Like many on this forum, my wife and I have PA LTCF's issued by mail from Centre County. The law has changed, and they are not allowed to issue or renew permits by mail.
I didn't want to drive up to State College (more than three hours each way), so I took the required paperwork up to Lancaster this afternoon to see if I could take care of it there.
They handled it as a new permit, not a renewal. I was in and out of there in 20 minutes, permit in hand.