QUESTION
You asked whether the Social Security Administration (SSA) should retroactively reinstate
disability insurance benefits (DIB) for a number holder during her period of commitment
to a hospital after a North Carolina court dismissed criminal charges against her
because NH remained incompetent to stand trial and was not likely to regain competency
to stand trial in the future.
OPINION
SSA should not reinstate the number holder’s DIB for during her period of commitment
to the hospital, and SSA properly suspended NH’s DIB during her civil commitment to
a hospital through November 2014.
BACKGROUND
According to the information provided, SSA found N~, the number holder (NH), entitled
to DIB from January 1979 to June 1981, and again starting in December 1981. In May
1991, A North Carolina prosecutor charged NH with two counts of assault with a deadly
weapon and one count of breaking and entering. However, a North Carolina court found
NH incompetent to stand trial and ordered NH hospitalized starting July 23, 1991.
On March 6, 2006, a doctor at Dorothea Dix Hospital re-evaluated NH’s competence to
stand trial. The doctor concluded NH remained incompetent to stand trial and was unlikely
to gain competency in the foreseeable future. Based on the doctor’s re-evaluation,
on November 15, 2006, a North Carolina judge dismissed NH’s pending criminal charges.
On February 8, 2007, another North Carolina judge ordered NH’s discharge from forensic
commitment, but also ordered NH civilly committed to an inpatient facility for no
more than ninety days at a hospital or “any other appropriate 24-hour facility.” In
May 2007, NH unsuccessfully contested her continued hospitalization, and a court recommitted
NH for another 180 days. Following this recommitment order, Dorothea Dix Hospital
initiated plans to transfer NH to Cherry Hospital.
On June 7, 2007, Dorothea Dix Hospital discharged NH for transfer to Cherry Hospital,
a state operated healthcare facility, for further evaluation and treatment. Cherry
Hospital admitted NH on June 7, 2007, for long-term care. On November 4, 2014, Cherry
Hospital discharged NH and she transferred to Longleaf Neuro-Medical Treatment Center
(Longleaf). Longleaf’s website indicates it serves two types of patients: (1) adults
with severe and persistent mental illness who also have long-term medical conditions
requiring residential, medical, and nursing care and who have been referred solely
from North Carolina’s psychiatric hospitals; and (2) adults diagnosed with Alzheimer’s
or other related dementia whose assaultive and combative behavior has resulted in
denial of care in a traditional nursing home setting. See Longleaf Neuro-Medical Treatment Center, http://www.longleafneuromedical.ncdhhs.gov/ (last visited May 1, 2015).
SSA suspended NH’s DIB from February 1995 through November 2014. SSA reinstated NH’s
benefits in December 2014. In a letter dated March 6, 2015, NH’s legal guardian asserted
SSA should not have suspended NH’s DIB from June 7, 2007, through November 2014, the
period NH remained hospitalized at Cherry Hospital. NH’s legal guardian asserted NH
did not appear to be under a civil commitment at Cherry Hospital and would have transferred
to a group home or other assisted living facility instead of Cherry Hospital on June
7, 2007, if SSA had reinstated NH’s DIB at the time.
DISCUSSION
Under section 202(x) of the Social Security Act (Act), SSA cannot pay DIB to any individual
for any month (or part of a month) for which the individual is confined by court order
in an institution at public expense in connection with a finding that the individual
is incompetent to stand trial under an allegation of a criminal offense. See Act § 202(x)(1)(A)(ii)(III); Program Operations Manual (POMS) GN 02607.001A, B.8, C.3; POMS GN 02607.040; POMS GN
02607.320; POMS GN 02607.330.[1] The POMS defines “confinement,” as used in section 202(x) of the Act, as residing
in a correctional or mental health institution. See Act § 202(x)(1)(A)(i)-(iii); POMS GN 02607.001B.2. Confinement ends when an individual is released, either conditionally or unconditionally,
from the care and supervision of the correctional or mental health institution and
such institution ceases to meet the individual's basic living needs. See Act § 202(x)(1)(B)(ii); POMS GN 02607.320C; POMS GN 02607.330A.4.
For an individual who has been committed and confined to an institution because a
court found her incompetent to stand trial, a change in commitment status from criminal
or forensic to civil does not result in reinstatement of benefits. See POMS GN 02607.852A.1. After a court changes an individual’s commitment status, SSA considers the individual
to be not guilty by reason of insanity (NGRI). See POMS GN 02607.001B.7; POMS GN
02607.852A.1. SSA will reinstate benefits for such an individual if the individual is no longer
under the care and supervision of an institution and the institution no longer provides
the individual with basic living needs, that is, food, clothing, and shelter. See POMS GN 02607.850A.1; POMS GN 02607.852A.1. SSA will also reinstate benefits if the individual is on official conditional release
and resides in a group home in the community. See POMS GN 02607.850A.1.c.
Under North Carolina law, when a court concludes a criminal defendant is incompetent
to stand trial, the court must determine whether the defendant also requires involuntary
commitment. See N.C. Gen. Stat. Ann. §§ 15A-1002(b1), 15A-1003(a) (West 2014). If the court places
the defendant under involuntary commitment at a hospital or institution, the court
must require the hospital or institution to report the condition of the defendant,
and the report must state the likelihood of the defendant gaining competency to stand
trial. See N.C. Gen. Stat. Ann. §15A-1004(d) (West 2014). A court may dismiss charges against
a defendant when the earliest of the following occurs: (1) it appears to the court
that a defendant who has been found incompetent to stand trial is not likely to gain
capacity to proceed; (2) the defendant has been deprived of her liberty for a period
equal to the maximum punishment allowable; or (3) a period of five years since the
determination of incapacity to proceed for misdemeanor charges, or a period of ten
years for felony charges, has elapsed. See N.C. Gen. Stat. Ann. § 15A-1008 (West 2014).
For an individual whom the court has initially committed as a result of conduct resulting
in a violent crime charge, including crime involving assault with a deadly weapon,
if an attending physician determines further commitment will be necessary, the court
will hold a rehearing on the need for additional commitment of the individual. See N.C. Gen. Stat. Ann. § 122C-276(a) (West 2014). The court can order a second commitment
of up to 180 days. See N.C. Gen. Stat. Ann. § 122C-276(e) (West 2014). A court may order additional commitments
after the second commitment, but each subsequent commitment can last only up to one
year. See N.C. Gen. Stat. Ann. § 122C-276(f) (West 2014).
After a North Carolina prosecutor charged NH with two counts of assault with a deadly
weapon and one count of breaking and entering in May 1991, a North Carolina court
determined NH incompetent to stand trial, and NH remained hospitalized continuously
starting in July 1991. A court dismissed the criminal charges against NH in November
2006 upon determining NH was not likely to gain competency to stand trial. However,
the court did not lift NH’s involuntary commitment and she was not discharged from
the hospital at that time. On February 8, 2007, while NH was still hospitalized, a
North Carolina court ordered an additional civil commitment not to exceed ninety days.
NH’s Dorothea Dix Hospital treatment records indicate that in May 2007, a North Carolina
court ordered an additional involuntary commitment of 180 days. Following this commitment
order, Dorothea Dix Hospital transferred NH to Cherry Hospital in June 2007. NH’s
Dorothea Dix Hospital discharge records and Cherry Hospital admission records do not
indicate any court had lifted the May 2007 180-day civil commitment order at the time
of the transfer, or that Dorothea Dix Hospital transferred NH pursuant to any official
or official conditional release from civil confinement. Nothing in the evidence provided
indicates NH was on official or official conditional release from civil commitment
before her transfer from Cherry Hospital to Longleaf in November 2014. Moreover, Cherry
Hospital also provided NH with her basic living needs throughout her stay from June
2007 through November 2014. Case law and the legislative history of section 202(x)
of the Act indicate the purpose of this nonpayment provision is to conserve scarce
Social Security resources and avoid payment of benefits to people whom taxpayers are
already supporting. See Davis v. Bowen, 825 F.2d 799, 801 (4th Cir. 1987) (noting congressional policy goal of section 202(x)
of the Act is to conserve scarce Social Security resources where an individual’s basic
economic needs are provided from other public sources); 140 Cong. Rec. H3198, *H3200-01
(daily ed. May 10, 1994) (statements of Reps. Bunning and Goss); POMS PR 06805.024A.2. Thus, for the period from June 2007 through November 2014, NH continued her confinement
as defined in section 202(x) of the Act and did not qualify for reinstatement of her
DIB. See POMS GN
02607.850A.1 and POMS GN 02607.852A.1.
CONCLUSION
Based on the evidence provided, NH remained confined in a mental health institution
based on a civil commitment order when she transferred to Cherry Hospital in June
2007, and Cherry Hospital provided NH with her basic living needs until her discharge
in November 2014. Therefore, SSA properly suspended NH’s DIB through November 2014
and should not retroactively reinstate her DIB for the period from June 2007 through
November 2014.
Sincerely,
Mary Ann Sloan
Regional Chief Counsel
By: /s/ _
Natalie Liem
Assistant Regional Counsel
cc:
Ms. Sloan
Mr. Harris
Mr. Wilson
^Regional Attorneys Opinions