Current through Register Vol. 54, No. 45, November 9, 2024
Section 451.3 - Requirements(a)General. A person may receive SBP category symbol "B" if he: (1) Meets the conditions of eligibility in subsections (c)-(i).(2) Agrees to an exploration and evaluation of his resources as described in subsection (i).(3) Fulfills the responsibility for reporting changes in his circumstances; this includes reporting improvement in vision that may affect eligibility.(b)Other benefits. A blind person eligible for SBP will receive a SBP unless he prefers to receive one of the categories of assistance provided in the Public Welfare Code (62 P. S. §§ 101-1411) and for which he is also eligible. No person may receive SBP concurrently with AFDC, GA or SSI. He may, however, receive MA benefits if he meets the eligibility conditions.(c)Vision. Vision requirements are as follows: (1) A person is blind if his visual acuity with best correcting lens is 3/60 or 10/200 or poorer in the better eye. A person shall undergo an examination for visual acuity as required by the Department. A person has the choice of examination by a physician skilled in the diseases of the eye, or by an optometrist.(2) The procedures for determining visual acuity are listed in Appendix A.(3) If the CAO has reason to believe that the client's vision has improved because of the factual evidence such as driving an automobile or other activities which normally require a greater amount of vision than the eligibility standard as set forth in this subsection, the CAO shall initiate a reexamination as provided in Appendix A, Item I, B, b. If the county medical consultant certifies ineligibility, the CAO shall discontinue SBP.(d)Age. Age requirements are as follows: (1) The person shall be at least 21 years of age. A person meets the age requirement on the first day of the month in which he has his 21st birthday.(2) There shall be proof of the year of birth. Proof consists of the statement of the applicant supported by written evidence. Examples of written evidence are: (i) A record of birth or baptism.(ii) A school, hospital or physician record.(iii) An enrollment record of voting districts.(iv) Records of civil or military service.(v) A marriage certificate.(vi) An insurance policy.(3) If the month and day of birth are not shown, the birth date of the person for PA records is July 1. If the month is known but the day is not, the first of the month is the birthdate of the person for PA records.(e)Residence. Reference shall be made to Chapter 147 (relating to residence) for residence requirements for SBP.(f)Institutionalization. A blind person who is an inmate of a penal institution or hospital for mental disease is not eligible for SBP. For SBP, an institution for only the mentally retarded is not a hospital for mental disease.(g)Payment name. The payment name is the name of the blind person, his guardian or trustee. For appointment of trustee, see Chapter 163 (relating to guardians and trustees).(h)Resources. A blind person is not eligible for SBP if he has more than $7,500 in real and personal property values combined, or $4,260 or more annual net income. See § 451.5(a) (relating to adjustments for fiscal year ending before July 1981). (1)Real property. Real property requirements for SBP are as follows: (i) Real property is resident or nonresident real estate. It includes houses on leased land, mineral or subsurface rights and life interests.(ii) The value of real property, exclusive of life interests, is its county assessed valuation less the recorded encumbrances against it. The assessed value may not be more than 30% of the official market value.(iii) The value of real property may not be increased solely by reason of reassessment. If the real property has been enlarged or improved resulting in an increased assessment, a recomputation of the value of the property is made using the formula set forth in subparagraph (vi).(iv) The value of a life interest in property will be determined by the Claim Settlement Area Office in accordance with the Department of Revenue's mortality tables. The CAO shall send to the Area Office, together with the document or excerpts from the document describing the life interest, information on the age of the owner of the life interest, the county assessed value of the property and the amount of the recorded encumbrances against the property.(v) When the blind person owns real property jointly with one or more persons, each person is considered to own an equal share unless the document of ownership specifies otherwise.(vi) If the county percentage rate of assessment is more than 30%, the following formula is used to determine the value of real property in determining eligibility: (A) Divide the county assessed value by the county percentage rate of assessment.(B) Multiply the figure arrived in clause (A) by 30%.(C) Deduct the recorded encumbrances.(2)Personal property. Personal property requirements for SBP are as follows: (i) The value of personal property is its market value minus encumbrances on it, such as minus those specific obligations secured by the property. For example, stocks or bonds pledged as collateral for a loan are valued at the selling price less the unpaid balance of the loan; goods being purchased on an installment plan are valued at market price less the remaining payments owed.(ii) If the blind person owns personal property jointly with one or more persons, a person is considered to own an equal share unless the document of ownership specifies otherwise.(iii) The value of the personal property as equipment and stock, other than securities, necessary to obtain income and household furnishings and personal effects, are not included in determining the value of the personal property the blind person has.(iv) Personal property is a resource other than real property or income. Examples of personal property are as follows:(A) Money: cash on hand, in a bank account or safe deposit box, in postal savings, on deposit with a building and loan association or otherwise held where it is payable on demand.(B) Securities: market value of stocks, bonds, mortgages or notes.(C) Cash value of life insurance.(D) Value of burial reserve.(E) Trust Funds: if the trustee has the right to use the principal for the benefit of the blind person.(F) Death Benefits: inheritances, lump sum death benefits, such as OASDI or Railroad Retirement, or, insurance payment received because of the death of another person.(G) Proceeds from the sale or conversion of property, including compensation for the loss or destruction of property.(3)Income considered in determining eligibility for SBP. Income considered in determining eligibility for SBP shall be as follows:(i) Income may be actual or potential. Actual income is that which is available to the blind person to meet his current living requirements. Actual income is on hand, ready for use when it is needed.(ii) Potential income is that which represents a possible future source for support for the blind person, and the eligibility of a blind person who has a claim or legal right to any benefit, award or pension, will be dependent on his agreement to take steps to make the resource currently available for his use. The blind person's decision as to the way the resource is to be developed and used will be accepted if the plan appears to be reasonable and sound.(iii) The actual income the blind person receives is used in determining eligibility. Money expended for the benefit of the blind person by friends, relatives or others, but which is not received directly by the blind person himself, will not be considered as his income. Thus, payments made on behalf of a blind person to meet living expenses, including payments to meet all or part of the charge for nursing home care, will not be considered income. The payments have no effect on eligibility for SBP unless the blind person is requesting an SBP nursing home care payment of more than $100 monthly; in which case the payments affect the need amount for nursing home care.(iv) Income is considered as described in § 451.4(a) (relating to procedures).(v) Income is money the blind person himself receives regularly, irregularly or as a one-time payment. Examples of income are as follows: (A) Wages, commissions and bonuses.(B) Gross receipts from a business, farm profession, renting rooms or providing meals.(C) Dividends from stocks; interest on bank deposits, bonds, mortgages, notes; periodic payments from trust funds; rental; royalties; and similar payments received because of the ownership of real and personal property.(D) Veteran's benefits, UMWA benefits, pensions, OASDI, Railroad Retirement and Unemployment benefits.(E) Disability and annuity payments, or damages for personal injuries.(F) Contributions or gifts; except insignificant amounts that are not likely to recur.(i)Disposition of property. Requirements for disposition of property are as follows: (1) Disposition of property may be accomplished by an exchange of title, or by diminishing the value of an interest through the placing of an encumbrance such as a mortgage or judgment, as well as by sale or gift.(2) Since the ownership of real and personal property with a combined value of $7,500 or less does not affect eligibility, subparagraph (3) will apply only to that portion of a blind person's property that is in excess of $7,500.(3) For the methods of determining "value," refer to § 177.24 (relating to determining value of resources).(i)Before application. If, within the 2-year period before his application, a blind person disposed of real or personal property, or both, and this reduced the value of property he owns to $7,500 or less, he is not eligible for SBP unless it is established that he received fair consideration in return for the property in excess of $7,500.(ii)While an SBP recipient. If an SBP recipient disposes of real or personal property, or both, and this reduces the value of property he owns to $7,500 or less, he will be ineligible for SBP for 2 years thereafter, unless it is established that he received fair consideration in return for the property in excess of $7,500.(j)Eligibility requirements for nursing home care. The eligibility requirements for nursing home care shall be as follows:(1) Nursing home care is available to persons eligible for SBP. The payment for nursing home care under this program is a postpayment, and is made to the eligible individual, not to the nursing home. For SBP recipients, this program applies to public as well as private nursing homes, except that an SBP recipient in a public nursing home may elect to receive the care under the MA program.(2) A person who meets the conditions of eligibility for SBP is eligible to receive an allowance for nursing home care under the conditions in subparagraphs (i), (ii) and (iii). (i)Determination of need for nursing home care.(A) A person is considered to be in need of nursing home care if he is physically or mentally ill and undergoing planned, continuing medical treatment or palliative measures for the illness, which include as an essential component the type of medical care provided by qualified nurses, registered or practical.(B) The need for residential or custodial care, or for supervision in taking routine medications or in the activities of daily living will not in themselves constitute a need for nursing home care. These services can be provided by other than medical personnel in other than nursing homes or other medical facilities. A need for nursing home care is distinguished from need from other types of care by the medical nature of the skill required to provide the care.(C) Medical findings, and other information on physical condition will be required for a decision. Need for nursing care and procedures shall be supported by medical findings, and the frequency and regularity with which these services are needed shall have a sound and reasonable basis.(D) The responsibility for determining the need for nursing home care and whether the blind person is eligible for the care rests with the CAO review team composed of the county medical consultant and a designated member of the social service staff. In CAOs without a medical consultant, the State Office Medical Review Team, Office of Medical Programs makes the decision.(ii)Eligibility conditions relating to the patient. The patient's physical condition shall be such that he requires nursing care as described in subparagraph (i).(iii)Eligibility conditions relating to the nursing home. Eligibility conditions relating to the nursing home are as follows:(A) The nursing home shall be a medical institution as certified by the Office of Medical Programs. Refer to guidelines in § 161.22 (relating to definitions).(B) The nursing home shall give the CAO a signed statement describing the financial arrangement the patient has with the nursing home. The statement shall include: the name of the patient; the actual charge for the patient's care; the monthly amount the patient is to pay out of his own resources; the monthly amount of additional payment that is to be paid by the source other than the patient and the name of the source. When there is a change in the financial arrangements, the nursing home gives the CAO a signed statement describing the new arrangements.(k)Eligibility for medical or other health care. An SBP recipient will be eligible for all MA services except inpatient hospital care, physician's services in the hospital, hospital home care, 3 pints of whole blood, laboratory and X-ray services in independent facilities, intermediate care or public nursing home care. To be eligible for these services, an SBP recipient shall also meet the eligibility requirements for the medically needy.(l)Eligibility for SBP. Eligibility for SBP is determined as follows: (1) A redetermination of eligibility that comprehends the factors of eligibility is made as often as is appropriate to the individual case but at least once a year.(2) A Form PA 743-R shall be completed at each redetermination interview and the client's signature obtained. The client's signature shall also be secured on the Form PA 743-S, Rights and Responsibilities Supplement, at redetermination interviews.(3) If the redetermination indicates the possibility that the blind person may be eligible for SSI, the advantages of receiving SSI, such as increased monthly cash benefits, full MA coverage and the like will be discussed with the client. If the blind person is interested in transferring to SSI, after discussion of the benefits to be derived as an SSI beneficiary, the person will be referred to the Social Security Administration. As part of the referral process, the worker will assist the person in filing an application by making available to the Social Security Administration information from the case records that would be helpful in establishing the blind person's eligibility.(4) The case record will show that a complete redetermination has been made.The provisions of this §451.3 adopted May 5, 1978, effective 5/6/1978, 8 Pa.B. 1278; amended November 10, 1978, effective 5/6/1978, 8 Pa.B. 3090; amended January 19, 1979, effective 12/4/1978, 9 Pa.B. 251; amended February 9, 1979, effective 3/12/1979, 9 Pa.B. 505; amended July 25, 1980, effective 7/1/1980, 10 Pa.B. 3102; amended August 26, 1988, effective 11/1/1988, 18 Pa.B. 3893.The provisions of this §451.3 amended under section 403(b) of the Public Welfare Code (62 P. S. § 403(b)).
This section cited in 55 Pa. Code § 451.4 (relating to procedures).