TN 26 (03-99)

SI 00520.131 Special Benefits for Institutionalized 1619 Eligibles -Institutional Agreements

Citations:

Social Security Act, Section 1611(e)(1)(E); P.L. 99-643

A. Background

The purpose of the special benefits institutionalized for 1619 eligibles is to provide continued benefits so that the recipient can maintain his living arrangement through short periods of institutionalization. In order to protect the SSI payment for this purpose, the law requires assurance that the benefit will not be required for payment of the costs of institutional care.

B. Policy

1. No Medicaid Involved — Agreement Needed

If an institution does not receive Medicaid payments on behalf of an individual, then the institution or controlling agency must agree that the individual will be allowed to keep any benefits paid under the special benefits provision for 1619 eligibles.

2. Medicaid Involved — No Agreement Needed

If an institution in which an individual is a resident receives Medicaid payments on behalf of the individual, a specific agreement with the institution is not needed.

State Medicaid plans are required by P.L. 99-643 to disregard these special SSI benefits in determining patients' expected contributions to the cost of care. When a State Medicaid plan has been revised to conform to P.L. 99-643, the provider agreement satisfies the requirement.

C. Procedure — general

1. Notify Institution

Use appropriate model forms at Exhibit E.1. through Exhibit E.4., reproduced locally, to notify institutions about the provision, to obtain an agreement when needed, and to notify the institution regarding specific cases and benefit months which are affected by the agreement.

2. Do Not Alter Forms

Do not alter these forms without the permission of the Office of Income Security Programs (OISP) obtained through the RO.

D. Procedure — no medicaid involved

1. Obtaining Agreement

Obtain an agreement when notified of the first potentially eligible resident of an institution. Make a personal contact with the institution's administrator prior to sending the informational letter, if possible. Do not authorize payment under this provision until an agreement is obtained.

When an agreement is obtained, note this on the institution's precedent at SEANET 8045.

NOTE: The FO may obtain an institutional agreement prior to the incidence of an actual case.

2. No Agreement Obtained

In the absence of an agreement, determine eligibility and payment without application of this provision. Make appropriate adjustments if an agreement is subsequently obtained.

3. Investigate Failure to Honor Agreement

Investigate any allegations that an institution has failed to honor the agreement. If local SSA management staff or RO staff cannot resolve the issue with the institution, report any such cases to OSSI through the RO.

E. Exhibits — model forms for institutionalized 1619 eligibles

  1. Model Informational Notice to Institutions

  2. Model Institutional Agreement Form

  3. Model Institutional Notice Form—No Medicaid Involvement

  4. Model Institutional Notice Form—Medicaid Involved

EXHIBIT 1 - MODEL INFORMATIONAL NOTICE TO INSTITUTIONS

 

SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
IMPORTANT INFORMATION

 

                                     Date:

Name of Administrator
Name of Institution
Street Address
City/State /Zip Code

 

Dear               :

 

We need your help to see that certain supplemental security income (SSI) recipients benefit from a special provision affecting their eligibility and payments for SSI.

Under Section 1611(e)(1)(E) of the Social Security Act, we can pay the full Federal benefit rate to certain institutionalized individuals. These individuals would be ineligible for SSI or their Federal payments would be no more than $30 a month. Under the provision, we can pay them for the first two full months of institutionalization. This allows individuals to continue to meet expenses outside the institution, such as maintaining their homes.

For us to make these specials payments, you must agree that your institution will not require the individual to pay any part of the SSI payment to the institution. Medicaid law also requires that you disregard these payments when determining the amount the individual would be expected to pay towards the cost of care.

We would appreciate your agreeing to the conditions outlined above. If you do agree, please sign (or have someone on your behalf sign) the enclosed agreement form. Please return the original form in the enclosed envelop.

If you agree, we will send you the name(s) and Social Security number(s) of any resident(s) of your institution who qualify under this provision. We will also provide the months for which the agreement applies.

If you have any questions, please call our office and ask for  (name of contact person)  . Her/His telephone number is (xxx) xxx-xxxx.

                                         Sincerely,

 

 

                                         Manager's name

                                         Manager's Title

Enclosure (2)

EXHIBIT 2 - MODEL INSTITUTIONAL AGREEMENT FORM

 

SOCIAL SECURITY ADMINISTRATION
SUPPLEMENTAL SECURITY INCOME
IMPORTANT INFORMATION

TO:

Field Office Manager
Social Security Administration
Street Address
City/State/Code

Acting on behalf of (name of institution(s)), I agree that any individuals identified as potential recipients of supplemental security income (SSI) under section 1611(e)(1)(E) of the Social Security Act will not be required to pay any part of the Section 1611(e)(1)(E) SSI payment to this institution.

I understand that the Social Security Administration (SSA) will send us the name(s) and Social Security number(s) of the resident(s) of our institution(s) who qualify under this provision. SSA will also provide the month(s) for which the agreement applies.

  
  .           .
 Signature of Authorized Person from Institution
  .           .
 Title
  .           .
 Date
  .           .
 Signature of Authorized Person from SSA
  .           .
 Title
  .           .
 Date

EXHIBIT 3 - MODEL INSTITUTIONAL NOTICE FORM - NO MEDICAID INVOLVEMENT

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

IMPORTANT INFORMATION

 Date

Name of Authorized Person

Name of Institution

Street Address

City/State/Zip code

The individual(s) listed below, who is a resident of your facility, is eligible for supplemental security income (SSI) payments under section 1611(e)(1)(E) of the Social Security Act. For the months listed below the individual(s) will not be required to pay any portion of the SSI payment to your institution. This is based on the agreement dated       between the Social Security Administration and your institution.

Recipient's NameRecipient's Social Security NumberMonths for which Special Payments Apply

If you have any questions, please call our office and ask for (name of contact person) . Her/His telphone number is (xxx) xxx-xxxx.

 Manager's Name
 Manager's Title

EXHIBIT 4—MODEL INSTITUTIONAL NOTICE FORM — MEDICAID INVOLVED

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

IMPORTANT INFORMATION

 Date

Name of Authorized Person

Name of Institution

Street Address

City/State/Zip code

The individual(s) listed below, who is a resident of your facility, is eligible for supplemental security income (SSI) payments under section 1611(e)(1)(E) of the Social Security Act. For the months listed below the individual(s) will not be required to pay any portion of the SSI payment to your institution.

Recipient's NameRecipient's Social Security NumberMonths for which Special Payments Apply

If you have any questions, please call our office and ask for (name of contact person) . Her/His telphone number is (xxx) xxx-xxxx.

 Manager's Name
 Manager's Title