135.312 When to Review Medical Exemption

The CAO will review a medical exemption:

55 Pa. Code § 165.21

When a change is reported that would affect the individual’s exemption status. The CAO may request an updated PA 635 .

At reapplication if the medical exemption will expire within the next 30 days.

When a Temporary Incapacity is ending. The system will automatically send the PA 253 with the PA 635 45 days prior to the temporary incapacity end date as entered on the disability screen. An 062 “Pending Verification Alert” will be generated on the caseworker’s dashboard. Upon receipt of the 062 alert, the CAO will attempt to contact the individual to review changes via telephone and narrate outcome. No negative action will be taken if the individual is unable to be reached. CAO will allow 30 days to return the form.

If the PA 635 is not returned because the individual is unable to get an appointment with the health care provider within the 30-day window or there is some administrative delay causing the PA 635 to be sent late while clearing the 062 alert, the CAO should recode the individual to ETP 60 with good cause code 53, input a good cause review date, and allow for up to 30 days good cause to have the PA 635 completed with potential extensions thereafter once the appointment date is verified.

If the PA 635 is returned refer to Reviewing the Completed PA 635.

If the PA 635 is not returned and no explanation provided, schedule the applicant/recipient for partial redetermination to complete or update the job readiness assessment and AMR. Review all potential barriers, refer to the appropriate program, and update the ETP code to 60 if no other good cause or exemption is indicated or demonstrated by the individual.

The CAO may also require the individual to submit to an independent examination as a condition of receiving assistance if:

55 Pa. Code § 165.21(c)(1)(iv)

The disability is not obvious.

The individual is eligible in Extended TANF (ETANF) Hardship Track 2 (TE 31). See Section 135.821 Extended TANF Hardship Tracks .

If an individual is exempt and enrolls in an approved education or training program, including but not limited to, the Office of Vocational Rehabilitation (OVR) or other rehabilitation agency, the individual may volunteer for RESET, and may receive special allowances. See Section 135.5 Volunteering to Participate in RESET and Section 135.6 Special Allowances for Supportive Services .

Participating in employment or an E&T program does not automatically mean the individual is no longer disabled. If the CAO has reason to believe the individual’s medical status is questionable the CAO may request verification of the status of the disability. See Section 129.31, Verification of Incapacity .

Individuals referred to and cooperating with the DAP process are considered exempt until a final eligibility determination for Retirement, Survivors, Disability Insurance (RSDI) or Supplemental Security Income (SSI) is made. If the individual is denied RSDI or SSI, the individual’s exempt status must be reviewed. See Section 135.31 The Medical Exemption and Section 129.31, Verification of Incapacity

Additional disability verification is not required while the RSDI/SSI application process is pending. The individual must continue to appeal any unfavorable Social Security Administration (SSA) decision at all levels until denied at the final appeal level.

NOTE: If an individual is denied for SSA benefits at the final appeal level, this does not mean the disability is automatically ended. A new PA 635 should be requested, and the DAP worker must refer the individual to the Medical Review Team (MRT) to review for an ongoing disability. While the MRT decision is pending, the individual continues to be coded as ETP 53 for RESET.