TN 35 (11-99)

SI 02305.045 Scheduled RZs for Recipients Residing in Medical Institutions

A. Policy

1. Scheduled Federal Living Arrangement “D” RZs

Federal living arrangement “D” (FLA-D) cases are selected for RZ only if they meet one of the following selection criteria:

  • UC profile RZs;

  • PE HEP, 1619(b) or critical birthday RZs; or

  • Limited issue cases.

2. Method of Completing the Redetermination

Generally, UC and HEP FLA-D RZs are completed in MSSICS or on a SSA-8203-BK. Critical birthday and 1619(b) cases are completed in MSSICS or on SSA-8202-F6. If the following conditions are met, an abbreviated RZ procedure may be used:

  • The recipient continually resided in the institution for the entire period of review and is expected to continue to reside there;

  • Medicaid continues to pay more than 50 percent of the recipient's cost of care at the institution, or for a child under age 18, Medicaid and/or private health insurance continues to pay more than half of the cost of care;

  • The recipient's record indicates the individual does not have earned income of more than $65 in any month of the period of review;

  • Unearned income does not exceed the unearned income exclusion regardless of whether the amount agrees with the amount on our records;

    NOTE: $30 plus any applicable State supplement is still payable.

  • The recipient's record does not indicate an excludable resource; and

  • The recipient does not have conserved funds at the institution or in a financial establishment that exceed the statutory resource limit considering applicable exclusions.

Abbreviated procedures may only be used in FLA-D RZs.

3. Unscheduled FLA-D Redeterminations

All unscheduled FLA-D RZs should be completed in MSSICS or on an SSA-8203-BK.

B. Procedures

1. Use Abbreviated Procedures

If the recipient meets the criteria outlined in A. above, an abbreviated RZ may be completed. MSSICS does not have an abbreviated path nor does it have a special completion indicator for an abbreviated path to close the RZ event. Therefore, MSSICS cannot be used to complete an abbreviated RZ. Use the following procedures when completing an abbreviated RZ:

  1. Contact the institution (by telephone whenever possible).

  2. If all of the conditions in A.2. are met for the period of review, document on a report of contact that the recipient:

    • Continuously resided at the institution (and expected to continue to reside there);

    • Had more than 50 percent of his/her cost of care paid for by Medicaid and is expected to continue to have Medicaid pay for the cost of care. For a child under age 18, had more than 50 percent of his/her cost of care paid for by Medicaid and/or private health insurance and is expected to continue to have Medicaid or private health insurance pay for the cost of care;

    • Is not receiving income from any previously unreported source;

    • Has not earned more than $65 in any month (some recipients receive income for chores or regular part-time work they perform at the facility);

    • Does not have conserved funds that exceed the statutory limit at the institution or (to the institution's knowledge) in a financial establishment.

    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 re source limit will be reached. (See SM 01301.230 for the RT diary procedure.)

  3. Input the appropriate completion indicator via 1719B (see SM 01501.003).

2. Completing an Abbreviated RZ When Recipient Has a Representative Payee

If the recipient has a representative payee and the record indicates income or resources in accordance with A.2. above, solicit the information to complete the abbreviated RZ from the institution. A signed statement from the recipient or his/her representative payee is not necessary.

3. Completing an Abbreviated RZ and Priority Diaries Are Present

Develop priority diaries (see SI 02305.017.B) that appear on the recipient's record even when abbreviated procedures are used.

4. Institution Outside FO Service Area

If the institution is outside your service area, initiate the contact by a Request for Assistance through the servicing FO or by using regional procedures.