RULES AND REGULATIONS
Title 55--PUBLIC WELFARE
DEPARTMENT OF PUBLIC WELFARE
[55 PA. CODE CHS. 140 AND 178]
Special MA Eligibility Provisions; Resource Provisions for Categorically Needy NMP-MA and MNO-MA
[31 Pa.B. 3196] The Department of Public Welfare (Department), by this order, adopts the amendments to read as set forth in Annex A under the authority of sections 201(2) and 403(b) of the Public Welfare Code (act) (62 P. S. §§ 201(2) and 403(b)) which, respectively, authorize the Department to promulgate regulations which will increase Federal funding in joint State/Federal welfare programs and delegate to the Department the power to adopt regulations setting rules and standards for eligibility for welfare programs. A notice of rule change (NORC) was published at 23 Pa.B. 2878 (June 19, 1993) effective June 1, 1993.
Notice of proposed rulemaking is omitted in accordance with section 204(1)(iv) of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. § 1204(1)(iv)), known as the Commonwealth Documents Law (CDL) and 1 Pa. Code § 7.4(1)(iv) (relating to omission of notice of proposed rulemaking) because the administrative regulations relate to Commonwealth grants and benefits. Additionally, notice of proposed rulemaking is omitted for good cause as unnecessary, under section 204(3) of the CDL and 1 Pa. Code § 7.4(3) because these regulations eliminate the resource standards when determining Medical Assistance (MA) eligibility for low-income children under 21 years of age and low-income families with children under 21 years of age. Notice of proposed rulemaking is omitted as impracticable because these amendments are already in effect and issuance of proposed rulemaking would unnecessarily delay this beneficial policy. These amendments have been implemented under the NORC effective June 1, 1993, and no public comments have been received by the Department.
Section 1902(r)(2) of the Social Security Act (42 U.S.C.A. § 1396(r)(2)) permits states to adopt a less restrictive methodology for the Federally-funded categories of MA when determining resource eligibility. The Health Care Financing Administration (HCFA) approved the Commonwealth's amendment to its Title XIX Medicaid State Plan based on a less restrictive resource methodology. The amendment applies to the Federally-funded categories of MA and will also be applied to the General Assistance (GA)-related MA categories with children under 21.
Purpose
The purpose of these amendments is to eliminate the resource standards used when determining MA eligibility for low-income children under 21 years of age and low-income families with children under 21 years of age. By applying a uniform standard, the MA application and eligibility determination process will be simplified. A child's immediate family includes the child, the biological or adoptive parent of the child under 21 years of age, the spouse of the parent, the child's relatives under 21 years of age and includes the brother, sister, step-brother, step-sister, half-brother or half-sister who are under 21 years of age who also live with this child. The resource exclusion also applies to the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under 21 years of age.
Background
The elimination of the different resource standards used in the MA eligibility determination process assures that all low-income children under 21 years of age and low-income families with children under 21 years of age will be treated in an equitable manner.
Need for Amendments
These amendments are needed to codify into the Department's regulations the Medicaid State Plan Amendment approved by HCFA and implemented by the Department by the NORC published at 23 Pa.B. 2878 effective June 1, 1993. The codification of the less restrictive resource methodology for MA eligibility determinations for low-income children and their families assures the continued access of Federal funding.
Summary of Amendments
A. Definition (§§ 140.2, 140.202 and 178.2)
The term ''immediate family'' is added to these sections and is defined as the child, the biological or adoptive parent of a child under 21 years of age, the spouse of the parent and the brother, sister, step-brother, step-sister, half-brother or half-sister who are under 21 years of age and who are living together.
B. Resources of Children Under 21 years of age and Families with Children Under 21 years of age (§ 140.100)
This section is added to specify that the resources of the Healthy Beginnings child under 21 years of age and the Healthy Beginnings applicant/recipient with children under 21 years of age are excluded. The resource exclusion also applies to the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under age 21 years of age.
C. Resources of Children Under 21 years of age and Families with Children Under 21 years of age (§ 140.305)
This section is added to specify that the resources of the Healthy Horizons child under 21 years of age and the Healthy Horizons applicant/recipient with children under 21 years of age are excluded. The resource exclusion also applies to the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under age 21 years of age.
D. Resources of Children Under 21 years of age and Families with Children Under 21 years of age (§ 178.84)
This section is added to specify that the resources of the blind and disabled Supplemental Security Income (SSI)-related child under 21 years of age and the aged, blind and disabled SSI-related applicant/recipient with children under 21 years of age are excluded when determining MA resource eligibility for Categorically Needy Nonmoney Payment (NMP) and Medically Needy Only (MNO) MA. The resource exclusion also applies to the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under 21 years of age.
E. Resources of Children Under 21 years of age and Families with Children Under 21 years of age (§ 178.163)
This section is added to specify that the resources of Temporary Assistance for Needy Families (TANF) and GA-related children under 21 years of age and TANF-related and GA-related families with children under 21 years of age are excluded when determining resource eligibility for NMP and MNO-MA. The resource exclusion also applies to the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under age 21 years of age.
Affected Persons and Organizations
These regulations apply to children under 21 years of age and immediate families with children under 21 years of age who are applying for, or receiving, MA. The regulations also exclude the resources of a caretaker with whom the child is living if the caretaker is not an immediate family member and is exercising care and control of the child under age 21 years of age.
Accomplishments/Benefits
These regulations will have a positive benefit for all low-income children under 21 years of age and families with children under 21 years of age who have, or receive, resources. The regulations will also benefit the caretaker who exercises care and control of a child.
Fiscal Impact
Commonwealth:
This change in requirements is effective retroactive to June 1, 1993, and is estimated to cost the Department $9.515 million ($4.408 million in State funds) during Fiscal Year 1998-1999. However, since this policy change was procedurally implemented on June 1, 1993, these increased costs are implicitly included in the Department's budget projections for Fiscal Year 1998-1999.
Public Sector:
There will be no costs or savings incurred by the public sector.
Private Sector:
There will be no costs or savings incurred by the private sector.
Paperwork Requirements
These regulations require no additional forms or reports.
Effective Date
Upon publication in the Pennsylvania Bulletin, these regulations are effective as final rulemaking retroactive to June 1, 1993.
Sunset Date
No sunset date is applicable. The Department continuously reviews the MA Program and regulations through the Federally-monitored Quality Control process. HCFA staff conduct audits periodically on specific aspects of the MA Program.
Public Comments
Although these regulations are being adopted without prior notice, interested persons are invited to submit written comments within 30 days from the date of this publication for consideration by the Department as to whether the regulations should be revised. Comments should be sent to the Department of Public Welfare, Edward J. Zogby, Acting Director, Bureau of Policy, Room 431, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-4081.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5886 (Voice users).
Regulatory Review Act
Under section 5.1(c) of the Regulatory Review Act (71 P. S. §§ 745.5a(c)), on April 25, 2001, the Department submitted copies of these final-omitted regulations to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare. On the same date, the final-omitted regulations were submitted to the Office of the Attorney General for review and approval under the Commonwealth Attorneys Act (71 P. S. §§ 732-101--732-506).
Under section 5.1(d) of the Regulatory Review Act, on May 15, 2001, these final-omitted regulations were deemed approved by the House and Senate Committees. Under section 5.1(e) of the Regulatory Review Act, on May 17, 2001, IRRC met and approved the final-omitted regulations.
Findings
The Department finds that:
(1) Public notice of intention to amend the administrative regulations amended by this order is omitted in accordance with section 204(1)(iv) of the CDL and 1 Pa. Code § 7.4(1)(iv) because administrative regulations relate to Commonwealth grants and benefits. Additionally, the procedures in sections 201 and 202 of the CDL (45 P. S. §§ 1201 and 1202) are unnecessary because these amendments eliminate the resource standards when determining MA eligibility for low-income children under 21 years of age and low-income families with children under 21 years of age. These amendments are based on the HCFA's approval of an amendment to the Commonwealth's Title XIX Medicaid State Plan excluding from the eligibility determination process, the resources of low-income children under 21 years of age and low-income families with children under 21 years of age. Furthermore, notice of proposed rulemaking is omitted as impracticable because these amendments are already in effect and issuance of proposed rulemaking would unnecessarily delay this beneficial policy. These amendments have been implemented under a NORC effective June 1, 1993, and no public comments have been received by the Department.
(2) The adoption of these amendments in the manner provided in this order is necessary and appropriate for the administration and enforcement of the act.
Order
The Department, acting under the act, orders that:
(a) The regulations of the Department, 55 Pa. Code Chapters 140 and 178, are amended by amending §§ 140.2, 140.202 and 178.2 and by adding §§ 140.100, 140.305, 178.84 and 178.163 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Secretary of the Department shall submit this order and Annex A to the Office of Attorney General and the Office of General Counsel for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin and apply retroactively to June 1, 1993.
FEATHER O. HOUSTOUN,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 31 Pa.B. 2855 (June 2, 2001).)
Fiscal Note: 14-449. (1) General Fund;
MA--Outpatient MA--Inpatient (2) Implementing Year 1998-99 is $1.283 million $3.125 million (3) 1st Succeeding Year 1999-00 is $1.445 million $3.522 million 2nd Succeeding Year 2000-01 is $1.663 million $3.978 million 3rd Succeeding Year 2001-02 is $1.845 million $4.495 million 4th Succeeding Year 2002-03 is $2.085 million $5.079 million 5th Succeeding Year 2003-04 is $2.356 million $5.739 million MA--Outpatient MA--Inpatient 1997-98 $792 million $452 million
1996-97 $799 million $437 million
1995-96 $663 million $428 million
(8) recommends adoption. Funds are included in the 1998-99 budget for this purpose.
Annex A
TITLE 55. PUBLIC WELFARE
PART II. PUBLIC ASSISTANCE MANUAL
Subpart C. ELIGIBILITY REQUIREMENTS
CHAPTER 140. SPECIAL MA ELIGIBILITY PROVISIONS
Subchapter A. THE CATEGORICALLY NEEDY HEALTHY BEGINNINGS PROGRAM FOR PREGNANT WOMEN AND QUALIFIED CHILDREN
GENERAL PROVISIONS § 140.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Applicant--A pregnant woman or qualified child, or an individual applying on their behalf.
Budget group--A pregnant woman or qualified child.
Earned income--Money or other compensation received in return for services rendered.
Emancipated--An individual, under the age of 19, whether residing in or out of the parental household, who is no longer under the care and control of the parent.
Family--Parents, spouses and their children under the age of 21, when living together.
Immediate family--The child, the biological or adoptive parent of a child under 21 years of age, the spouse of the parent, and the brother, sister, step-brother, step-sister, half-brother or half-sister who are under 21 years of age. The immediate family members must be living together.
LRR--Legally Responsible Relative--The spouse of a pregnant woman, or the biological or adoptive parent of an unemancipated child under the age of 19.
Nonrecurring income--Income that is received in a single payment and not expected to continue.
Qualified child--A child who meets the age standards in section 1902 of the Social Security Act (42 U.S.C.A. § 1396a).
Qualified provider--An MA provider designated by the Department for the purpose of determining presumptive eligibility.
Restricted income--Income limited by the payer for the use of a specified person.
Unearned income--Money or other compensation received for which a service is not rendered.
RESOURCE EXCLUSIONS § 140.100. Resources of children under 21 years of age and families with children under 21 years of age.
The resources of the Healthy Beginnings child under 21 years of age and the Healthy Beginnings applicant/recipient immediate families with children under 21 years of age are excluded. If the child who is under 21 years of age is living with a caretaker who is not immediate family as defined in § 140.2 (relating to definitions) and who exercises care and control of the child, the resources of the caretaker are excluded.
Subchapter B. ELIGIBILITY PROVISIONS FOR THE HEALTHY HORIZONS PROGRAM FOR THE ELDERLY/DISABLED
GENERAL PROVISIONS § 140.202. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Applicant/recipient--A person who is applying for, or receiving, benefits under the Healthy Horizons Program.
Calendar quarter--A period of 3-full calendar months beginning with January, April, July or October.
Countable net income--Income counted in determining income eligibility for Healthy Horizons, less appropriate exemptions, deductions and disregards.
Earned income--Money or other compensation received in return for services rendered.
Immediate family--The child, the biological or adoptive parent of a child under 21 years of age, the spouse of the parent, and the brother, sister, step-brother, step-sister, half-brother or half-sister who are under 21 years of age. The immediate family members must be living together.
Infrequent income--Income that is received not more than once in a calendar quarter.
Irregular income--Income that is not subject to scheduling or is unpredictable.
Legal guardian--A person who is court appointed as the legal guardian.
Personal property--Privately owned possessions which are not real property. The term includes cash, bank accounts, stocks, bonds, mortgages, cash value of life insurance policies, household furnishings, personal effects, motor vehicles, boats and Federal, State and local tax refunds.
QI--Qualifying individual--An individual who is enrolled in Medicare hospital insurance under Part A and meets the income requirements in § 140.231(c) or (d) (relating to income eligibility limitations) and resource requirements in § 140.301 (relating to resource eligibility limitations).
QI-1s--Qualifying Individual-1s--A qualifying individual who meets the income requirements in § 140.231(c). Eligibility for Medicaid benefits is limited to full payment of Medicare Part B premiums.
QI-2s--Qualifying Individual-2s--A qualifying individual who meets the income requirements in § 140.231(d). Eligibility for Medicaid benefits is limited to partial payment of Medicare Part B premiums.
QMB--Qualified Medicare beneficiary--An individual who is entitled to, or voluntarily enrolled in, Medicare hospital insurance under Part A.
Real property--Land, buildings, mobile homes and improvements thereto.
SLMB--Specified low-income Medicare beneficiary--An individual who meets the eligibility requirements for QMB status except for income in excess of the QMB income limit, but not exceeding the limits specified in § 140.231.
SSI--Supplemental Security Income--The benefit amount paid to an eligible person or to an eligible person and the eligible spouse under Title XVI of the Social Security Act (42 U.S.C.A. §§ 1381--1383c).
Spouse--A person who is married to another by legal ceremony or by common-law.
RESOURCES EXCLUSIONS § 140.305. Resources of children under 21 years of age and families with children under 21 years of age.
The resources of the Healthy Horizons child under 21 years of age and the Healthy Horizons applicant/recipient immediate families with children under 21 years of age are excluded. If the child who is under 21 years of age is living with a care-taker who is not immediate family as defined in § 140.202 (relating to definitions) and who exercises care and control of the child, the resources of the caretaker are excluded.
Subpart D. DETERMINATION OF NEED AND AMOUNT OF ASSISTANCE
CHAPTER 178. RESOURCE PROVISIONS FOR CATEGORICALLY NEEDY NMP-MA AND MNO-MA
Subchapter A. GENERAL PROVISIONS FOR MA RESOURCES COMMON TO ALL CATEGORIES OF MA
GENERAL PROVISIONS FOR MA RESOURCES § 178.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Immediate family--The child, the biological or adoptive parent of a child under 21 years of age, the spouse of the parent, and the brother, sister, step-brother, step-sister, half-brother or half-sister who are under 21 years of age. The immediate family members must be living together.
* * * * *
Subchapter B. AGED, BLIND AND DISABLED CATEGORIES OF MA
RESOURCE EXCLUSIONS FOR THE AGED, BLIND AND DISABLED CATEGORIES OF MA § 178.84. Resources of children under 21 years of age and families with children under 21 years of age.
The resources of the SSI-related child under 21 years of age and SSI-related applicant/recipient immediate families with children under 21 years of age are excluded. If the child who is under 21 years of age is living with a caretaker who is not immediate family as defined in § 178.2 (relating to definitions) and who exercises care and control of the child, the resources of the caretaker are excluded.
Subchapter C. TANF-RELATED AND GA-RELATED CATEGORIES OF MA
RESOURCE EXCLUSIONS FOR THE TANF-RELATED AND GA-RELATED CATEGORIES OF MA § 178.163. Resources of children under 21 years of age and families with children under 21 years of age.
The resources of the TANF-related and GA-related child under 21 years of age and TANF-related and GA-related immediate families with children under 21 years of age are excluded. If the child who is under 21 years of age is living with a caretaker who is not immediate family as defined in § 178.2 (relating to definitions) and who exercises care and control of the child, the resources of the caretaker are excluded.
[Pa.B. Doc. No. 01-1041. Filed for public inspection June 15, 2001, 9:00 a.m.]
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