Opinion by
This is an appeal, in the form of a Petition for Review from an Order and Adjudication of the Department of Public Welfare (DPW). The Adjudication and Order sustained the action of the Bucks County Assistance Office (CAO) reclassifying Petitioner’s level of nursing care from skilled care to intermediate care, and discontinuing her skilled care benefits. Petitioner, Susan Maturo, challenges the propriety of the actions of the CAO with respect to the procedure it followed in reducing her level of nursing care.
Petitioner, Susan Maturo, is a seventy (70) year old woman who, in May, 1980 began receiving skilled nursing care benefits under DPW’s Medical Assistance Program. At the time of the filing of the instant appeal, Mrs. Maturo was a nursing home patient residing in MediCenter of America, located in Bristol, Pennsylvania. On June 12, 1980, the CAO received a recommendation from the Facility Utilization Review Committee that the Petitioner’s care classification be changed from skilled care to home or foster home care. Shortly thereafter, the. .County Review Team suggested that Mrs. Maturo be placed in an intermediate care facility.
On June 18, 1980, the CAO sent an Advance Notice reducing Mrs. Maturo’s level of care benefits from skilled care to intermediate care, effective June 28, 1980. Subsequently, Petitioner filed an appeal from the CAO’s decision, discontinuing her skilled care benefits.
In urging this Court to reverse the order of the DPW, Petitioner alleges that the CAO acted improperly and in violation of DPW regulations in effecting a. reduction in her level of nursing care. Specifically, Petitioner argues, DPW regulations mandate that the CAO is responsible for participating in a patient’s review process relating to discharge planning and alternate care placement.
Under the Medical Assistance Program, the DPW provides payment to participating nursing homes for the care of eligible patients.
Medical Assistance Begulations specify the procedures to he followed in determining the proper level of a patient’s nursing care. Additionally, the regulations set forth the appropriate steps to he taken when it is recommended that a patient he transferred to an alternate care facility.
Under those regulations, each participating nursing home is required to have a Utilization Beview Committee for the purpose of evaluating, at regular intervals, the nursing care needs of each medical assistance and medicare patient.
In the instant case, it is undisputed that the CAO caseworker did not participate in the decision to reduce Petitioner’s level of nursing care. Furthermore, no action whatsoever was taken hy the CAO to transfer Petitioner to an alternate care facility. Thus, it is readily apparent that the CAO did not act in accordance with Medical Assistance Begulations when it reduced Petitioner’s level of nursing care, and recommended that she he placed in home or foster home care. Accordingly, we must reverse the hearing
Order
And Now, the 13th day of January, 1982, the order of the Commonwealth of Pennsylvania, Department of Public Welfare, dated September 9, 1980, reducing Susan Maturo’s level of care and discontinuing her skilled care nursing benefits is reversed. It is ordered that Ms. Maturo’s skilled care benefits be reinstated until such time as DPW’s CAO, in compliance with DPW regulations, initiates such action as is necessary to transfer Ms. Maturo to an alternate care facility.
A patient has the right to appeal a reduction or discontinuance of Public Assistance payments under 55 Pa. Code §3275.1 (a) (i) (A)(B).
See DPW-OMP-MA Manual §9424.51.
See DPW-OMP-MA Manual §9424.5324.
Act of June 13, 1967, P.L. 31, as amended, added by Section 5 of the Act of July 31, 1968, P.L. 904, as amended, 62 P.S. §443.1.
See DPW-OMP-MA Manual §9424 et seq.
See DPW-OMP-MA Manual §9425 et seq.
42 CFR§ §456.301, 456.331.
See DPW-OMP-MA Manual §9424.51.
DPW-OMP-MA Manual §9424.5324.
