Appeal from the Order of the Department of Public Welfare in the case of Appeal of Susan Maturo, CR No. 94481-TA.
David Gates, for petitioner.
Jason W. Manne, Assistant Counsel, for respondent.
Judges Mencer, Williams, Jr. and Palladino, sitting as a panel of three. Opinion by Judge Williams, Jr. This decision was reached prior to the expiration of the term of office of Judge Palladino.
[ 64 Pa. Commw. Page 121]
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.
[ 64 Pa. Commw. Page 122]
An administrative hearing in this matter was held in August, 1980. The Hearing Examiner denied the appeal, finding that "the CAO acted in accordance with the Departments [sic] regulations in finding the appellant ineligible for skilled care based on the facilitys [sic] U.R. (Utilization Review Committee)." This appeal followed.*fn1
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.*fn2 Petitioner asserts that those regulations further dictate that if the CAO agrees that a patient should be placed in an alternate care facility, the CAO is chargeable with initiating such action as is necessary to transfer that patient to such a facility.*fn3 It is the Petitioner's position that the CAO did not fulfill its obligation with respect to the aforementioned regulations. Thus, Petitioner contends, the hearing examiner erred in upholding CAO's actions as proper and sustaining CAO's decision to discontinue skilled care benefits. We agree.
Under the Medical Assistance Program, the DPW provides payment to participating nursing homes for the care of eligible ...