Pennsylvania Code › Title 55 - HUMAN SERVICES › Part II - Public Assistance Manual › Subpart B - Intake and Redetermination › Chapter 133 - REDETERMINING ELIGIBILITY › REDETERMINING ELIGIBILITY PROVISIONS FOR MA FOR THE MEDICALLY NEEDY › Section 133.84 - MA redetermining eligibility procedures

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Redetermining permanent and total
					 disability.
The degree of a person's disability may change so that he
					 will no longer be totally disabled or so that he will have become totally
					 disabled. Whenever any kind of change takes place in the condition or
					 circumstances of an individual or when new information becomes available that
					 may affect his eligibility for MA, the case should be reevaluated. In these
					 cases information in the record that was submitted earlier will be resubmitted
					 to the review team with the new medical findings and current social
					 information.
(b)
Reapplication.
If a disabled person who was previously found
					 eligible reapplies for MA, an evaluation will be made of the physical,
					 emotional and social situation of the client to determine whether the
					 permanence or totality of the disability has changed. If this study indicates
					 there has been no change in these conditions, the original disability
					 certification will still be valid. However, if there is reason to believe there
					 may have been a change in the permanence or totality of the disability, a
					 review and finding of permanent and total disability will be required. If a
					 reexamination or social information had been required by a specific date and
					 the person reapplies after the date, this information will be obtained as
					 promptly as possible and sent to the review team.
(c)
Complete
					 redetermination.
A complete redetermination is a review of eligibility
					 factors. A personal interview will be required, except for patients in State
					 institutions and children in court determined placement provided by a county
					 children and youth social service agency. A Form PA 743-R and Form PA 743-S are
					 completed and signed at each complete redetermination. Also, a Form PA 743-TPR
					 or Form PA 743-TPR-T is completed at each complete redetermination only if
					 medical indicator 2, 3 or 7 has been entered in item 35 on the Form PA 743.
					 This information will be used to ensure that medical assistance payments are
					 not made when another person or organization is responsible for the medical
					 bills of the recipient. The decision on when to redetermine eligibility is
					 based on the eligibility requirements for the individual, the possibility of
					 change in the circumstances of the individual, and the frequency requirements
					 for redetermination for the specific category. Appropriate controls must be
					 established. Eligibility will be redetermined as frequently as warranted by the
					 circumstances of the individual case, but no less frequently than the
					 following:
(1) At least every 12 months for
					 aged, blind and disabled categories. Note, however, that Income and Assets
					 Evaluation must be made every 6 months as required by subsection
					 (d)(1).
(2) At least every 6 months
					 for other categories.
(3) Within 30
					 days following the receipt of the case record of a person who has made a
					 permanent move into the county.
(4)
					 When a person is added to an existing family unit.