Effective Dates: 09/11/2024 - Present Previous | Next

TN 61 (09-24)

SI 00520.920 Processing Prerelease Claims

NOTE: This POMS section applies to SSI prerelease claims only. For procedure on processing Title II prerelease claims, see EM-22026 REV2.

A. Procedure for processing SSI prerelease claims

1. Initiating the prerelease procedure

Upon receipt of a prerelease referral (see SI 00520.930 Exhibit 2 for a model prerelease referral), obtain all information and forms required for an initial claim, reinstatement, or change in living arrangements. Obtain a signed release from the individual allowing the field office (FO) to discuss the case with the institution's staff. Use the form SSA-3288 (Consent for Release of Information) for all prerelease claims except those involving individuals housed in a Federal Bureau of Prisons (BOP) facility. For those claims, use the modified form SSA-3288 located in SI 00520.930, Exhibit 3 instead.

Add completed forms and referrals to the Evidence Portal (EP) for documentation purposes.

2. Processing applications with or without an agreement

Process an application under the prerelease procedure without regard to whether an agreement exists with the institution. For more information about prerelease agreements, see SI 00520.910.

3. Using simultaneous development for prerelease claims

Do not use deferred development with prerelease applications. Use the simultaneous development procedures in SI 00603.002C.4, but do not adjudicate the claim. Place it in payment status code H80 pending the DDS medical decision.

4. Determining the proper applicant and potential need for a representative payee

If the institution files on behalf of the individual, determine who the proper applicant is and, if necessary, develop for a representative payee.

5. Timeframes for processing claims under the prerelease procedure

If the referral does not list an anticipated release date, obtain a statement from the institution with the approximate date the individual will be released. Record the statement on a Report of Contact page. Apply the prerelease procedure using the following timeframes:

a. Claimants housed in non-BOP institutions

For SSI aged claims, apply prerelease procedures to claims when the individual’s expected release date will be within 30 days.

For SSI disability claims, apply prerelease procedures to claims when the individual’s release date will be within 30 days of the estimated time for getting a medical decision from the Disability Determination Services (DDS). For example, if the DDS processing time averages about 90 days, the FO can take the claim 120 days before the scheduled release date of the claimant.

b. Claimants housed in BOP institutions

Apply prerelease procedures using the following timeframes:

  • •

    For SSI aged claims: Apply prerelease procedures to claims received within 30 days prior to the individual’s scheduled date of release from BOP custody or 30 days prior to the home confinement placement date.

  • •

    For SSI disability claims: Apply prerelease procedures to claims received within 120 days prior to the individual’s scheduled date of release from BOP custody or 120 days prior to the home confinement placement date.

REMINDER: When the application is received earlier than the allowed timeframe for processing a claim under the prerelease procedure, deny the application.

6. Determining potential eligibility before sending prerelease claims to DDS

a. All disability claims

Before sending an SSI disability prerelease claim to the DDS, determine whether the claimant is potentially eligible for SSI based on the claimant’s anticipated income, resources, and living arrangement upon release. However, for purposes of establishing the claim in the Consolidated Claims Experience (CCE) (formerly MSSICS), the residence address is the institution where the individual resides.

Following this general rule, input SSI prerelease claims into the system following instructions in MS 08110.007. For cases unable to be entered into the CCE, see SM 01005.420, SM 01005.422, SM 01005.424, and SM 01005.430 for coding the RA, RY, RT, and ZC fields on form SSA-450-SI (SSI Data Input and Determination).

b. Additional Step for BOP conditional release and BOP skilled nursing care cases

There are special processing rules (outlined in SI 00520.920A.6 in this section) for holding medically-approved BOP conditional release and BOP skilled nursing care cases for extended periods of time before adjudicating the claim.

For these claims, BOP instructs the claimant to add a comment within the SSI application’s REMARKS section (or to provide a verbal statement if they are filing over the phone) indicating that their case is a conditional release or skilled nursing care case.

  • •

    Add special remarks to identify these cases - Add the following remark on the SSID and Development Worksheet page before sending the case to the DDS: “BOP conditional release/skilled nursing case. Special adjudication required if medically approved by DDS. See SI 00520.920A.6.b.” This alerts the FO technician who receives a medically approved BOP conditional release/skilled nursing care case that the special processing rules apply.

  • •

    Exclude these cases from processing time - On the Development Worksheet page, input unit code “ZZZ” for the first 3 digits in the UNIT field to exclude processing time. Build the SSR to create a new record.

 

7. Holding adjudication of aged claims and disability claims after obtaining a favorable DDS disability determination

For procedure on medical development for prerelease claims, see SI 00520.920B in this section.

a. For all aged prerelease claims

  1. 1. 

    Ask the institution for the expected release date, and advise the institution that we cannot pay SSI until we verify the release date and new living arrangements.

  2. 2. 

    If the anticipated release date is not within 30 days of the application date, advise the institution that we will deny the claim.

  3. 3. 

    If the anticipated release date is within 30 days of the application date, hold the initial claim until release. Input payment status code H10 (living arrangement change in process) pending verification of the claimant’s release. For more information on inputting payment status code H10, see SM 01301.545C.

  4. 4. 

    Re-contact the institution for an update if the claimant is still in the institution after the anticipated release date before taking action to deny the claim as N02 (resident of a public institution) or N22 (inmate of a penal institution).

b. For all disability prerelease claims except BOP conditional release and BOP skilled nursing care cases

Once the FO receives a favorable medical decision from the DDS, follow these steps:

  1. 1. 

    Contact the institution promptly to:

    • •

      Ask the institution for the expected release date; and

    • •

      Advise the institution that we cannot pay SSI until we verify the release date and the new living arrangements.

  2. 2. 

    If the anticipated release date is not within 30 days of getting the favorable DDS decision, advise the institution that the FO will deny the claim.

  3. 3. 

    If the anticipated release date is within 30 days of getting the favorable DDS decision, hold the initial claim until release. Input payment status code H10 (living arrangement change in process) pending verification of the claimant’s release. For more information on inputting payment status code H10, see SM 01301.545C.

  4. 4. 

    Re-contact the institution for an update if the claimant is still in the institution after the anticipated release date before taking action to deny the claim as N02 or N22.

c. Exception/Special processing instructions for BOP conditional release and BOP skilled nursing care cases

Contact the institution to notify them of the favorable medical decision. Follow the instructions below for conditional release cases and skilled nursing care cases.

  1. 1. 

    Conditional Release cases: Hold medically approved cases for up to 180 days before adjudicating. (This is an exception to existing SSI adjudication policy in SI 00601.080.) The BOP cannot request a release hearing before a Federal judge for the BOP inmate until there is a favorable medical allowance, which signals a funding source (i.e., SSI/Medicaid) for the individual once released. The additional time will give BOP sufficient time to locate a facility to place the inmate, to present the release plan to the judge, and for the judge to approve the release from the BOP facility.

    Within the Development Worksheet page, add a new issue labeled "Prerelease" and a tickle date for 180 days. At the end of the holding period, follow up with the BOP institution to see if the claimant has been placed. If they have not, issue a technical denial of N22.

  2. 2. 

    Skilled nursing care cases: Hold medically approved cases for up to 180 days before adjudicating. (This is an exception to existing SSI adjudication policy in SI 00601.080.) The BOP is unable to contact skilled nursing facilities for placement of the inmate until there is a favorable medical allowance. The additional time will allow BOP sufficient time to find the individual permanent placement in a skilled nursing facility before they release the inmate from the BOP facility.

    Within the Development Worksheet page, add a new issue labeled "Prerelease" and a tickle date for 180 days. At the end of the holding period, follow up with the BOP institution to see if the claimant has been placed. If they have not, issue a technical denial of N22.

REMINDER: Within the Development Worksheet page, leave unit code “ZZZ” as the first 3 digits in the UN field to exclude processing time.

d. Appeal of technical denial - All prerelease claims

If a technical denial occurs after the favorable medical decision, the claimant has 60 days to request an appeal.

  • •

    If the claimant is released within 60 days and requests reconsideration, use the recent favorable medical decision to complete the claim after processing the reconsideration, following instructions starting in GN 03102.100.

  • •

    If the 60-day appeal period has expired, and there is no good cause, take a new application and determine if the prior Title XVI medical decision can still be used or if a new medical decision is necessary, following instructions in DI 11055.077.

8. Adjudicating prerelease claims upon release

When the institution releases the individual, contact the individual to verify the release, update the address and living arrangements, adjudicate the claim, and initiate payment.

For BOP prerelease claims, BOP will also advise the individual that they must contact SSA upon their release to give us this information.

9. Processing prisoner reinstatements under prerelease

We cannot reinstate SSI benefits until after the institution releases the prisoner. However, the FO and the institution should do prerelease development appropriate to reinstatements, so we can reinstate benefits more quickly after the prisoner’s release.

For example, the FO can:

  • •

    provide the institution with information about what documents the FO needs to process a reinstatement;

  • •

    set up an appointment for an interview shortly after the release; and

  • •

    encourage close cooperation between the institution, the prisoner, and the FO to avoid unnecessary delays.

The institution can:

  • •

    provide the FO with the prisoner’s new address;

  • •

    provide documents to verify the prisoner’s release; and

  • •

    encourage the prisoner to respond immediately to any FO requests for information, and not to miss any interview appointments. For instructions about SSI reinstatements for prisoners, see GN 02607.875.

B. Procedure for medical development in prerelease claims

1. Procedure for obtaining medical evidence

It is the responsibility of the FO to obtain all available medical evidence from the institution in prerelease claims, whether or not there is a formal prerelease agreement with the institution. (For additional information about preparing the case for DDS, see DI 23530.001B.2.).

a. Existing regional or local DDS procedures

Apply any existing regional or local procedures between the institution, DDS, and the local FO for obtaining and completing medical evidence for the DDS.

b. No existing regional or local DDS procedures

In the absence of local procedures, regional and local FOs should work with institutions and DDS to establish procedures acceptable to all parties. In the interim, use the following guidelines for securing medical evidence from the institution:

  • •

    Request all available medical evidence from the institution. Make sure the institution understands the importance of medical evidence beginning with the alleged onset date and its importance in establishing a period of disability.

  • •

    If the applicant was in a hospital or saw a physician outside the institution, get the providers’ addresses.

  • •

    Obtain one signed SSA-827 (Authorization to Disclose Information to the Social Security Administration) and scan it into the electronic folder for DDS to use to obtain all of an applicant’s medical records. For more information about using the SSA-827, see DI 11005.055.

  • •

    In mental impairment cases, consider the need for a representative payee and begin development if necessary.

2. Evaluating adequacy of medical evidence

The FO does not question the adequacy of the medical information submitted by the institution. If the institution refuses to submit medical evidence or states it has no medical evidence, or the evidence appears incomplete and no other source of medical evidence is available, do not attempt further development. Follow the procedure in SI 00520.920B.3 in this section.

3. Consider other prior medical decisions

Before obtaining medical information and sending the claim to DDS consider prior Title II and Title XVI medical decisions. To use collateral estoppel or a prior Title XVI medical decision that was technically denied, see DI 11011.001 and DI 11055.077.

4. Referring cases to DDS

Refer the claim to the DDS when the medical evidence development procedures in SI 00520.920B.1 in this section are complete and the income, resources, and other non-medical factors of eligibility appear to be met.

Flag the Electronic Disability Collect System (EDCS) as a “Prerelease Case”. Explain any missing or incomplete medical evidence using EDCS 3367. For more information about flags in EDCS, see DI 81010.080. For information on completing the SSA-3367, see DI 11005.045.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500520920
SI 00520.920 - Processing Prerelease Claims - 09/11/2024
Batch run: 09/11/2024
Rev:09/11/2024