The Department of Aging is involved in limited hearings and appeals. Primarily, it receives appeals of eligibility determinations for the Pharmaceutical Assistance Contract for the Elderly (PACE) programs, which provide prescription drug benefits to low income Pennsylvanians over age 65, from findings of Area Agencies on Aging regarding reports of need under the Older Adults Protective Services Act, 35 P.S. §§ 10225-101 et. seq., and from adverse actions concerning programs and activities funded by the Department of Aging.

 

Individuals may appeal determinations of income ineligibility for PACE and the PACE Needs Enhancement Tier (PACENET), which is based on a retrospective review of income tax filings. The PACE statute and regulations (72 P.S. §§ 3761-502, 517, 519; 6 Pa. Code § 22.21-26) establish eligibility for the programs. Appeals are provided for in the regulations at 6 Pa. Code § 22.91-95. If informal efforts to resolve eligibility issues are unsuccessful, individuals may appeal. Hearings are presided over by DPW’s Bureau of Hearings and Appeals (BHA). Appeals may also be filed by program providers (pharmacies) to dispute audit findings. Such appeals are governed by 6 Pa. Code §§ 22.101 -104 and are also presided over by BHA in accordance with general administrative practice and procedure. 6 Pa. Code § 22.111. Historically, PACE has received fewer than 10 appeals per year; since the advent of Medicare Part D, the eligibility appeals have fallen to fewer than 5 per year. Only one provider audit appeal has been litigated in the past 5 years.

 

Appeals may also be pursued by individuals named as alleged perpetrators under the Older Adults Protective Services Act (OAPSA), 35 P.S. §§ 10225-101 et. seq. OAPSA provides for reports of suspected abuse, neglect, exploitation or abandonment (of a care dependent older adult) to be made and investigated by Area Agencies on Aging (AAAs). If an individual is suspected of causing the abuse, neglect, exploitation or abandonment, and if the AAA’s investigation substantiates the report, the individual named (the "alleged perpetrator") may appeal if informal resolution efforts are not satisfactory. Such appeals are governed by general administrative practice and procedure, and the fair hearings and appeals provisions of 6 Pa. Code Chapter 3. See also 35 P.S. § 10225.308; 6 Pa Code § 15.82. The Department of Aging is not a party to OAPSA appeals; rather, the dispute is between the alleged perpetrator and the AAA. The Secretary of Aging is the hearing authority; formal hearings are conducted by Administrative Law Judges at BHA. In the 2008 calendar year, BHA handled four OAPSA formal appeals.

 

Finally, Chapter 3 of 6 Pa. Code provides for fair hearings and appeals from adverse actions concerning services and activities funded by the Department of Aging. 6 Pa. Code § 3.1. AAAs can appeal, for example, if the Department of Aging withdraws the AAA’s designation for that geographic area. Individuals whose services are denied or terminated also have a right to appeal. The Secretary of Aging appoints a hearing examiner, which has always been BHA. Individual appeals, which often concern financial or clinical eligibility for Older Adult Daily Living Centers or one of the home and community-based Medicaid Waiver programs and are often pro se, have historically. been the most likely to require interpreter/translation services.

Jeffrey John Wood, Senior Counsel
Phone: 717-783-2670
Email: jefwood@pa.gov

 

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