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Enrollment 101

If you are already receiving services and are considering switching your Service Coordination provider, call 1 (855) 715-1350 to learn about SCR, or contact us online.

If you are currently not receiving any services and need help, please follow the instructions below to help you get started on enrollment.

STEP 1

Contact the PA Independent Enrollment Broker (PA IEB)

  • Find out more about Home and Community Based Waiver Services
  • Tell PA IEB you want to apply for waiver services.

If you have Medical Assistance, PA IEB starts your waiver application when you contact them. Contact the PA IEB by phone at 1-877-550-4227.

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STEP 2

Fill out Medical Assistance forms if you do not have Medical Assistance

  • Go to www.compass.state.pa.us and fill out the forms online, or
  • Ask PA IEB to mail you the forms. Fill out the forms and mail them back to PA IEB.

If you do not have Medical Assistance, PA IEB starts your waiver application when they receive your forms.

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STEP 3

Make sure your doctor fills out the Physician’s Certification Form

  • Once PA IEB starts your waiver application, they send a Physician’s Certification Form to your doctor.
  • Your doctor fills out the form and returns it to PA IEB.
  • If PA IEB does not get the form back, they ask you to remind your doctor.

AND

Have your first in-home visit

  • Once PA IEB starts your waiver application, they send a request to the Area Agency on Aging (AAA).
  • AAA contacts you to schedule your first in-home visit.
  • At your in-home visit, a person from AAA assesses your “clinical eligibility”—whether you qualify for waiver services based on the care you need. This is called a “Clinical Eligibility Determination.”
  • After your in-home visit, AAA sends your Clinical Eligibility Determination to PA IEB.

PA IEB must receive both documents within 30 days after they start your waiver application.

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STEP 4

Have your second in-home visit

  • Once PA IEB has your Clinical Eligibility Determination and Physician’s Certification Form, they contact you. They schedule your second in-home visit.
  • At your in-home visit, a person from PA IEB asks about your needs and abilities to see if waiver services or other programs will meet your needs.
  • After your in-home visit, PA IEB sends your application to the County Assistance Office.
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STEP 5

Send missing information to the County Assistance Office

  • The County Assistance Office (CAO) reviews your waiver application to see if you qualify financially.
  • If any information is missing, CAO contacts you. They tell you how to send information to them.
  • Once your application is complete, CAO approves or denies your application.
  • They send a notice to you, PA IEB and your chosen Service Coordination Agency.

A decision about whether you qualify will be sent to you within 60 days after PA IEB starts your waiver application. If you do not get a decision within 90 days, you can ask for a fair hearing.

YES

If your waiver application is approved, you are enrolled in Home and Community Based Waiver Services.

 

OR

NO

If your waiver application is denied, and you disagree with that decision, you can ask for a fair hearing.

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If you have questions about enrollment or HCBS services, contact us for more information.