CHAPTER 285. PAYMENT FOR BURIAL

§ 285.1. Policy.

 (a)  According to the Public Welfare Code (62 P. S. § §  101—1503), the Department has authority to establish rules, regulations and standards as to eligibility for burial.

 (b)  Within the regulations the Department has established, it will pay a funeral director for burial of a deceased person only if other resources to pay for his burial are insufficient, according to the standards of the Department for decent burial.

 (a)  Eligibility conditions under which payment is made for burial. The following conditions shall be met if payment is to be made for burial. The same conditions apply if the deceased person was out of this Commonwealth at the time of death. The eligibility conditions are as follows:

   (1)  Source of request. The request for payment of burial shall be made by a relative, a friend, the representative of a fraternal society of which the deceased was a member or the representative of a charitable or religious organization; or, if the request comes from another source, it shall be accompanied by a certificate issued by the Anatomical Board, Department of Health, declaring the body unfit for anatomical purposes. A request for payment of burial will not be accepted from the funeral director, or anyone acting for him. The person requesting payment of burial shall apply to the CAO; or, the funeral director may notify the CAO that the person is requesting payment of burial. In either case, the person requesting payment of burial utilizes the Form PA 118 (Burial Request-Invoice).

   (2)  Date of request. The request for payment of burial, or notice by the funeral director of the request, will normally be acceptable only when made before burial. An exception may be made if there were unusual circumstances that constituted valid cause for the delay.

   (3)  Assistance status of deceased. The deceased person shall have been receiving a money payment—TANF, GA, SBP or SSI—at the time of death. The phrase receiving a money payment at the time of death includes the following:

     (i)   A person whose eligibility for assistance, including SBP, had been determined and assistance authorized, whether or not he had received his first check. Eligibility begins with the date the first Form 122 or 122-E is typed and signed. Eligibility for burial payment extends through the period covered by the last check issued, for which the recipient was eligible.

     (ii)   A former assistance recipient whose assistance had been discontinued because of his hospitalization, and who died while hospitalized and within 3 months from the date of his admission to the institution.

     (iii)   A child born dead to an assistance recipient.

     (iv)   A child of an assistance recipient who had died so soon after birth that assistance could not have been authorized on his behalf.

     (v)   A member of a recipient’s family who formerly received assistance with the family; who had recently returned to live with the family after an absence; who was planning to apply for assistance as a member of the assistance unit of the recipient, or on whose behalf the recipient was planning to apply, and who died before these plans could be carried out and assistance authorized for him.

     (vi)   A person who was receiving nursing home care payments and who was transferred over to the MA vendor payment system effective January 1, 1973, and who has continuously received NHC under the MA Program.

     (vii)   A migrant worker who may be eligible under §  147.21 (reserved).

 (b)  Deceased persons who are not eligible. The following deceased persons are not eligible for payments for burial:

   (1)  Because of the benefits available on behalf of certain deceased veterans, the Department will not pay for the burial of a veteran unless the amount of the VA Death Benefit is less than the Department Burial payment as set forth in §  285.4 (relating to procedures). A person requesting payment for the burial of a veteran shall be referred to the service officer of a recognized veteran’s organization, to the County Director of Veteran’s Affairs or to the American Red Cross local chapter for information on burial benefits for veterans.

   (2)  The Department will not pay for the burial of a deceased UMWA member for whom the UMWA Welfare and Retirement Funds will pay funeral expenses or death benefits. A person requesting payment for the burial of a deceased miner shall be referred to the local UMWA Union.

 (c)  Standards for burial. The standards for burial are as follows:

   (1)  Payment of goods and services, and interment. The minimum requirements for goods and services, unless the remains are cremated, are as follows:

     (i)   Standard casket.

     (ii)   Standard wooden outer case, unless a cave-proof container is contributed, or unless an outer case is contrary to custom or cemetery regulations.

     (iii)   Suitable clothing for the remains, if not otherwise provided.

     (iv)   Preparation of the remains.

     (v)   Transportation of the remains, except what is paid for by contributions permitted in subsection (e)(1)(iii).

     (vi)   Transportation of the funeral party, if not otherwise provided.

     (vii)   The usual professional services.

   (2)  If the remains are cremated, the following goods and services are the minimum requirements.

     (i)   Standard casket, if a viewing is requested.

     (ii)   Suitable containers for the ashes, if requested.

     (iii)   Suitable clothing, if necessary.

     (iv)   Necessary preparation of the remains.

     (v)   Transportation of the remains, except what is paid for by contributions permitted in subsection (e)(1)(iii).

     (vi)   Transportation of the funeral party, if not otherwise provided.

     (vii)   The usual professional services.

   (3)  Interment consists of grave space in a place other than potter’s field selected by the person requesting payment; opening and closing the grave in accordance with health laws and regulations, related services or cremation and appropriate disposition of the ashes.

 (d)  Department payment schedule. The Department’s total payment for burial, if there are no resources to reduce the payment, are as follows:

 (e)  Resources that do not reduce Department payment. If a person or agency makes small contributions, such as articles of clothing, the use of cars to carry the funeral party, newspaper advertising, flowers, religious services, and the like, they are not considered in determining the amount of the Department payment.

   (1)  Resources for special burial costs. Resources for special burial costs are as follows:

     (i)   The Department burial payments are based on a minimum standard for burial. To recognize certain circumstances that the minimum standard does not include, the following resources do not reduce the Department payment: contributions in money, goods or services by an agency or person, including legally responsible relatives, for clauses (A), (B) and (C), up to a total of $180 for any or all of the following:

       (A)   The amount by which the actual charges for interment exceed $70, or $35 for a child born dead, in the cemetery chosen by the person requesting burial payment.

       (B)   The charge for a cave-proof container to meet the minimum standards of a cemetery that requires that type of container.

       (C)   The charge for transporting the remains for the number of miles over 15. This charge shall be no more than the prevailing local rate for hearse hire, or charge for rail transportation, whichever is used.

     (ii)   If agencies or persons, or both, make total contributions of over $180 for subparagraph (i)(A), (B) and (C), the difference between $180 and the value of the actual contributions reduces the Department payment.

     (iii)   If a contribution is made for an item other than subparagraph (i)(A), (B) and (C), the total value of the contribution reduces the Department payment as set forth in subsection (f)(1).

   (2)  Resources from which the Department will seek to collect. Under the following circumstances, the Department payment is not reduced by the value of the resources described in subsection (f), but instead the State Office will seek recovery:

     (i)   If the CAO reports resources to the funeral director after the deadline date as set forth in §  285.4(b)(4), and the funeral director does not collect from these resources.

     (ii)   If the resources become available only after the Department pays for burial.

 (f)  Resources reducing Department payments. If payment for burial is requested, the CAO shall determine whether the types of resources described in paragraphs (1)—(9) exist or are obtainable. These are resources which, at the death of the individual, may be in the estate of the deceased, may be payable on the behalf of the deceased, to the estate or to another person or may be contributed on the behalf of the deceased, and thus become available for meeting burial expenses. The CAO shall explore possible contributions from known relatives or friends with the aim of developing resources for burial. The value of the following resources reduces the amount the Department pays for burial:

   (1)  Except under the conditions set forth in subsection (e)(1), the value of contributions for burial items by an agency or person.

   (2)  Burial reserve in the estate of the deceased, and the value of a burial reserve and burial space as set forth in §  177.2 (relating to definitions).

   (3)  Cash on hand in the estate of the deceased.

   (4)  Other personal property in the estate of the deceased that may be readily converted into cash, and is not needed to meet a living requirement for the survivors.

   (5)  Life insurance death benefits—any insurer—and burial benefits from a lodge or fraternal organization. The Department recognizes insurance as a means of providing for burial as provided in §  177.24(1) (relating to determining value of resources), whether the benefits are payable to the estate, a relative or another person. Death benefits from insurance over which the deceased had no control as provided in §  177.24 reduces the Department payment only when payable to LRRs, or persons or organizations that paid insurance premiums by agreement with the insured that the benefits would be used for burial as provided in §  177.24. Among the sources of information on death benefits is the physician who signed the death certificate. This physician is usually the one who signs the ‘‘proof of death’’ on the basis of which insurance companies make payments on policies.

   (6)  A lump-sum death benefit from OASDI payable to a surviving spouse or to a funeral director or from railroad retirement payable to a surviving spouse. The lump-sum death benefit is payable to a surviving spouse only if they were living together in the same household. If there is a surviving spouse, the CAO may not send the Form PA 118 to Bureau of Finance until it knows, and has informed the funeral director, of the amount of a lump-sum death payment. Definite information about payment may be obtained only after the surviving spouse files a claim for benefits. The surviving spouse will receive a notice of award which may be inspected, or if this is not practical, the OASDI field office or RR Retirement Board District Office where the claim was filed shall furnish the necessary information upon request made on PA 31 or PA 84-R respectively. If there is no surviving spouse, or if he died before receiving payment, the procedure to be followed depends on the source of the lump-sum death payment.

     (i)   OASDI. OASDI determinations are made as follows:

       (A)   The funeral director is entitled to the entire lump-sum death benefit to the extent of the unpaid burial expenses, if the person who assumed responsibility for payment of the funeral expenses authorizes that the lump-sum payment be paid to the funeral director. Generally, the person who made the arrangements for the funeral is considered to have assumed responsibility, and he authorizes the payment to the funeral director. If that person does not want to authorize the payment to the funeral director, or in an unusual case OASDI determines that the person who arranged burial did not assume responsibility, the Executive Director or a delegate, at the request of the funeral director, may authorize that the lump-sum payment be paid to the funeral director.

       (B)   The Department will not pay burial costs until definite information about payment of the lump-sum death benefit is obtained from the funeral director. If the claim is disallowed, the funeral director shall attach the notice of disallowance, OA-CL 231, to the Form PA 118. The Form PA 118 shall be submitted within 15 days of the receipt of the benefit or the OA-CL 231.

     (ii)   RR retirement. The lump-sum death benefit is payable to the persons or agencies that pay the burial expenses. The lump-sum is prorated among those who paid, in proportion to the shares they paid of total burial expenses. The Department will pay for all or part of the burial expenses, as necessary, and the State Office will file a claim. The CAO shall complete Form AA-21 and send it to the Bureau of Finance with the Form PA 118 unless it is known that the deceased had never been employed on a job covered by RR retirement. The CAO shall enter on the Form AS-21 contributions, other than by PA, toward the burial expenses. If the RR Retirement Board requests additional information not available in the State Office, the Bureau of Finance will ask the CAO to supply it.

   (7)  Benefits available from the county commissioners on behalf of deceased widows of certain deceased veterans; also, burial for them in a national cemetery, if chosen as the place of burial by the person requesting burial payment.

   (8)  Workmen’s Compensation Benefits in accordance with the following:

     (i)   If death results from an accident or injuries sustained in connection with the employment of the deceased, benefits up to a maximum of $500 are available from the employer for burial expenses. These benefits are payable to the funeral director.

     (ii)   The claim for benefits against the employer or his insurance carrier shall be filed either by the surviving dependents, such as dependent widow, dependent children or dependent parents of the deceased, or by the administrator of the estate of the deceased. To file a claim, the claimant shall complete a Form LIBC-353 (Fatal Claim Petition for Compensation by Dependents of Deceased Employee). This form may be obtained from the Bureau of Workmen’s Compensation, Department of Labor and Industry, Harrisburg, Pennsylvania. Upon completion, it shall be filed with the Bureau of Workmen’s Compensation. If, after a hearing, the claimant is rejected by the Bureau, the claimant has 20 days from the date of the distribution of the decision, to appeal to the Workmen’s Compensation Board.

     (iii)   If there is no surviving dependent or administrator to file a claim, the funeral director shall file the claim. The Department will not authorize payment of burial costs while a claim is pending for Workmen’s Compensation Benefits. When the funeral director receives the final decision of the Workmen’s Compensation Board, he shall submit to the CAO evidence of this decision. This evidence shall be submitted to the CAO within 15 days after the funeral director is informed of the decision. Only if the claim is rejected and other resources are inadequate, will the Department authorize payment of burial costs. The CAO shall transmit to the Division of Assistance Payments the evidence submitted by the funeral director.

     (iv)   For more complete information on Workmen’s Compensation Benefits, refer to Chapter 205 (relating to steps in verification).

   (9)  Awards resulting from accidental death not connected with the employment of the deceased reduce the payment of the Department. Pending awards do not. When an award is pending, the Department will pay for burial and the State Office will seek recovery when the award is made.

   The provisions of this §  285.3 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended August 26, 1988, effective November 1, 1988, 18 Pa.B. 3893. Immediately preceding text appears at serial pages (109226) to (109233).

 (a)  General. Burial payment policy in general will be as follows:

   (1)  Under the conditions stated in this section the Department will not pay for burial if the total value of resources available equals or exceeds the allowable payment for burial. If the total value of resources available is less than the allowable payment for burial, the Department will pay the difference.

   (2)  The data the county office gives the funeral director on resources, verbally or in writing, will not constitute an authorization of payment. The State office will authorize payment. The county office will certify the request for payment of burial expenses after the funeral director returns to it all forms and other required materials, complete and correct, and the county office is satisfied that the regulations of the Department have been complied with. The State office will authorize payment after it receives forms and other required materials from the county office, and the State office is satisfied that the regulations of the Department have been complied with. Payment will then be made to the funeral director.

 (b)  Responsibilities of county office and funeral director. The county office should recognize the importance of providing prompt and courteous determinations of eligibility for the person requesting assistance and the funeral director. The county office will be responsible for giving the following information to the funeral director selected by the person requesting payment for burial:

   (1)  If the person requests burial payment after the burial, or if the funeral director does not notify the county office of the request until after the burial, the request is not acceptable unless the provisions of §  285.3(a)(2) (relating to requirements) apply.

   (2)  Whether the assistance status of the deceased at the time of this death was in accordance with regulations. If it was not, the Department will not pay for the burial.

   (3)  If the request has come from a source other than those specified in §  285.3, the request will be acceptable only if it is accompanied by an unfit certificate from the Anatomical Board.

   (4)  If the Department has been asked to pay, the funeral director shall be responsible for notifying the county office promptly of resources he knows or learns of in a burial he is handling. This will include the assignment of an OASDI lump-sum death benefit. The county office will notify the funeral director in writing of resources it knows or learns of that reduce the Department payment. The type of resource and the approximate amount, rather than the exact amount, should be given, since in many instances the exact amount will not be known; for example, the amount payable on an insurance policy, the value of personal property and lump-sum death benefits. Resources the county office informs the funeral director of by the deadline date set forth in this subsection will reduce the Department payment. The deadline date will be the later of either the work-day following the date the county office receives the request for burial payment, or the day before the funeral. The county office will inform the funeral director of any resource which becomes known to them after the deadline date. The funeral director shall notify the county office promptly whether he is able to collect and any amount collected. If the Form PA 118 has not been forwarded for payment, the resource collected will reduce the amount to be paid. Noncollection will not reduce the payment, but an explanation will be attached to the Form PA 118. If the Form PA 118 has been forwarded for payment, the Bureau of Finance will be notified of either collection or noncollection.

   (5)  Standards for Department payment for burial goods and services.

   (6)  The Department payment plus the resources shown on the Invoice, that is, those that reduce the payment and those that do not, must constitute the entire bill incidental to the burial of the deceased. The funeral director may not accept other payment from any source.

 (c)  Preparing and processing Form PA 118 (Burial Request-Invoice). Under the circumstances set forth in §  257.24 (relating to procedures) the county office will submit a Form PA 173-S (Reimbursement Referral).

   (1)  Preparing the Form PA 118. Use of the Form PA 118 will be in accordance with the following:

     (i)   The county office will fill in on four copies of the PA 118, the information pertaining to identification including the date of request and the assistance status of the decedent at time of death. The date of request must be the date on which the county office was first requested to pay for the burial, not the date on which the person requesting burial payment signs the section of the form titled ‘‘To Be Filled In By Person Making Request.’’

     (ii)   Three copies will be sent to the funeral director. Along with these will be sent a statement of the resources that reduce the Department payment, and a copy of Leaflet No. 3, Information for Funeral Director, if the funeral director has not had one before. On the Form PA 118, the funeral director shall have the person requesting payment complete and sign two copies of that portion of the form titled ‘‘To Be Filled In By Person Making Request.’’ The funeral director shall complete that section of the form titled ‘‘To Be Filled In By Funeral Director’’ on all three copies and return all copies of the Form PA 118 to the county office. The Form PA 118 and accompanying material must be returned within 30 days from the death of the deceased, except:

       (A)   In unusual circumstances when the funeral director submits valid reasons for delay.

       (B)   When the funeral director has been awaiting a report from the county office on the amount of the OASDI or RR lump-sum death payment to the surviving spouse.

       (C)   When the funeral director’s claim for the OASDI lump-sum death payment has been pending; in this case the forms must be returned within 15 days after the funeral director has received the payment or the OA-CL 231.

       (D)   If the county office approved a request after burial as provided in §  285.3; in such case the forms must be returned within 30 days from the date of the request.

       (E)   A claim for Workmen’s Compensation Benefits has been pending as provided in §  285.3; in this case, the forms must be returned within 15 days after the funeral directorhas been informed of the final decision, of which he submits evidence. An explanation of the delay signed by the Executive Director will be attached by the county office to the Form PA 118. The explanation should indicate what other arrangements for payment, if any, had been contemplated, and why the arrangements would not be carried out.

   (2)  Checking forms and other material returned by funeral director. The county office will examine the completed forms and the accompanying material returned by the funeral director to check on the following points:

     (i)   Completion of sections titled, ‘‘To Be Filled In By Person Making Request’’ and ‘‘To Be Filled In By Funeral Director.’’

     (ii)   Accuracy of item, ‘‘Net to be paid by DPW.’’ This will be verified as follows:

       (A)   By checking each charge against §  285.3.

       (B)   By totaling the correct charges.

       (C)   By comparing the item ‘‘Resources Which Reduce DPW Payment’’ with the county office’s information on resources. If the total of these resources equals or exceeds the total burial charges, the request for burial payment will not certified.

       (D)   By subtracting the correct total of these resources from the correct total charged to Department. The difference becomes the amount the Department will authorize and pay the funeral director for burial.

     (iii)   The item titled, ‘‘Contributions Received That Do Not Reduce DPW Payment,’’ for accordance with §  285.3.

     (iv)   Compliance with the required date of return of the PA 118 as set forth in subsection (c)(1), or a statement from the funeral director explaining the unusual circumstances. The county office will submit this explanation with its recommendation to the Bureau of Finance, together with the Form PA 118.

     (v)   The county office will return the forms or other material to the funeral director for correction or clarification under the following circumstances: the funeral director is collecting from resources reported to him after the deadline date and before the form has been certified for payment, and these resources have not been included on the form in the total of the item ‘‘Resources Which Reduce DPW Payment;’’ there are omissions or errors in the Form PA 118 or accompanying material; or the county office questions the validity of any charge.

     (vi)   The funeral director shall be responsible for making the necessary changes and returning material promptly to the county office.

   (3)  Disposition of forms and other material. When the county office finds the Form 118 and accompanying material complete and correct, and is certifying it for payment, it will complete ‘‘Certification of Executive Director.’’ The county office will retain one copy of the Form PA 118 in the record; it will forward promptly to the Bureau of Finance the original and one copy of the Form PA 118 and all supporting statements and explanations. If there is good reason for not forwarding the material promptly, and if the delay exceeds 60 days after the death of the deceased, the county office will attach to the Form PA 118 an explanation of the delay, signed by the Executive Director. No explanation will be necessary when §  285.3 applies.

   (4)  Forms returned by Bureau of Finance for correction. If the Bureau of Finance returns the Form PA 118 and other material to the county office with a Form PA 260-F (Recommendation by County Review Team) because of errors on the Invoice, the county office will return copies of the forms to the funeral director, asking him to correct them and send them again to the county office. When the county office receives the corrected forms, it will send all material to the Bureau of Finance.

   (5)  Notice by Bureau of Finance of payment, nonauthorization, or reduced payment. The Bureau of Finance will notify the county office of the date and amount of the payment to the funeral director. If the Bureau of Finance advises the county office and the central disbursing office that it is not authorizing payment, the county office will note this fact on the Form PA 118 in the record. If the notice advises that a lesser amount is being paid than appears on the Invoice, the county office will correct the Form PA 118 in the record. For State office and central disbursing office auditing of Invoices, reference should be made to §  7400, The Auditing of Invoices.

 (d)  Letter to person who requested payment for burial. When the county office receives notice that the funeral director has been paid, it will send a letter to the person who requested burial payment if he is a relative of the deceased. Otherwise, sending the letter is discretionary. The letter is aimed at preventing duplication of burial payment. The general content of the letter will be like that of the sample letter below. A typed letter is preferable to a mimeographed form letter. The sender of the letter will be noted in the record. If the county office receives notice that the Bureau of Finance is not authorizing payment, it will notify the relative who requested burial payment that it was not authorized and the reason, for example, other resources were available to pay for burial.

SAMPLE LETTER
to
Person Who Requested Payment for Burial

  Dear

---

,
 We are writing to let you know that the Department of Public Welfare has paid

---

, funeral director, $

---

for all expenses connected with the burial (or: cremation) of

---

.  (If ‘‘all’’ is not correct, omit it and add: Total charges for the burial were $

---

. The balance was paid from other sources.)
 If you know of any other payment made for this burial, please get in touch with this office immediately.
 Because of the deceased’s circumstances, the price charged by the funeral director was less than he usually charges.
Very truly yours,

Executive Director

 (e)  Action on violations by funeral directors. The following will constitute possible actions on violations by funeral directors:

   (1)  If the county office learns that a funeral director has or appears to have violated regulations of the Department, the county office will notify the Director, Bureau of Finance, at once, giving the facts and evidence immediately available, and will recommend final action to be taken.

   (2)  Evidence the county office sends the Director, Bureau of Finance, will include the original or photostat of receipt for additional payment a person has made, the original or photostat of the bill or letter the funeral director has sent the person requesting additional payment, or any proof that the funeral director has charged for goods or services he has not supplied. If evidence is not immediately available to the county office, the report will be sent without delay and the evidence sent later as soon as it has been assembled.

   (3)  If the Director, Bureau of Finance, has information indicating a funeral director may have violated the regulations of the Department, he may withhold all payments to the funeral director involved and may send representatives to the locality to determine the facts.

   (4)  The State office will determine the final action taken on the violation. This action may be any or all of the following: collecting from the funeral director, prosecuting him and barring him from receiving future payments under the burial program.

   The provisions of this §  285.4 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180.

   This section cited in 55 Pa. Code §  285.3 (relating to requirements); 55 Pa. Code §  1251.42 (relating to ongoing responsibilities of providers); and 55 Pa. Code §  1251.81 (relating to provider misutilization).