Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 52 Pa.B. 6342 (October 1, 2022).

55 Pa. Code § 140.311. Verification requirements.

VERIFICATION REQUIREMENTS


§ 140.311. Verification requirements.

 (a)  Verification requirements under Healthy Horizons are as follows:

   (1)  Verification of income. Verification of income is required prior to the authorization of Healthy Horizons benefits. However, an applicant/recipient may not be denied MA under the Healthy Horizons Program for lack of verification if the applicant/recipient has cooperated in the verification attempt under Chapter 125 (relating to the application process) and §  133.73 (relating to requirements).

   (2)  Verification of resources. Verification of ownership, the value of resources and the disposition of resources is required of an applicant/recipient or the person acting on behalf of the applicant/recipient including guardians and trustees under §  178.3 (relating to resource reporting and verification for all categories of MA).

   (3)  Verification of qualified Medicare beneficiary status. The Medicare Part A Card is considered verification of qualified Medicare beneficiary status.

 (b)  Under the Healthy Horizons Categorically Needy Program, the following verification is also required:

   (1)  Verification of age.

     (i)   Documentation verifying the date of birth for persons 65 years of age or older is required. Benefits may be authorized if the stated date of birth appears to be reasonable. The applicant/recipient is required to provide verification of age within 30 days from the date of authorization.

     (ii)   Documentation of date of birth is not required if previously verified and properly notated in the case record unless a discrepancy exists.

   (2)  Verification of disability.

     (i)   Recipient of Social Security Disability Benefits or disability benefits based on SSI disability criteria is considered verification of disability.

     (ii)   If the applicant is not receiving disability benefits, the following shall be submitted:

       (A)   Medical verification of a disability which meets the SSI disability criteria.

       (B)   Proof that the person has applied for disability benefits and is awaiting a decision.



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