TN 12 (07-99)

SI 00603.034 Limited Preeffectuation Review Contacts (PERCs)

A. Introduction

For the following simultaneous development claims, only limited development is required for the PERC:

  • Living Arrangement (LA) D Claims

  • Profiled Claims

B. Policy - LAD claims

1. Introduction

For claimants who are in Federal LA D, different information is obtained depending on whether:

  • a “full” monthly payment is due (the Federal Benefit Rate (FBR), limited only by the payment cap, plus any optional supplement); or

  • the claimant is eligible but countable income exceeds the payment cap plus any optional supplement.

2. General Requirements

In order to qualify for a limited LAD PERC, the record must show that the claimant has been in either situation as described in SI 00603.034B.1. for all months since the latest of the following:

  • the date of first eligibility (SI 00603.030A.5.),

  • the date the initial application was received, or

  • the date the SSA-8000-BK or the full MSSICS application was completed when the claim was switched from deferred to simultaneous development prior to receipt of a medical allowance.

If the information required for the limited PERC cannot be confirmed, you must conduct a full PERC.

C. Procedure - LAD claims

1. General Procedures

a. Create PERC Record - Non-MSSICS Processing

For a paper application or a claim taken on MSSICS but the MSSICS record is locked, record the required information on Form SSA-5002 (Report of Contact). Annotate “PERC” in the upper right-hand corner.

b. Create PERC Record - MSSICS Processing

When the claim can be processed via MSSICS, select WITH EXCLUSION on the PERC screen, but record the required information on the Report of Contact (DROC) screen.

c. Systems Input

For non-MSSICS processing, enter the month/year of the contact as the PERC date in the PERC-Update (PC) field (SM 01005.660).

For MSSICS processing, the date that WITH EXCLUSION is selected on the PERC screen becomes the PERC date. Enter “Y” in response to CLOSE OPEN EVENT on the DSSR screen and enter the INITIAL CLAIM DECISION on the DADJ screen.

2. Documenting Full Payment Cases

Confirm (by phone, if possible) with a representative of the institution that since the reference date, the claimant has continuously resided at the institution and is expected to continue residing there, and

  • (if age 18 or over) had more than 50% of his/her cost of care paid for by Medicaid and this arrangement is expected to continue (see SI 00520.011E.2.b. if Medicaid is the only source of payment), or

  • (if a child under age 18) had more than 50% of his/her cost of care paid for by private health insurance alone or in combination with Medicaid, and

  • has not received income from any previously unreported source and does not expect to, and

  • has not earned more than $65 in any month and does not expect to, and

  • does not have conserved funds exceeding the statutory limit at the institution or in a financial establishment to the institution's knowledge.

    NOTE:If the recipient has conserved funds approaching the resource limit, diary the case to update the amount of funds the following year or earlier if you can predict when the resource limit will be reached.

3. Documenting eligible but not payable cases

Contact a representative of the institution (by phone, if possible) and confirm that:

  • the claimant has resided at the institution since the reference date and is expected to continue to reside there, and

  • no income decrease is expected.

D. Policy - profiled claims

1. Introduction

In claims with certain profiled case characteristics, development consists of ascertaining if the claimant has moved and if so, determining if the subsequent LAs continue to meet the profile.

2. Profile characteristics

The claim must be a DDS allowance.

The record must show that since the latest of the following dates:

  • the date of first eligibility,

  • the date the application was rec