TN 35 (04-12)
SI 00520.720 Decertification of Medicaid Facilities
A. Introduction to decertification of Medicaid facilities
The Social Security Administration, the Centers for Medicare & Medicaid Services, and State Medicaid certifying agencies must work together closely when de- certifying Medicaid facilities.
Although decertification is prospective rather than retroactive, overpayments or underpayments will occur if SSA delays decertification notifications and SSA does not adjust Supplemental Security Income (SSI) payments (including federally administered State supplementary payments) beginning with the month of decertification.
B. Policy for the application of $30 payment limit for the month of decertification
The $30 payment limit applies for the month of decertification only if the
individual was a resident of the facility or of the facility and another Medicaid institution throughout the entire month, and
Medicaid payment exceeds 50 percent of the cost of care for the period in the Medicaid facility during that month, and
facility is a public institution.
NOTE: If the facility is private, we adjust SSI payments beginning with the month of decertification.
C. Procedure on notification of the decertification of a Medicaid facility
For the decertification of a Medicaid facility, the servicing field office must identify all affected residents and process any changes to their records.