation of income will be made in accordance with the following procedures:
(1)
Earned income. Earned income will be computed as follows:
(i) Income which a blind person receives from
operating a business or farm, or practicing a profession, or as an employe will
be designated earned income. The amount of earned income available to the blind
person will be determined by deducting expenses necessary to obtain the income.
Personal expenses such as income taxes, social security taxes, occupational
taxes will not be deducted. Allowable expenses from the different types of
earned income are as follows:
(A) From gross
wages, commissions and bonuses the following shall be deducted:
(I) Employment expenses necessary to the type
of job, and not paid by the employer, for example, the cost of tools,
materials, special uniforms or telephone.
(II) Actual cost of transportation to and
from employment.
(III) Actual cost
of guide service or maintenance of a dog guide necessary to the
employment.
(B) From
gross income from operating a business or farm, or practicing a profession, the
actual expenses necessary to produce, protect and continue the income shall be
deducted.
(C) From gross income
received from renting rooms or apartments or furnishing meals, where the blind
person is responsible for providing service in addition to the use of space and
equipment, the following shall be deducted: $10 per month for a tenant or
tenant group; $20 per month for a boarder; $30 per month for a separate
tenant-border, persons not included above; $30 per month for the first person
and $20 per month for an additional person in a tenant-boarder group, persons
not included above; and 50% of the remainder.
(ii) As used in this subsection, the terms
tenant and tenant-boarder mean a lone person whose rent or rent and board
arrangements with the client are independent of other persons; the terms tenant
group and tenant-boarder group mean a group of two or more persons who are
living together as a family normally would and who have a joint rent, or rent
and board, arrangement with the client. A husband and wife, or parents and
their children, are always included in a tenant group or tenant-boarder group;
other persons whose plan is to rent living accommodations as a group rather
than as individuals also are considered to be a tenant group or tenant-boarder
group.
(iii) If income is derived
from renting space or equipment only, the income will not be considered to be
earned income and the deductions in paragraph (2) will apply.
(2)
Other income.
From other income, the expenses necessary to get or to assure the continued
receipt of the income shall be deducted.
(i)
The amount of monthly OASDI for purposes of SBP eligibility will be determined
as follows:
(A) Determine the monthly amount
of OASDI as the monthly benefit received on 1/1/71 or the monthly benefit
awarded after 1/1/71, then
(B)
Disregard the first $4 from the monthly benefit.
(C) Disregard future increases.
(ii) The amount of monthly
railroad retirement and veterans' benefits for purposes of SBP will be
determined as follows:
(A) Determine the
monthly amount of railroad retirement and veterans' benefits as the monthly
benefit received on January 1, 1976 or the monthly benefit awarded after
January 1, 1976, then
(B) Disregard
any future increases.
(b) Amount of monthly SBP payment - exclusive of NHC payment. Procedures for determination of monthly SBP payment are as follows:
(1) A blind person's
income and total SBP payments may not exceed $4,260 during a 12-month period;
therefore, the amount of the monthly payment is based on annual net income.
Reference should be made to §
451.5(a)
(relating to adjustments for fiscal year ending before July 1981). The 12-month
period is termed fiscal year and consists of 12-consecutive monthly payment
periods. A monthly payment period will be the fiscal month for persons
receiving regular SBP payment. An SBP recipient's fiscal year will begin on the
first day of the first full monthly payment period and ends on the day before
the thirteenth monthly payment period begins. The beginning and ending dates of
a fiscal year will not change if SBP is discontinued and resumed during one
fiscal year, except that if SBP is discontinued because of the authorization of
nursing home care payment, the date SBP is again authorized will start a new
fiscal year.
(2) The monthly SBP
payment will be $100 if the blind person's annual net income is expected to be
$3,060 or less.
(3) If the annual
net income is expected to be more than $3,060, the monthly SBP payment will be
figured this way: subtract the annual net income from $4,260, divide the
remainder by 12. The result is the monthly payment, unless it is less than
95¢, in which case no SBP payment is made. Reference should be made to
§
451.5 (a).
(4) If, during the fiscal year, the amount of
income changes from what had been expected, or the SBP payment is discontinued
and resumed in the same fiscal year, the monthly SBP payment for the rest of
the fiscal year will be figured as follows: add the net income already received
during the fiscal year to the amount of net income that will probably be
received during the rest of the fiscal year. If the total is not more than
$3,060, the monthly SBP payment will be $100. If the total is more than $3,060,
the monthly payment will be figured this way: add the total annual net income
and the SBP payments already made in the fiscal year, but do not include any
NHC payments; subtract this total from $4,260, divide the remainder by the
number of months remaining in the fiscal year. The result is the monthly
payment, unless it is less than 95¢, in which case no SBP payment is made.
Reference should be made to §
451.5 (a).
(c) Amount of SBP monthly NHC payment. The amount of SBP monthly NHC payment will be determined as follows:
(1) The monthly payment when the
blind person is in a nursing home will be the excess of the maximum amount paid
for nursing home care for recipients of assistance under the Public Welfare
Code in like circumstances; over the amount of the blind person's actual
income, but shall in no case be less than the amount determined in accordance
with subsection (b).
(2) In
determining the amount of the monthly NHC payment for a blind person requesting
SBP-NHC of more than $100 monthly, the actual income will also include payments
made on behalf of a blind person to meet any or all of the cost of the nursing
home care the blind person is receiving. NHC payment will not be made for care
covered under Medicare. However, payments made under Medicare will not be
considered as income in determining the SBP monthly payment of $100.
(d) Use of the Form PA 21-BI, computation sheet. Form PA 21-BI will be used as follows:
(1) The Form PA 21-BI will be used to
determine whether or not the total income and pension of an SBP recipient in a
given fiscal year are within the legal limits of $4,260 yearly set by law.
Reference should be made to §
451.5.
(2) The form will be prepared for all SBP
recipients who have income, except for those receiving SBP nursing home care,
BN. The $4,260 limit on annual income and pension will not apply to BN
recipients and a fiscal year computation of income and BN payments, therefore,
will have no significance. Reference should be made to §
451.5.
Overpayments and underpayments for BN recipients will be determined on a
monthly basis.
(3) Form PA 21-BI
Part I will be used to record the following for each payment in the fiscal
year:
(i) The anticipated amount of monthly
income used to determine the SBP payment.
(ii) The actual monthly income subsequently
found to be available for the same payment period.
(4) Column 1-Payment
Date-The beginning date for the first monthly payment period in the
fiscal year will be entered on the first line. The dates subsequent payment
periods begin will be entered on the following lines. If SBP is discontinued
during the fiscal year, the effective date of the discontinuance and "Disc"
will be entered.
(5) Column
2-Source-The source of the income used to determine the amount
of the SBP payment will be entered. A separate line will be used for a
source.
(6) Column
3-Anticipated Income-Should not be completed if determination
of payment was made solely on actual income.
(i)
Block A. Gross Amount
Expected-The amount expected to be received from a source during the
payment period, will be entered including any FSBP payment received.
(ii)
Block B. Deductions, Kind,
Amount-The kinds of expenses necessary to secure the income and the
amount will be entered.
(iii)
Block C. Net Income Detail-The anticipated net income from a
source will be entered. If there is only one source, this space should be left
blank.
(iv)
Block D. Net
Income Total-The anticipated total net income from sources will be
entered.
(7) Column
4-SBP Payment-Opposite the entry described in paragraph
(6)(iv) the amount of an SBP payment or the payment which would be made if an
overpayment were not being satisfied will be entered. "O" will be entered for
each payment period an SBP payment was not made for reasons other than
satisfying an overpayment.
(8)
Column 5 will be completed as follows:
(i)
Block A. Gross Amount Actual-The actual gross income received
will be entered.
(ii)
Block
B. Deductions, Kind, Amount-The kinds of expenses necessary to secure
the income, and the amount will be entered.
(iii)
Block C. Net Income
Detail-The actual net income from each source will be entered. If
there is only one source, this space should be left blank.
(iv)
Block D. Net Income
Total-The actual total net income from all sources will be
entered.
(9) Form PA
21-BI, Part B is used to compute for each fiscal year the total income and SBP
received in a fiscal year to determine whether or not the SBP recipient was
overpaid or underpaid during the year. Part B is completed:
(i) At the end of the recipient's fiscal
year.
(ii) When SBP payments are
discontinued during the fiscal year.
(iii) When an SBP nursing home care payment
is authorized for a person who has been receiving SBP.
(e) Use of the Form PA 21-B, authorization sheet. Form PA 21-B will be used as follows:
(1) Form PA 21-B (Authorization Sheet), will
be used to authorize payment.
(2) A
separate Form PA 21-B will be prepared in ink or indelible pencil for each
person eligible for SBP.
(3) Form
PA 21-B will be completed as follows:
(i)
Record No.-Name-Enter the record number and
name of the blind person.
(ii)
Date-Enter the date of authorization.
(iii)
Category Symbol-Enter
"B".
(iv)
BP
Payment-Enter the amount of the SBP payment.
(v)
Amount Withheld-Enter
the monthly amount to be withheld because of an overpayment for the previous
fiscal year.
(vi)
Cash
Grant-Enter the difference between the SBP payment and the amount
withheld. Adjust the figure to the nearest 10 cents. That is, amounts ending in
.01 to .04 are adjusted downward; in .05 to .09, upward.
(vii)
Effective Date-Enter
the date as defined in §
225.22 (relating to
definitions).
(viii)
Statistical Code-Enter the appropriate Statistical
Code.
(ix)
Financial
Code-This item was deleted on the 9/56 revision of the form. On all
prior revisions, make no entries in this space. Reference should be made to
"Financial" as set forth in subparagraph (xiv).
(x)
Ref. No. PA 21-Enter the
same column code numbers that are used on the Form PA 21 to indicate a change
in information.
(xi)
Authorized By-The person authorizing the payment enters his
initials.
(xii)
Checked By
Date-The person who checks the authorization enters his initials and
the date the authorization is checked.
(xiii)
122 Typed By
Date-Authorization typist enters his initials and date the Form PA 122
is typed.
(xiv)
Financial-Enter the column number of the authorization and the
Financial Code and the explanation.
(f) Nursing home care eligibility procedures. Procedures for determination of nursing home care eligibility are as follows:
(1)
Date
eligibility begins. Eligibility for nursing home care will begin
either the date that forms are completed and the person is found eligible for
nursing home care or the date the person enters the nursing home, whichever is
later. No payment may be authorized earlier than the following appropriate
date:
(i) Two calendar months before the date
of certification of the first Form PA 122-N authorizing nursing home care
payments, if the patient was receiving SBP at the time of certification, but no
earlier than the date the SBP grant was authorized.
(ii) The first day of the month on which the
first Form PA 122-N authorizing nursing home care is certified if the nursing
home care payment is an initial grant.
(2)
Forms used to determine medical
eligibility for nursing home care. The following forms will be used to
determine medical eligibility for nursing home care:
(i) For First 60 Days of Nursing Home Care,
Medical Assistance Physician's Prescription, Form PA 4-M.
(A) Medical eligibility for up to 60 days of
nursing home care may be established by means of a Physician's Prescription,
Form PA 4-M.
(B) If a longer period
of care is required, medical eligibility for continued nursing home care is
determined in accordance with subparagraphs (ii) and (iii).
(ii) For Continued Nursing Home
Care, Request for Nursing Home Care Payment, Form PA 258-N.
(A) The physician uses Request for Nursing
Home Care Payment, Form PA 258-N, to provide the medical information needed by
the Company Assistance Office to determine eligibility. The form shall be
signed by the patient's physician. No payment will be made to the patient's
physician for completing the form. The physician shall send the signed form to
the County Assistance Office, which stamps the date of receipt on the first
page.
(B) The contents of the Form
PA 258-N will not be revealed to anyone without the consent of the patient and
the attending physician, except in the administration of public
assistance.
(iii)
Supplement-Request for Nursing Home Care Payment, Form PA 258-NS. A
Supplement-Request for Nursing Home Care Payment Form PA 258-NS, will be used
to record the pertinent social factors as they relate to the patient's need for
nursing home care.
(3)
Redetermination of need for care in the nursing home.
Redetermination of need for care in the nursing home will be made as follows:
(i) Whenever there is reason to believe that
the patient may no longer require nursing home care, a redetermination of
eligibility for nursing home care will be initiated.
(ii) A new Form PA 258-N must be completed
and signed by the patient's physician; the patient is not required to sign. A
new Form PA 258-NS must also be completed for each redetermination. The
responsibility of the County Assistance Office Review Team will be the same as
for an initial determination.
(iii)
If assistance to a patient found eligible for nursing home care was
discontinued, or if payment to a patient found eligible for nursing home care
was not authorized, and a patient reapplies for nursing home care before 1 year
has elapsed from the date of eligibility entered on the last Form PA 258-NS, no
new determination will be made then of eligibility for nursing home care,
unless there is reason to believe that the patient's condition may have
changed.
(iv) If, after the review
of the patient's medical needs, the Medical Consultant decides that the patient
no longer needs nursing home care, the CAO will send the patient notification
on the Form PA 162-A.
(4)
Office of Medical Programs. The Office of Medical Programs
makes selective reviews of determinations of the need for nursing home care,
and provides consultation to County Assistance Offices on request.
(5)
Annual medical
examination. Every patient in a nursing home is required to have an
annual medical examination.
(i) The
Department will pay for the annual medical examination for SBP recipients on
request to the County Assistance Office. The request will include the name of
the physician or clinic who is to make the examination.
(ii) On receipt of the request, the County
Assistance Office will determine whether at least one year has elapsed since
the last annual medical examination. If the request is approved by the County
Assistance Office, it sends the physician or clinic the following:
(A) Two Form PA 258-N's, Request for Nursing
Home Care Payment. The patient does not have to sign the Form PA
258-N.
(B) Two Form PA 48's,
Authorization for Service and Supplies.
(C) One envelope addressed to the County
Board of Assistance to be used by the physician or clinic to return the
forms.
(iii) Fees for
general medical examination are as follows: Physician's Office or Nursing Home
$10
Clinic (including blood serology and urinalysis specific $ 5 gravity, sugar, albumin)
(iv) The County Assistance Office will always
retain the original of the Form PA 258-N and send the nursing home a
copy.
(v) The County Assistance
Office reviews the Form PA 258-N, which contains the report of the annual
medical examination, to determine whether there has been any significant change
in the patient's condition. The County Assistance Office takes whatever action
is appropriate.
(g) Nursing home care services and allowances. Allowances for nursing home care services are as follows:
(1)
Nursing home care and
allowances. Nursing home care shall be at the direction of a physician
and indicates the following services and care:
(i) Room and board.
(ii) Bed and bath linens.
(iii) Laundry of patient's personal
clothing.
(iv) Therapeutic
diets.
(v) Any of the nursing care
and procedures which determine the need for nursing home care.
(vi) Any or all of the following medications:
(A) Alcohol.
(B) Antacids.
(C) Antiseptics.
(D) Aspirin, APC, and similar analgesic
compounds.
(E) Cold
medications.
(F) (Over-the-Counter)
cough medicines.
(G)
(Over-the-Counter) creams.
(H)
Emollients.
(I)
Laxatives.
(J) Liniments.
(K) Mouth Washes.
(L) (Over-the-Counter) ointments.
(M) Simple eye preparations.
(N) Talcs.
(O) Vitamins (alone or in
combination).
(vii)
Medical supplies such as the following:
(A)
Bandages.
(B) Catheters (except
Foley Catheters).
(C) Cellu-cotton
and other types of pads.
(D) Hot
water bags.
(E) Ice bags.
(F) Plasters.
(G) Rubber gloves.
(H) Compresses.
(I) Cotton.
(J) Dressing.
(K) Gauzes.
(L) Sponges.
(M) Syringes.
(N) Tapes.
(O) Thermometers.
(viii) No pharmacist or vendor will be paid
for any of the medications or supplies listed in this paragraph. A pharmacist
will be paid for other drugs in accordance with Part III (relating to medical
assistance). The pharmacy of a hospital that operates a nursing home, a long
term facility, will be paid for drugs not listed above for a patient in the
nursing home in accordance with Part III.
(ix) The allowance for public and private
skilled nursing home care will be the Department's established rate, plus $5
per month for personal items.
(2)
Physical therapy.
Physical therapy allowances will conform with the following:
(i) This includes diathermy, massage,
hydrotherapy, electrotherapy and the like, given by a licensed physical
therapist with the objective of helping the patient to meet one or more of the
normal demands of everyday life without continuous help from others; or to
attain the ability to be partially or wholly self-supporting.
(ii) A request for authorization of physical
therapy shall be made in writing by the attending physician. Space is provided
on the Form PA 258-N for a request if it is made at the time of the request for
nursing home care payment. A request for physical therapy made thereafter, or
if a Form PA 4-M is used, shall be made in writing by the attending physician
and may be in narrative style; the request shall include diagnosis, specific
procedures recommended, duration of therapy and approximate degree of
improvement anticipated.
(iii) A
request for continuance by physical therapy shall be made in like fashion and
must include, in addition, a brief report of the patient's progress to
date.
(iv) Payment is authorized
for not more than a three month period and is reauthorized only if there is
adequate evidence of improvement. The County Assistance Office notifies the
nursing home of each authorization for physical therapy.
(v) There will be a maximum monthly allowance
of $15 in addition to the allowances for nursing home care.
(h) Nursing home care authorization sheet, Form PA 21-N. The NHC Authorization Sheet, Form PA 21-N, will be used to compute the amount of the nursing home care payment and to authorize the payment. The Form PA 21-N will be prepared in ink or indelible pencil for each patient. A separate column will be used for each month in which there is a change in the allowance or income. The instructions for completion of the Form PA 21-N are as follows:
(1)
Record number-Enter the
number of the SBP record.
(2)
Date-Enter the date of authorization.
(3)
Category-Enter "BN".
This indicates that the person is eligible for SBP and there is need for
nursing home care.
(4)
Physical therapy-Enter $15 if physical therapy has been
approved.
(5)
Nursing home
care-Enter the actual cost as appropriate.
(6)
Special items-Make no
entries in this section.
(7)
Total allowance-Enter the sum of paragraphs (4), (5) and
$5.
(8)
Total
income-Enter the total monthly income as defined in §
451.3(h)(3)
(relating to requirements), including the amount paid on behalf of the blind
person. A one-time grant to compensate for a fiscal year underpayment is
income. In computing the initial nursing home care payment, also include as
income (1) money available to meet the cost of nursing home care from an SBP
check received after the effective date of the initial grant because of a delay
in payment due to suspension, or change of address; and (2) any advance payment
to the nursing home for the period covered by the initial nursing home care
payment.
(9)
Need-amount-Enter the amount by which "Total Allowance"
exceeds "Total Income". If the amount is less than the amount determined as
provided in subsection (e), the person is not eligible for nursing home care
payments. If the person has been receiving SBP, no change is necessary;
otherwise, use Form PA 21-B for the authorization. Reference shall be made to
subsection (e) for instructions for completion of the Form PA 21-B.
(10)
Effective date-Enter
the date.
(i) For initial payments, see
subsection (f)(1).
(ii) For a
patient who moves from one type of nursing home to another, and for whom the
allowance is to change, the old allowance is payable up to and including the
day before the patient enters the new home; the new allowance is payable
thereafter.
(iii) A change in the
allowance resulting from change in classification of a home a patient is in is
effective the first full calendar month whose deadline can be met. This applies
also when a nursing home is reclassified to a boarding home.
(iv) For a discontinuance, the effective date
is the date following the last day the client was eligible for a nursing home
care allowance or received nursing home care.
(v) For a change in income, payment name or
address, the effective date is the first day in the calendar month in which the
change occurs.
(11)
Statistical code-Enter the appropriate statistical code.
Action Code Letter "A" with the appropriate reason code is used when
authorizing the initial nursing home care payment. Action Code Letter "C" with
the appropriate reason code is used when authorizing discontinuance. In
addition, enter PT, if an allowance for physical therapy is made. Use a single
statistical code for all computations made at one time even though different
amounts are used for two or more months; select the most appropriate code for
the total authorization.
(12)
Ref. No. PA 21-Enter the same column code numbers that are
used in the Form PA 21 to indicate a change in information.
(13)
Authorized by-The
person authorizing the payment enters his initials.
(14)
Checked by date-The
person who checks the authorization enters his initials and the date the
authorization is checked.
(15)
122-N Typed by date-Authorization typist enters his initials
and the date the Form PA 122-N is typed.
(16)
Financial-Enter the
column number of the authorization and the financial code and the
explanation.
(i) Miscellaneous authorization and disbursement instructions for NHC. Miscellaneous authorization and disbursement instructions for NHC shall conform with the following:
(1)
Payment schedule. Regular payments are made each month for
services for the previous calendar month and are mailed on 1 day each
month.
(2)
Discontinuance. The Form PA 122-N for a discontinuance should
be submitted as soon as possible if regular SBP is being authorized for the
patient. The Form PA 122-N for discontinuance of the nursing home care payments
and the Form PA 122 authorizing the initial regular SBP payment will be sent
grouped together to the central disbursing office. Prorated payments are issued
by the central disbursing office for the regular SBP payment, whenever
necessary to avoid a break in assistance, except that no prorated grant is
issued for less than $1.00.
(3)
Direct payment to nursing home. When a patient dies or leaves
a nursing home, the amount of the nursing home care for which a nursing home
care payment has not yet been received by the patient is paid directly to the
nursing home.
(i)
SBP is
discontinued. If the payment for nursing home care is discontinued and
no assistance is being authorized for any part of the remainder of the month,
authorize the change of payment name and the discontinuance on the same Form PA
122-N. Use Financial Code 175, also 106 if applicable. In computing the amount
of the payment, the central disbursing office will automatically exclude the
allowance for personal items of $5 per month.
(ii)
SBP is continued. If
the person continues to receive SBP, the payment is made directly to the
nursing home only if the person requests the County Assistance Office, orally
or in writing, to do so. The County Assistance Office arranges to hold the
regular payment that would have been paid to the person and authorizes one-time
grants for the final payment to the nursing home and the initial payment to the
client. In computing the amount of the payment to the nursing home, the County
Assistance Office excludes the allowance for personal items of $5.00 per
month.
(4)
Change
in regular SBP payment because nursing home care payment starts or
stops. When it is necessary to discontinue, change or start a regular
SBP payment because the nursing home care payment starts or stops, Form PA 21-B
is used for authorizing such action. The appropriate Statistical Code is used
for the action authorized. For example, Action Code Letter "C" is used to
discontinue regular SBP payment. The Form PA 122 and 122-N prepared in the
usual manner are used for authorizing the necessary action.
(5)
Move from one Commonwealth county
to another. A County Assistance Office authorizes nursing home care
payments for eligible patients in nursing homes located in its county. When a
patient living in one county enters or plans to enter a nursing home located in
a different county, the two County Assistance Offices plan together to
authorize the payment for which the person is eligible.
(j) Overpayment and underpayment. Procedures for overpayment and underpayment are as follows:
(1) An SBP recipient is overpaid if
he was not eligible for some part or all of his SBP payments.
(2) The blind person is not considered to
have been overpaid because of visual acuity unless the County Assistance Office
decides on the basis of evidence it considers valid that the person knew he was
visually ineligible and failed to report as promptly as possible; or the County
Assistance Office does not suspend and discontinue SBP in accordance with
§
451.3(b), because
of administrative delay.
(3) An SBP
recipient is underpaid if he was eligible for more than his SBP
payments.
(4) The primary period of
time involved in deciding the amount of SBP payments an SBP recipient was
eligible for, in relation to income eligibility conditions, is his fiscal year;
in relation to any other eligibility condition, the period is the fiscal
month.
(5) If an overpayment or
underpayment is less than $1.00, disregard it. Otherwise, for an overpayment,
restitution as shown in subparagraph (ii) is required; for an underpayment, a
one-time grant is authorized, shown in subparagraph (iii).
(i)
Determining amount of
overpayment. If the computation on the Form PA 21-BI, Part B,
subsection (d) of this section, indicates the SBP recipient received a
combination of SBP payments and income in excess of $4,260, the amount in
excess of $4,260 is the amount of the overpayment. Reference should be made to
§
451.5.
(ii)
Restitution.
Restitution is waived if the overpayment is due solely to administrative error.
(A) The overpayment is due to administrative
error only if all of the following conditions exist:
(I) The County Assistance Office failed to
obtain, interpret or appropriately apply the facts about the client's
situation.
(II) The client
fulfilled his obligation for reporting to the best of his ability.
(III) The client could not have been expected
to know that his grant was more than he was eligible to receive. If overpayment
is not waived due to administrative error, and the person continues to be
eligible for SBP, restitution is made by either of the following
methods:
(IV) The SBP recipient
repays the entire amount in one payment. If he chooses this method, the County
Assistance Office submits a Form PA 189, Referral for Restitution or
Prosecution, Chapter 255, and SBP continues. If he fails to repay, the County
Assistance Office, on notice from the area office, suspends or reduces the
payment as described below, and notifies the area office of this
action.
(V) The SBP recipient
repays by having the SBP payment suspended or reduced for a period. This period
may not go beyond the end of the fiscal year immediately following the one in
which the overpayment took place. If the full amount of the overpayment has
been repaid at the end of this period, or if SBP is discontinued before the end
of this period, the County Assistance Office submits a Form PA 189 for that
part of the overpayment that has not been repaid.
(B) If the blind person received SBP when he
was ineligible for reasons other than income, restitution of the amount of SBP
he received during the period of ineligibility is made by any one of the
methods described above that is appropriate. If one of the circumstances below
exists, the procedures of Chapter 255 (relating to restitution) apply:
(I) The SBP recipient was overpaid at the
time of discontinuance.
(II) The
recipient received NHC payments for which he was not eligible.
(III) The overpayment is discovered later
than 1 fiscal year after the overpayment took place.
(IV) More than one fiscal year has elapsed
since the end of the fiscal year in which the overpayment took place, and SBP
is resumed.
(V) Full restitution
has not been made by suspending or reducing the SBP payment.
(iii)
Underpayment. An SBP recipient is underpaid if his SBP
payments for his fiscal year were less than the maximum amount he is entitled
to and his net income plus SBP payments totaled less than $4,260 for his fiscal
year. Reference should be made to §
451.5 If the computation made at
the end of the fiscal year shows that the SBP recipient has been underpaid, a
one-time grant is authorized for the amount shown in Item 6, Form PA 21-BI,
Part B, except in circumstances that follow. If the recipient was ineligible
for SBP during any month in the fiscal year for reasons other than income, or
if he received an NHC payment during the month, total $100 for each such month,
and subtract the sum from the amount in Item 6; the difference is the amount of
the one-time grant that is authorized.
This section cited in 55 Pa. Code § 451.3 (relating to requirements).
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