Identification Number:
SI 00520 TN 46
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Updating all four Prerelease POMS sections
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 005 – Eligibility
Subchapter 20 – Institutionalization
Transmittal No. 46, 05/09/2022

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

We are revising all four POMS sections on Prerelease policies, procedures, and agreements (SI 00520.900 through SI 00520.930) to:

  • Incorporate EM-16054, which housed information about SSA’s Memorandum of Understanding (MOU) with the Federal Bureau of Prisons (BOP) to facilitate prerelease claims involving BOP inmates (Central Office maintains this MOU);

  • Add processing instructions for BOP prerelease claims, including new special instructions for BOP conditional release and BOP skilled nursing care cases (all of which are governed by the national MOU);

  • Clarify how processing BOP prerelease claims differs from processing non-BOP prerelease claims (the latter are governed by individual prerelease agreements between the respective RO/FO and the non-BOP institution); and

  • Consolidate and streamline the information to make our policies and procedures clearer for technicians.

NOTE: We will issue a temporary Emergency Message (EM-22XXX) with instructions for processing Title II prerelease claims at the same time that we publish the updates in this transmittal. Eventually, that EM will be replaced by a new POMS section housing the Title II prerelease instructions permanently.

 

Summary of Changes

SI 00520.900 Prerelease Procedure - Institutionalization

In addition to minor formatting and editorial revisions, we made the following substantive changes to SI 00520.900:

  • Section A: Reformatted the background section for clarity and comprehensiveness;

  • Section B (New): Consolidated the prior sections B and C to streamline the criteria for applying the prerelease procedure; and

  • Removed Section C and moved that information to SI 00520.920.

 

SI 00520.910 Prerelease Agreements with Institutions

In addition to minor formatting and editorial revisions, we made the following substantive changes to SI 00520.910:

  • Section A: Added information about the Memorandum of Understanding (MOU) between SSA and the Federal Bureau of Prisons (BOP) for prerelease claims involving BOP inmates;

  • Section B: Clarified in the title that this section applies non-BOP prerelease claims;

  • Section B.3 and previous B.4 (removed): Replaced the prior list of responsibilities of SSA and the institution with a cross-reference to find that information in SI 00520.930;

  • Section C: Clarified in the title that this section applies to non-BOP prerelease claims;

  • Section D: Clarified in the title that this section applies to non-BOP prerelease claims; and

  • Section E (new): Added background on our MOU with BOP to facilitate BOP prerelease claims; Added responsibilities of SSA and BOP under the MOU.

 

SI 00520.920 Processing Prerelease Claims

In addition to minor formatting and editorial revisions, we made the following substantive changes to SI 00520.920:

  • Added a note under the title that SI 00520.920 applies to SSI prerelease claims only and to reference EM-22XXX for procedure on processing Title II prerelease claims.

  • Section A.1: Added guidance to use the modified Form SSA-3288 located in SI 00520.930 for BOP prerelease claims;

  • Section A.5: Added guidance on timeframes for processing prerelease claims for individuals housed in BOP institutions;

  • Section A.6: Added an additional step for BOP conditional release and BOP skilled nursing care cases to add a remark to the SSID and DW01 before sending the claim to the DDS for a medical determination. This additional step is due to the special processing rules for those two types of cases;

  • Section A.7: Incorporated procedural information from the old Section C, which has since been removed. Separated the instructions for holding adjudication of aged claims versus disability claims (for clarity). Added special processing instructions to hold medically-approved BOP conditional release and BOP skilled nursing care cases for longer periods before adjudicating the claim;

  • Section A.8: Added guidance that BOP will advise individuals to contact SSA upon their release from the institution; and

  • Removed Section C because it was duplicative; incorporated relevant information into the procedural instructions within section A.

 

SI 00520.930 Exhibits of Prerelease Agreements, Referrals, and Forms

In addition to minor formatting and editorial revisions, we made the following substantive changes to SI 00520.930:

  • Title: Updated the title with relevant information about this section’s content;

  • Removed the prior Exhibit 1 (Summary of prerelease procedure) because the information was duplicative (it is already in sections SI 00520.900 and SI 00520.910);

  • Exhibit 1 (previously Exhibit 2): Clarified that the model prerelease agreement can be modified to meet the local needs of the FO and/or institution; and

  • Exhibit 3 (new): Added a link to the modified Form SSA-3328 (Consent for Release of Information) for use in BOP prerelease claims.

SI 00520.900 Prerelease Procedure - Institutionalization

CITATIONS:

Social Security Act, Section 1631(m)

A. Background

SSA’s prerelease procedure helps institutionalized individuals, who are ineligible for SSI and/or Title II benefits or who are subject to the $30 Federal payment limit, begin receiving benefits shortly after they reenter the community upon release. The purpose is to promote deinstitutionalization, prevent homelessness, and reduce recidivism.

The prerelease procedure allows SSA to take and process benefit applications for an institutionalized individual before their anticipated release. We can make a prospective determination of potential eligibility and payment amount based on the individual’s anticipated circumstances upon release.

Congress enacted legislation requiring SSA to allow individuals to apply for benefits prior to their release from a public institution. In addition to helping those who have never received benefits, the prerelease procedure facilitates reinstatement of benefits after a period of suspense due to the institutionalization.

B. Criteria for applying the prerelease procedure

Process claims using the prerelease procedure in the following situations.

1. The individual is in a public institution and is:

  • ineligible for SSI and/or Title II benefits due to institutionalization; or

  • receiving the $30 SSI payment limit while in an institution where Medicaid pays for more than half the cost of the care (for more information, see SI 00520.011); or

  • suspended from receiving Title II benefits due to incarceration (for more information, see GN 02607.160).

NOTE: The prerelease procedure applies to penal institutions as well as other public institutions.

2. The individual is potentially eligible as follows:

  • the individual appears likely to meet the criteria for SSI eligibility or Title II entitlement when they are released from the institution; and

  • the anticipated release date is within the prerelease timeframes in SI 00520.920A.5.

NOTE: There may be situations when an institutionalized individual inquires about filing for benefits when the anticipated release date is far in the future, or when no release date has been determined. If the individual decides to file, take the application following GN 00201.005C. If the individual decides not to file, close out any Title II and SSI protective filings following the instructions in GN 00204.012 and SI 00601.037.

REMINDER: For SSI prerelease claims, if the individual is insured for Title II disability benefits, a Title II claim is required, per SI 00510.001.

C. Reference

SI 01801.040 - Living Arrangements that May Affect Supplemental Nutrition Assistance Program (SNAP) Eligibility

SI 00520.910 Prerelease Agreements with Institutions

A. Introduction to prerelease agreements

A prerelease agreement is a written or verbal agreement between a public or penal institution and the Social Security Administration (SSA) to cooperate in the processing of Title II and Title XVI (or Supplemental Security Income (SSI)) prerelease applications and reinstatements. A written agreement is preferred, though not required, and is a non-binding means of ensuring understanding by all parties and facilitating an individual’s successful integration back into the community.

The prerelease agreements process is slightly different for Federal Bureau of Prisons (BOP) institutions compared with non-BOP institutions. As of November 9, 2016, SSA and the BOP have a national Memorandum of Understanding (MOU) providing prerelease planning assistance to inmates at BOP institutions. Central office maintains the MOU. For an overview of SSA’s and BOP’s responsibilities under the MOU for BOP prerelease claims, see SI 00520.910E in this section.

In contrast, the prerelease agreements process with non-BOP institutions is more varied. Agreements can be formal or informal, and they are established and maintained by regional offices (ROs) and field office (FOs). For instructions on prerelease agreements with non-BOP institutions, see SI 00520.910B through SI 00520.910D in this section.

B. The prerelease agreements process for non-BOP institutions

The following information describes the prerelease agreements process for non-BOP institutions.

1. Parties to a prerelease agreement

The parties to a prerelease agreement are SSA and the institution (or the agency that administers more than one institution). An FO or an RO can establish a prerelease agreement. The agreement can be for one facility or for multiple facilities (e.g., for all the facilities in a State or a county).

FOs should use the model prerelease agreement in SI 00520.930, Exhibit 1, as a framework for new agreements. ROs may use the model agreement or consult previous statewide prerelease agreements when developing a new prerelease agreement for a State prison system.

2. Formal or informal prerelease agreements

An agreement may be formal (a written agreement signed by both parties) or informal (an unsigned written agreement or a verbal agreement).

An FO can have an informal prerelease agreement for a single claim. If the FO receives an inquiry from an institution to initiate a claim for an institutionalized person, the FO can use the prerelease procedure if the institution allows the individual to communicate with SSA and provides information necessary to process the claim. An informal one-time agreement could lead to a more comprehensive prerelease agreement between the FO and the institution.

3. Responsibilities of the parties in a prerelease agreement

For a list of responsibilities that SSA and the institution typically have under a prerelease agreement, see SI 00520.930, Exhibit 1 (Model Prerelease Agreement Between SSA and Non-BOP Institution).

4. Disability Determination Service (DDS) participation in prerelease agreements

DDS participation in the prerelease agreement process is very important. The DDS works with FOs and the institution to facilitate and provide feedback to improve the process of getting medical evidence.

5. Regional Office (RO) review of prerelease agreements

ROs will review the use of prerelease agreements annually (e.g., conduct surveys of the FOs for status of the prerelease agreements in their areas) and take appropriate action to ensure that all staff are aware of, and fully utilize, the procedure.

C. Procedure for establishing prerelease agreements with non-BOP institutions

FOs must take the following steps to establish prerelease agreements with public institutions in their service area.

  1. 1. 

    Identify public institutions within the service area with a potential prerelease population, including (but not limited to):

    • institutions for persons with mental disabilities;

    • residences for persons with mental retardation;

    • residences for persons with physical disabilities;

    • medical treatment facilities;

    • prisons; and

    • halfway houses (For information about halfway houses, see GN 02607.200C. and SI 00520.009B).

  2. 2. 

    Make a personal contact with institution staff to explain the benefits of the prerelease procedure, and attempt to establish a new prerelease agreement or update an existing agreement as needed. If the FO and the institution do not establish an agreement, the FO should check periodically to see if the institution is currently interested.

  3. 3. 

    Contact the RO regarding DDS participation in any existing prerelease agreements involving other FOs.

  4. 4. 

    Consult with the DDS about its participation on prerelease claims. The DDS may already have procedures for processing prerelease claims for other FOs. The FO can provide the DDS with information about the prerelease procedure by referencing SI 00520.900 through SI 00520.930.

  5. 5. 

    Attempt to obtain a formal agreement with the institution, using the model agreement in SI 00520.930, Exhibit 1. The FO can modify the model agreement to meet the needs of the institution. However, substantial deviations from the model should be sent to the RO for regional OGC review prior to enacting a new agreement. Follow operating procedures to store and maintain written prerelease agreements.

  6. 6. 

    If the institution is unable or unwilling to complete a formal agreement, attempt to establish an informal agreement based on the same general elements from the model agreement in SI 00520.930, Exhibit 1. Document what is agreed to on a DROC.

  7. 7. 

    Review with the institution staff the information SSA needs to determine an individual's potential SSI eligibility (including age or disability, and the income and resource limits) and/or Title II entitlement.

  8. 8. 

    Establish guidelines for the date the institution refers the case to the FO. This date depends on the average DDS processing time and the expected date of release. The goal is to allow enough time for the DDS to complete a disability determination that is within 30 days of the scheduled release date. For example, if the DDS processing time averages about 90 days, the FO can take the claim 120 days before the scheduled release date of the claimant.

  9. 9. 

    Identify and share contact information with the institution and FO liaisons who will handle referrals, applications, follow-up activities, and staff training, as needed.

  10. 10. 

    Establish the detailed steps for filing and processing the prerelease claim (e.g., will the interview be by telephone or in person, will the institution staff, the claimant, or the FO complete the claims forms).

D. Procedure for maintaining prerelease agreements with non-BOP institutions

The FO or RO must take the following actions to maintain existing prerelease agreements.

  • Review and update prerelease agreements to ensure they operate effectively when there is a change in circumstances.

  • Send substantive agreement updates to the RO for regional OGC review

  • Review FO and DDS experiences to determine if improvements are necessary.

  • Contact the institution staff to discuss problems and determine if they are satisfied with how the prerelease procedure is working.

  • Address any barriers to the prerelease process to encourage and ensure the institution continues to refer prerelease claims.

  • Provide refresher training, as needed for FO and institution staff.

E. Prerelease Memorandum of Understanding (MOU) with the BOP

As of November 9, 2016, SSA and the BOP have an MOU that provides prerelease planning assistance to inmates at all BOP correctional facilities. The MOU does the following:

  • Outlines the responsibilities of SSA and BOP for prerelease planning of inmates’ benefit applications.

  • Provides guidance on the development of local procedures between SSA FOs and BOP correctional facilities.

  • Helps ensure prerelease applications are processed efficiently so individuals have access to Title II benefits and/or SSI shortly after their return to the community.

For detailed instructions on processing BOP prerelease claims, see SI 00520.920.

The responsibilities of BOP and SSA under the MOU are as follows.

1. BOP's responsibilities under the MOU

The BOP has agreed to:

  1. a. 

    Provide guidelines to BOP facilities to maintain consistent procedures nationwide. Provide BOP facilities with the procedures for working with the local SSA FO to develop any additional local procedures that may be necessary to achieve the desired results.

  2. b. 

    Appoint a national BOP liaison to serve as the point of contact for SSA headquarters staff. Appoint one point of contact at each BOP correctional facility to assist the local servicing SSA office with inquiries and concerns regarding prerelease claims. Appoint one point of contact at each BOP correctional facility for SSA to send the SSA-827 for obtaining medical records.

  3. c. 

    Notify SSA servicing office points of contact of changes in BOP points of contact.

  4. d. 

    Provide inmates access to eligibility information for Title II benefits and SSI.

  5. e. 

    Provide inmates with the necessary SSA forms and contact information for the local servicing SSA office that will process the inmates’ prerelease claims.

  6. f. 

    Permit the inmate to contact SSA FO staff to apply for benefits and to discuss other matters necessary for processing the inmate's prerelease claim(s), using existing methods as permitted. Under no circumstances will BOP staff - in any formal or informal capacity - perform any responsibilities or duties of SSA, such as formally reviewing an inmate's application to ensure compliance with SSA requirements or making any SSI eligibility determinations.

  7. g. 

    For conditional release and skilled nursing care cases: Inform inmates they must add a comment within the SSI and/or Title II application’s REMARKS section (or provide a verbal statement to the SSA employee if filing over the phone) that their case is a conditional release or skilled nursing care case. This will ensure SSA adjudicates their claim properly.

  8. h. 

    Inform inmates that for SSA to disclose information to the BOP, the inmate must sign the modified form SSA-3288 (Consent for Release of Information), located at Exhibit 3 in SI 00520.930, and provide the form to SSA.

  9. i. 

    Inform inmates of the need for the inclusion of a signed medical release form SSA-827 (Authorization to Disclose Information to the Social Security Administration) and medical history form SSA-3368 (Disability Report - Adult) with the application when the inmate files for disability benefits under Title II or SSI.

  10. j. 

    Provide all requested medical evidence upon receipt of the SSA-827 consistent with SSA guidelines and recommendations of the DDS.

  11. k. 

    Inform inmates filing a prerelease claim to notify the local SSA FO if there is a change in their release date.

  12. l. 

    Track all prerelease claim referrals and respond to any local servicing office inquiries.

  13. m. 

    Provide the released inmate with documents to verify the inmate’s formal release date from custody (e.g., Release and Gratuity form, Notice of Release and Arrival).

  14. n. 

    Advise inmates that they must contact the servicing SSA FO when they leave the BOP facility and provide SSA with their new address and phone number (e.g., home, BOP contracted facility, different correctional institution, skilled nursing facility, mental health group home). For conditional release and skilled nursing care cases, also advise the inmate to remind SSA their case is a conditional release or skilled nursing care case. This will facilitate the timely processing of their SSI and/or Title II claim.

  15. o. 

    Not discourage Residential Reentry Center (RRC) contractors or RRC contractor staff from facilitating access to SSA FOs for inmates who wish to apply for benefits or have already begun the application process.

2. SSA's Responsibilities under the MOU

SSA has agreed to:

  1. a. 

    Provide national guidelines for SSA FOs for processing prerelease claims for BOP inmates. Within those guidelines, SSA FOs will work with their local BOP facilities to develop additional local procedures that may be necessary to achieve desired results.

  2. b. 

    Appoint a national SSA liaison to serve as the point of contact for BOP headquarters staff. SSA will appoint one point of contact at each local SSA office that services each BOP correctional institution or BOP-contracted facility or facilities to assist with inquiries and claims. The SSA office that services a BOP facility will be responsible for processing prerelease claims for inmates in that BOP facility.

  3. c. 

    Notify the BOP points of contact of changes in SSA servicing office points of contact.

  4. d. 

    Receive and process an inmate’s signed consent form SSA-3288 (Consent for Release of Information), which is required prior to release of information to BOP staff involved with processing the inmate’s prerelease claim. The SSA-3288, pre-filled with language specific to this agreement, is Exhibit 3 in SI 00520.930.

  5. e. 

    Provide BOP with information to share with inmates regarding eligibility requirements for Title II benefits and SSI.

  6. f. 

    Provide BOP with all necessary application forms (including the SSA-827 (Authorization to Disclose Information to the Social Security Administration)), instructions, and a checklist of the necessary forms (e.g., SSA-8001. SSA-3368) for distribution to inmates who wish to apply for Title II or SSI. Provide updates to forms and instructions as changes occur. Process prerelease applications as permitted under existing policies and procedures.

  7. g. 

    Mail the completed form SSA-827 (Authorization to Disclose Information to the Social Security Administration) directly to the point of contact at the BOP facility that maintains the inmate’s medical records.

  8. h. 

    Process claims under the prerelease procedure using the following timeframes:

    • For Title II and SSI disability claims: apply prerelease procedures to claims received within 120 days prior to the inmate’s scheduled date of release from BOP custody or 120 days prior to the home confinement placement date.

    • For Title II retirement and survivor’s claims, as well as SSI aged claims (age 65 or older): apply prerelease procedures to claims received within 30 days prior to the inmate’s scheduled date of release from BOP custody or 30 days prior to the home confinement placement date.

  9. i. 

    For conditional release cases:

    • SSI claims: Hold medically approved claims for up to 180 days before adjudicating. The BOP cannot request a release hearing before a Federal judge for the inmate until there is a favorable medical allowance, which signals a funding source (i.e., SSI/Medicaid) upon release. The additional time will give BOP sufficient time to locate a facility to place the inmate, to present the release plan to the judge, and for the judge to approve release from the BOP facility.

    • Title II claims: Adjudicate the claim to suspension. Once the inmate is released, follow the Title II procedures for post-entitlement reinstatement.

  10. j. 

    For skilled nursing care cases:

    • SSI claims: Hold medically approved claims for up to 180 days before adjudicating. The BOP is unable to contact skilled nursing facilities for placement of the inmate until there is a favorable medical allowance. The additional time will allow BOP sufficient time to find the inmate permanent placement in a skilled nursing facility before they release the inmate from the BOP facility.

    • Title II claims: Adjudicate the claim to suspension. Once the inmate is released, follow the Title II procedures for post-entitlement reinstatement.

  11. k. 

    Follow existing SSA procedures when the BOP facility releases an inmate who has filed a prerelease claim and leaves the service area of the local SSA office. The local SSA office will transfer the prerelease claim to the SSA office that services the inmate’s new address. In doing so, the local SSA office will follow existing SSA procedures for the electronic transfer of claims.

    For pending prerelease claims, when the inmate transfers from a BOP facility in one location to a BOP-contracted facility or home confinement in another location, SSA will transfer the prerelease claim to the new local servicing SSA FO.

    SSA acknowledges that some BOP inmates affected by this MOU are housed in residential reentry centers (RRCs). Such inmates are thus in facilities operated by contractors, and not in institutions operated by the BOP. Such RRC contractors are not parties to this MOU, and this MOU will not be incorporated via modification to such RRC-BOP contracts. As such, the BOP cannot require RRC contractors to perform any specific actions to facilitate such inmate access.

  12. l. 

    Ensure that the SSA servicing office reviews prerelease procedures with the local BOP facility on an as-needed basis and whenever there is a change in policy or procedure that necessitates review.

  13. m. 

    Make reasonable efforts to process prerelease claims in a timely manner to facilitate inmates’ continuity of care.

  14. n. 

    Notify the inmate of the Title II or SSI eligibility determination.

SI 00520.920 Processing Prerelease Claims

NOTE: This POMS section applies to SSI prerelease claims only. For procedure on processing Title II prerelease claims, see EM-22XXX.

A. Procedure for processing SSI prerelease claims

1. Initiating the prerelease procedure

Upon receipt of a prerelease referral (see SI 00520.930 Exhibit 2 for a model prerelease referral), obtain all information and forms required for an initial claim, reinstatement, or change in living arrangements. Obtain a signed release from the individual allowing the field office (FO) to discuss the case with the institution's staff. Use the form SSA-3288 (Consent for Release of Information) for all prerelease claims except those involving individuals housed in a Federal Bureau of Prisons (BOP) facility. For those claims, use the modified form SSA-3288 located in SI 00520.930, Exhibit 3 instead.

Add completed forms and referrals to the Evidence Portal (EP) for documentation purposes.

2. Processing applications with or without an agreement

Process an application under the prerelease procedure without regard to whether an agreement exists with the institution. For more information about prerelease agreements, see SI 00520.910.

3. Using simultaneous development for prerelease claims

Do not use deferred development with prerelease applications. Use the simultaneous development procedures in SI 00603.002C.4, but do not adjudicate the claim. Place it in payment status code H80 pending the DDS medical decision.

4. Determining the proper applicant and potential need for a representative payee

If the institution files on behalf of the individual, determine who the proper applicant is and, if necessary, develop for a representative payee.

5. Timeframes for processing claims under the prerelease procedure

If the referral does not list an anticipated release date, obtain a statement from the institution with the approximate date the individual will be released. Record the statement on a DROC screen. Apply the prerelease procedure using the following timeframes:

a. Claimants housed in non-BOP institutions

For SSI aged claims, apply prerelease procedures to claims when the individual’s expected release date will be within 30 days.

For SSI disability claims, apply prerelease procedures to claims when the individual’s release date will be within 30 days of the estimated time for getting a medical decision from the Disability Determination Services (DDS). For example, if the DDS processing time averages about 90 days, the FO can take the claim 120 days before the scheduled release date of the claimant.

b. Claimants housed in BOP institutions

Apply prerelease procedures using the following timeframes:

  • For SSI aged claims: Apply prerelease procedures to claims received within 30 days prior to the individual’s scheduled date of release from BOP custody or 30 days prior to the home confinement placement date.

  • For SSI disability claims: Apply prerelease procedures to claims received within 120 days prior to the individual’s scheduled date of release from BOP custody or 120 days prior to the home confinement placement date.

REMINDER: When the application is received earlier than the allowed timeframe for processing a claim under the prerelease procedure, deny the application.

6. Determining potential eligibility before sending prerelease claims to DDS

a. All disability claims

Before sending an SSI disability prerelease claim to the DDS, determine whether the claimant is potentially eligible for SSI based on the claimant’s anticipated income, resources, and living arrangement upon release. However, for purposes of establishing the claim in the Consolidated Claims Experience (CCE) (formerly MSSICS), the residence address is the institution where the individual resides.

Following this general rule, input SSI prerelease claims into the system following instructions in MS 08110.007. For cases unable to be entered into the CCE, see SM 01005.420, SM 01005.422, SM 01005.424, and SM 01005.430 for coding the RA, RY, RT, and ZC fields on form SSA-450-SI (SSI Data Input and Determination).

b. Additional Step for BOP conditional release and BOP skilled nursing care cases

There are special processing rules (outlined in SI 00520.920A.6 in this section) for holding medically-approved BOP conditional release and BOP skilled nursing care cases for extended periods of time before adjudicating the claim.

For these claims, BOP instructs the claimant to add a comment within the SSI application’s REMARKS section (or to provide a verbal statement if they are filing over the phone) indicating that their case is a conditional release or skilled nursing care case.

  • Add special remarks to identify these cases - Add the following remark on the SSID and DW01 before sending the case to the DDS: “BOP conditional release/skilled nursing case. Special adjudication required if medically approved by DDS. See SI 00520.920A.6.b. This alerts the FO technician who receives a medically approved BOP conditional release/skilled nursing care case that the special processing rules apply.

  • Exclude these cases from processing time - On the DW01, input unit code “ZZZ” for the last 3 digits in the UNIT field to exclude processing time. Build the SSR to create a new record.

 

7. Holding adjudication of aged claims and disability claims after obtaining a favorable DDS disability determination

For procedure on medical development for prerelease claims, see SI 00520.920B in this section.

a. For all aged prerelease claims

  1. 1. 

    Ask the institution for the expected release date, and advise the institution that we cannot pay SSI until we verify the release date and new living arrangements.

  2. 2. 

    If the anticipated release date is not within 30 days of the application date, advise the institution that we will deny the claim.

  3. 3. 

    If the anticipated release date is within 30 days of the application date, hold the initial claim until release. Input payment status code H10 (living arrangement change in process) pending verification of the claimant’s release. For more information on inputting payment status code H10, see SM 01301.545C.

  4. 4. 

    Re-contact the institution for an update if the claimant is still in the institution after the anticipated release date before taking action to deny the claim as N02 (resident of a public institution) or N22 (inmate of a penal institution).

b. For all disability prerelease claims except BOP conditional release and BOP skilled nursing care cases

Once the FO receives a favorable medical decision from the DDS, follow these steps:

  1. 1. 

    Contact the institution promptly to:

    • Ask the institution for the expected release date; and

    • Advise the institution that we cannot pay SSI until we verify the release date and the new living arrangements.

  2. 2. 

    If the anticipated release date is not within 30 days of getting the favorable DDS decision, advise the institution that the FO will deny the claim.

  3. 3. 

    If the anticipated release date is within 30 days of getting the favorable DDS decision, hold the initial claim until release. Input payment status code H10 (living arrangement change in process) pending verification of the claimant’s release. For more information on inputting payment status code H10, see SM 01301.545C.

  4. 4. 

    Re-contact the institution for an update if the claimant is still in the institution after the anticipated release date before taking action to deny the claim as N02 or N22.

c. Exception/Special processing instructions for BOP conditional release and BOP skilled nursing care cases

Contact the institution to notify them of the favorable medical decision. Follow the instructions below for conditional release cases and skilled nursing care cases.

  1. 1. 

    Conditional Release cases: Hold medically approved cases for up to 180 days before adjudicating. (This is an exception to existing SSI adjudication policy in SI 00601.080.) The BOP cannot request a release hearing before a Federal judge for the BOP inmate until there is a favorable medical allowance, which signals a funding source (i.e., SSI/Medicaid) for the individual once released. The additional time will give BOP sufficient time to locate a facility to place the inmate, to present the release plan to the judge, and for the judge to approve the release from the BOP facility.

    Within the DW01, add a new issue labeled "Prerelease" and a tickle date for 180 days. At the end of the holding period, follow up with the BOP institution to see if the claimant has been placed. If they have not, issue a technical denial of N22.

  2. 2. 

    Skilled nursing care cases: Hold medically approved cases for up to 180 days before adjudicating. (This is an exception to existing SSI adjudication policy in SI 00601.080.) The BOP is unable to contact skilled nursing facilities for placement of the inmate until there is a favorable medical allowance. The additional time will allow BOP sufficient time to find the individual permanent placement in a skilled nursing facility before they release the inmate from the BOP facility.

    Within the DW01, add a new issue labeled "Prerelease" and a tickle date for 180 days. At the end of the holding period, follow up with the BOP institution to see if the claimant has been placed. If they have not, issue a technical denial of N22.

REMINDER: Within the DW01, leave unit code “ZZZ” as the last 3 digits in the UN field to exclude processing time.

d. Appeal of technical denial - All prerelease claims

If a technical denial occurs after the favorable medical decision, the claimant has 60 days to request an appeal.

  • If the claimant is released within 60 days and requests reconsideration, use the recent favorable medical decision to complete the claim after processing the reconsideration, following instructions starting in GN 03102.100.

  • If the 60-day appeal period has expired, determine whether there is good cause to extend the time limit to file an appeal, per GN 03101.020. If there is no good cause for late filing of the appeal, take a new claim and request a new medical decision, per DI 11011.001E.1.

8. Adjudicating prerelease claims upon release

When the institution releases the individual, contact the individual to verify the release, update the address and living arrangements, adjudicate the claim, and initiate payment.

For BOP prerelease claims, BOP will also advise the individual that they must contact SSA upon their release to give us this information.

9. Processing prisoner reinstatements under prerelease

We cannot reinstate SSI benefits until after the institution releases the prisoner. However, the FO and the institution should do prerelease development appropriate to reinstatements, so we can reinstate benefits more quickly after the prisoner’s release.

For example, the FO can:

  • provide the institution with information about what documents the FO needs to process a reinstatement;

  • set up an appointment for an interview shortly after the release; and

  • encourage close cooperation between the institution, the prisoner, and the FO to avoid unnecessary delays.

The institution can:

  • provide the FO with the prisoner’s new address;

  • provide documents to verify the prisoner’s release; and

  • encourage the prisoner to respond immediately to any FO requests for information, and not to miss any interview appointments. For instructions about SSI reinstatements for prisoners, see GN 02607.875.

B. Procedure for medical development in prerelease claims

1. Procedure for obtaining medical evidence

It is the responsibility of the FO to obtain all available medical evidence from the institution in prerelease claims, whether or not there is a formal prerelease agreement with the institution. (For additional information about preparing the case for DDS, see DI 23530.001B.2.).

a. Existing regional or local DDS procedures

Apply any existing regional or local procedures between the institution, DDS, and the local FO for obtaining and completing medical evidence for the DDS.

b. No existing regional or local DDS procedures

In the absence of local procedures, regional and local FOs should work with institutions and DDS to establish procedures acceptable to all parties. In the interim, use the following guidelines for securing medical evidence from the institution:

  • Request all available medical evidence from the institution. Make sure the institution understands the importance of medical evidence beginning with the alleged onset date and its importance in establishing a period of disability.

  • If the applicant was in a hospital or saw a physician outside the institution, get the providers’ addresses.

  • Obtain one signed SSA-827 (Authorization to Disclose Information to the Social Security Administration) and scan it into the electronic folder for DDS to use to obtain all of an applicant’s medical records. For more information about using the SSA-827, see DI 11005.055.

  • In mental impairment cases, consider the need for a representative payee and begin development if necessary.

2. Evaluating adequacy of medical evidence

The FO does not question the adequacy of the medical information submitted by the institution. If the institution refuses to submit medical evidence or states it has no medical evidence, or the evidence appears incomplete and no other source of medical evidence is available, do not attempt further development. Follow the procedure in SI 00520.920B.3 in this section.

3. Referring cases to DDS

Refer the claim to the DDS when the medical evidence development procedures in SI 00520.920B.1 in this section are complete and the income, resources, and other non-medical factors of eligibility appear to be met.

Flag the Electronic Disability Collect System (EDCS) as a “Prerelease Case”. Explain any missing or incomplete medical evidence using EDCS 3367. For more information about flags in EDCS, see DI 81010.080. For information on completing the SSA-3367, see DI 11005.045.

SI 00520.930 Exhibits of Prerelease Agreements, Referrals, and Forms

 

EXHIBIT 1 - Model Prerelease Agreement between SSA and non-BOP Institution

EXHIBIT 2 - Model Prerelease Referral

EXHIBIT 3 – Modified Form SSA-3288 (Consent for Release of Information) for use in BOP prerelease claims

 

EXHIBIT 1 - Model Prerelease Agreement between SSA and non-BOP institution

NOTE: This agreement is just a model; it can be modified to meet the needs of the local institution. However, substantial deviations from the model should be sent to the RO for regional OGC review prior to enacting a new agreement. For more information about establishing prerelease agreements with non-BOP institutions, including timeframes for processing claims using prerelease procedures, see SI 00520.910C.

FOs and ROs must establish operating procedures to store and maintain prerelease agreements.

 

 

Parties: _____________________ (called the “facility”)
______________________________ (called the “local office”)

    

The facility :

  1. 1. 

    Identifies patients or residents scheduled or considered for discharge from the facility within 30 days after the notice of the SSI eligibility decision or for whom eligibility for Social Security benefits has been established;

  2. 2. 

    Provides the local SSA office with the names of potential prerelease applicants, as well as their social security number, date of birth, and anticipated discharge date;

  3. 3. 

    Refers only those individuals who appear to meet the SSI income and resource criteria or those potentially entitled to Social Security benefits;

  4. 4. 

    Provides nonmedical information for development of whether the individual meets all eligibility requirements;

  5. 5. 

    Provides current medical evidence consistent with SSA guidelines and recommendations of the Disability Determination Services (DDS) and a statement about the individual’s ability to handle funds;

  6. 6. 

    Notifies the local SSA office of any changes that could result in discharge over 30 days after the notice of the eligibility decision;

  7. 7. 

    Notifies the local SSA office as soon as the facility discharges the patient or resident; and

  8. 8. 

    Designates a liaison to:

    • handle all referrals;

    • notify the local SSA office of any pertinent changes; and

    • respond to any local SSA office inquiries.

    

The local SSA office :

  1. 1. 

    Provides guidelines for the kinds of information requested from the facility;

  2. 2. 

    Reviews with facility personnel the prerelease procedures at least once a year and whenever procedures or the facility liaison changes;

  3. 3. 

    Designates a local SSA office liaison to:

    • assist the facility’s staff in initiating and completing prerelease applications; and

    • respond to the facility’s inquiries.

  4. 4. 

    Processes all prerelease claims in an expeditious and timely manner;

  5. 5. 

    Identifies prerelease cases for the DDS to ensure prompt handling; and

  6. 6. 

    With the individual’s permission, notifies the facility of the eligibility decision.

 

 

 

Manager _________________________

 

Social Security Field Office

________________________

Date ________

 

Address

________________________

 

 

Phone

________________________

Superintendent ____________________

 

Facility Name

_________________________

Date ________

 

Address

________________________

 

 

Phone

__________________

  

EXHIBIT 2 - Model Prerelease Referral from Facility to SSA Office  

 

 

Agency: ___________________________ Social Worker: _______________
Building/Unit: ______________________ Phone: ______________________
Name of 
Resident:  _________________________
Anticipated Date of
Release: _____________________
Social Security Number: _____________
Date of Birth: ______________________
Reason for Referral:_________________

 

EXHIBIT 3 - Modified Form SSA-3288 (Consent for Release of Information) for use in BOP prerelease claims

 

 


SI 00520 TN 46 - Updating all four Prerelease POMS sections - 5/10/2022