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Posts tagged "eligibility"

BHA Hearing Delays and Requesting Interim Assistance

Historically, the Bureau of Hearings and Appeals (BHA) has prioritized the scheduling and adjudication of Medical Assistance (MA) eligibility appeals over other types of appeals. Recently, however, beneficiaries and providers have experienced significant delays in the resolution of MA eligibility appeals. In some instances, the BHA is taking several months to schedule hearings on MA eligibility determinations. Generally, the BHA must take "final administrative action" within 90 days of the filing date of the appeal. "Final administrative action" means a decision by the hearing officer. If final administrative action is not taken within 90 days of the filing of the appeal, the Department of Human Services is required to authorize the payment of MA benefits to the provider on behalf of the resident pending the final administrative action. Interim assistance is not subject to restitution absent an affirmative misrepresentation by the beneficiary. In cases where the beneficiary is responsible for delaying the hearing process, the time limit for final administrative action is extended by the length of the delay.

Refunds of Resident Trust Accounts

On June 26, 2013, the General Assembly of the Commonwealth of Pennsylvania amended the Probate, Estates, and Fiduciaries Code to allow nursing facilities to disperse up to $10,000 from a resident trust account after the resident's death in certain circumstances. If the deceased resident was a recipient of Medical Assistance benefits, the facility may disperse up to $10,000 from the resident trust account to a licensed funeral director to contribute to burial expenses, regardless of whether a personal representative has been appointed. If the decedent's burial expenses total less than $10,000, then the facility may pay the remaining funds to the decedent's family members, not to exceed $10,000. Preference is given to family members in the following order: spouse, child, parent, then sibling. Previously, facilities could only disperse up to $3,500 from a patient's care account to a licensed funeral director and could not exceed a total of $4,000 after paying the remainder to family members. If a facility makes such a payment, it will be released to the same extent as if the payment had been made to the decedent's personal representative.

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