TN 47 (07-99)
SI 00835.707 Procedures For Determining ISM Provided To Residents of Institutions
The following general procedures are used for determining ISM received by residents of all types of institutions. However, see the following sections for additional instructions applicable to specific institutions:
A. Procedure — developing and documenting ism in institutions
1. Developing ISM In Institutions
Determine the typeof institution using the precedent at SEANET 8045.
Determine the CMVof the food and shelter provided to the individual by the institution. For ISM purposes, only the food and shelter portion of the total cost is considered. If the CMV is not shown on the precedent, contact the institution.
Determine the source, amount and applicable months of any payments made by the individual or a third party towards the CMV of the food and shelter by contacting the institution or the third party.
NOTE: If the institution is amulti-purposefacility (e.g., a residential section and a medical section), determine the purpose of the individual's confinement before determining whether the individual receives ISM. The following references provide guidance in determining the purpose of institutionalization:
2. Documenting the File
Reference the precedent or record the information about the type of institution and the CMV on the evidence screen (EVID). See SI 00520.800 if information is uncovered that indicates that the precedent should be updated.
Document the file with the source, the amount, and the months covered for any payments made by the individual or a third party toward the CMV of the food and shelter. Use a paper Report of Contact, the MSSICS DROC screen, or a signed statement provided by the institution or third party. The signed allegation of the eligible individual is not sufficient.
B. Procedure — computing the value of ism
1. Individual Pays for the Food and Shelter
Compare the individual's payment with the CMV of the food and shelter.
If the individual's payment equals or exceeds the CMV, determine that there is no countable ISM.
If the individual's payment is less than the CMV, determine the countable ISM by computing the difference between the individual's payment and the CMV. The ISM is capped at the PMV.
If the individual's payment is less than the CMV, determine whether the institution itself or a third party pays the balance and develop accordingly.
NOTE: If the individual's payment is less than the CMV, and he/she lives in a private for-profit residential care institution, develop whether there is a “payment in full” agreement per SI 00835.708B. If there is such an agreement, determine that there is no countable ISM.
2. Third Party Pays for the Food and Shelter
Determine whether the third party payment is countable as ISM per SI 00835.706C.
If it is notcountable, the individual does not receive ISM based on the third party payment.
If it is countable, compare the payment to the PMV and count the lower amount as ISM.
If the payment is less than the PMV and does not cover the entire CMV, determine whether ISM is being provided by another source (another third party or the institution itself) and develop accordingly.
EXAMPLE: Third party pays the institution (ISM excluded)
Gene Smith, who is filing for SSI, lives in a private for-profit residential home called Sunny Acres. The home charges $600 per month. Of this amount, $500 is for food and shelter (the CMV). The Homeless Outreach Project (HOP) pays the entire $600 for Mr. Smith's care. Following the instructions in SI 00830.605, the claims representative (CR) checks the regional instructions and finds a precedent which confirms that HOP is certified by the State as a nonprofit organization which provides excludable support and maintenance assistance. Therefore, the CR determines that no ISM is countable.
3. Institution Pays for the Food and Shelter
If nobody pays the institution, the institution may be providing countable ISM.
Determine whether food and shelter provided by the institution itself can be excluded as support and maintenance assistance (SI 00830.605) or as assistance based on need (SI 00830.175).
Determine whether the ISM exclusion described in SI 00835.712 applies if the individual lives in a privatenonprofit residential care institution.
If these exclusions are not applicable, compare the CMV of the food and shelter provided by the institution with the PMV and charge the lesser amount as countable ISM.
4. More Than One Source Pays for the Food and Shelter
When more than one source pays for the food and shelter (e.g., several third parties, or the individual and the institution) follow the procedure for third party payment. In addition, use the following guidelines.
Determine the source of the payments for the CMV of food and shelter. If any of the payments toward food and shelter can be excluded, use them in the computation first.
Do not count as ISM that portion of a payment to the institution that exceeds the CMV of food and shelter. For example, payments made to the institution to provide personal services to the individual are not ISM.
EXAMPLE 1: Both Individual and Third Party Pay — No ISM
Ms. Malone resides in the Hillcrest Home for the Aged, a private for-profit residential home for the aged. The home's total charge is $800 per month, of which $425 is for food and shelter (the CMV). Ms. Malone uses her SSI benefits to pay $425 per month. Her sister pays the balance of $375. Because Ms. Malone pays the CMV of the food and shelter, she does not receive countable ISM. The $375 paid by her sister is for personal care and services and is not counted as ISM or income.
EXAMPLE 2: Both Individual and Third Party Pay — ISM Counted
Mr. Jones also resides in the Hillcrest Home. The home's total charge is $800 per month, of which $425 is for food and shelter (the CMV). Mr. Jones pays $300 per month for his own care. His brother pays the remaining $500 each month. Mr. Jones is charged with $125 of ISM ($425 CMV minus his payment of $300). Although his brother pays $500 per month, only $125 counts as ISM. Any payments the brother makes in excess of the CMV amount do not count as ISM.