PROGRAM OPERATIONS MANUAL SYSTEMPart SI – Supplemental Security IncomeChapter 005 – EligibilitySubchapter 20 – InstitutionalizationTransmittal No. 45, 08/25/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.
Summary of Changes
SI 00520.920 Processing Prerelease Cases
Subsection C - Updating POMS to reflect changes already in place. After we technically deny a case because a claimant is still incarcerated technicians will need to take a new claim and request a new medical decision following new instructions in DI
11011.001E.1. This applies after the 60 day appeal period has expired.
Upon receipt of a 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 an SSA-3288, Consent for Release of Information, for this purpose.
Do not use deferred development with prerelease applications. Use the simultaneous development procedures per SI 00603.002C.4. Do not adjudicate the claim, but place it in H80 status pending verification of the claimant’s release.
If the institution files on behalf of the individual, determine who the proper applicant is, and if necessary, develop for representative payee.
Obtain a statement from the institution that they plan to release the individual in the near future and the approximate date of release. Record the statement on a DROC screen. Take the claim so that the individual’s release date will be within 30 days of the estimated time for getting a Disability Determination Services (DDS) decision.
EXAMPLE: If the DDS processing time averages about 90 days, the FO should take the claim about 90 days before the scheduled release date of the claimant.
Before sending a Supplemental Security Income (SSI) case to the DDS, determine that the claimant is potentially eligible for SSI based on the claimant’s anticipated living arrangement upon release. However, for purposes of establishing the claim in the Modernized Supplemental Security Income Claims System (MSSICS), the residence address is the institution where the individual resides.
Following that general rule, input MSSICS prerelease cases, per MS INTRANETSSI 010.007 Residence Address and Jurisdiction. For non-MSSICS cases, see SM 01005.320H.2.e.
When the institution actually releases the individual, contact the individual to verify the release, update the address and living arrangements, adjudicate the claim, and initiate payment. If the individual is still in the institution when the DDS makes the medical decision, contact the institution to determine the expected release date and follow the procedure in SI 00520.920C.
We cannot reinstate Title II or Title XVI 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 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 prisoner reinstatements, see GN 02607.840 and GN 02607.875.
It is the responsibility of the FO to obtain all available medical evidence from the institution in prerelease cases, whether or not it has a formal prerelease agreement with the institution. (For additional information about preparing the case for DDS, see DI 23530.001B.2.).
Apply any regional or local procedures established between the institution, DDS, and the local office for obtaining and completing medical evidence for the DDS.
In the absence of local procedures, regional and local field offices 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 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.
Do not question the adequacy of the information contained in the medical report 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 and follow the procedure in SI 00520.920B.3.
Refer the claim to the DDS when the medical evidence development procedures in SI 00520.920B.2 are complete and income, resources, and other nonmedical 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.
When the FO receives a favorable decision from the DDS, notify the institution promptly. Advise them that we cannot pay SSI benefits until we verify the release date and the new living arrangements.
Contact the institution for an update if the claimant is still in the institution after the anticipated release date.
If the anticipated release date is within 30 days of the determination of potential eligibility, hold the initial claim until release. Input payment status code H10 (living arrangement change in process). For information about inputting H10, see SM 01301.545C.
If the anticipated release date is not within 30 days of getting the favorable DDS decision, advise the institution that the FO will disallow the claim.
The institution should notify the FO promptly when it releases the individual. At the time of the release, the institution should get the individual’s new address and phone number and provide this information to the FO.
When the institution releases the individual, the FO should contact him or her to verify the new living arrangement and any other significant changes. After completing development, initiate payments.
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 request a reconsideration, use the recent favorable medical decision to complete the claim, after processing the reconsideration following instructions starting in GN 03102.100. However, if the 60 day appeals period has expired, take a new claim and request a new medical decision, per DI 11011.001E.1.