§ 21.23. Application process for domiciliary care service and the
domiciliary care supplement.

 The following procedure shall be used for determining the eligibility of an applicant for domiciliary care service and making payment for the domiciliary care supplement:

   (1)  The application process includes activity relating to a request by an applicant for an eligibility determination. It begins with the receipt of an application by an AAA and continues until there is a determination of eligibility or ineligibility.

   (2)  The applicant is responsible for:

     (i)   Initiating, completing and signing necessary application forms as promulgated by the Department and the Department of Public Welfare.

     (ii)   Participating in an assessment interview with the AAA.

     (iii)   Sending required application forms to the appropriate AAA.

     (iv)   Promptly notifying the appropriate AAA of changes in circumstances that may affect continued eligibility for domiciliary care service or the domiciliary care supplement.

     (v)   Contacting the appropriate Social Security District Office to place an application for SSI if the applicant is applying for SSI at the same time the applicant is applying for domiciliary care service.

   (3)  The AAA is responsible for:

     (i)   Providing the applicant with the necessary application forms and, if appropriate, assisting the applicant with completing the forms.

     (ii)   Receiving the application and reviewing it to assure that forms are complete and the necessary documentation is attached.

     (iii)   Accepting an application from a designate when the applicant is incapable of filing an application on the applicant’s own behalf.

     (iv)   Notifying the applicant of the nature of the error and that an application date cannot be established, and assisting the applicant in correcting errors on the application, if the application is incomplete or incorrect.

     (v)   Assisting the applicant in contacting the appropriate Social Security District Office, if the applicant is applying for SSI at the same time the applicant is applying for domiciliary care service.

     (vi)   Arranging for a face-to-face assessment interview within 15 days of the applicant’s request for service.

     (vii)   Performing, with the applicant’s informed consent, a thorough, indepth, face-to-face assessment of the applicant’s level of functioning and the need for domiciliary care service, as stated in §  21.21 (relating to eligibility for domiciliary care service), using the forms as prescribed by the Department.

     (viii)   Arranging for a medical examination of the applicant and ensuring that appropriate documentation of the examination is recorded on forms prescribed by the Department of Public Welfare.

     (ix)   Requesting the domiciliary care review team, within 30 days of the assessment, to review and recommend appropriate action for applicants for whom the AAA is unable to reach a decision concerning the need for domiciliary care service.

     (x)   Providing notice, in writing, to the applicant or the designate of the applicant’s ineligibility for domiciliary care service, if determined ineligible by the AAA, within 10 days after the decision has been made, and providing the reasons for the determination of ineligibility, along with information on the applicant’s right to appeal the decision under §  21.101 (relating to fair hearings and appeals).

     (xi)   Forwarding the original application, along with necessary documentation and forms, to the appropriate CAO and retaining a copy for the AAA’s files when the AAA has determined that the applicant is eligible for domiciliary care services and an appropriate domiciliary care home is available in which to place the client.

     (xii)   Assigning the client to a waiting list until an appropriate domiciliary care home becomes available, when the AAA has determined that the applicant is eligible for domiciliary care service and has made an initial verification that the applicant’s income is low enough to meet the eligibility requirements for the supplement, but there is no appropriate domiciliary care home available in which to place the client and informing, in writing, the client or the designate of the determination and the action which has been taken.

     (xiii)   Initiating domiciliary care services to the client on a private payment basis when the AAA has determined that the applicant is eligible for domiciliary care service, but the CAO has determined that the applicant is not eligible for the domiciliary care supplement because the applicant’s income is too high. If there is no appropriate domiciliary care home available in which to place the client, the client shall be assigned by the AAA to a waiting list until an appropriate domiciliary care home becomes available, and the client or the designate shall be informed in writing of the determination and the action which has been taken.

     (xiv)   Beginning the actual process of placing the client into a domiciliary care home as soon as necessary forms and eligibility determinations have been completed by the AAA and the CAO under this section, and the AAA has available an appropriate domiciliary care home in which to place the client, and informing the client and the designate, if one exists, in writing of the determination of eligibility and the action which is being taken. The written notification shall take place within 30 days of the date the eligibility determination was made.

   (4)  The CAO is responsible for determining eligibility for the domiciliary care supplement under 55 Pa. Code Chapter 299 (relating to supplemental sucurity income program and State supplementary payment program) and, in cases where applicants appeal that determination, conducting hearings and appeals under 55 Pa. Code Chapter 275 (relating to appeal and fair hearing).

Cross References

   This section cited in 6 Pa. Code §  21.52 (relating to AAA service responsibilities); and 55 Pa. Code §  299.2 (relating to eligibility requirements for SSA-administered optional SSP for DCS and PCS).



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