When the recipient or a third party pays the CMV for all of the food and shelter, to determine whether the individual receives countable ISM, follow the instructions in SI 00835.706 and SI 00835.707. It is not necessary to develop whether the exclusion for support and maintenance applies.

When the private non-profit institution pays for some or all of the food, or shelter, or both, the following procedure applies:

1. a. 

   Determine whether the ISM provided by the institution is excludable under the support and maintenance exclusion (“Church amendment”). To determine if the “Church amendment” applies, use the procedures in SI 00835.712B. NOTE: The name “Church Amendment” refers to the late Senator Frank Church who drafted this legislation. This provision is not exclusive to religious organizations such as churches.

2. b. 

   If the ISM is not excludable under the “Church amendment,” decide whether the ISM provided by the institution is excludable under the Support and Maintenance Assistance (SMA) exclusion in SI 00830.605.

3. c. 

   If the ISM is not excludable under the SMA exclusion, to determine whether the individual receives countable ISM, follow the procedures in SI 00835.707B.3.

Donations to the institution are not third party payments. They do not count as ISM. Use the following procedures if the issue of a donation is present:

1. a. 

   Do not routinely inquire about, or document, the existence of donations to the institution on behalf of the eligible individual.

2. b. 

   If a question material to the ISM determination arises about whether funds provided to the institution are a charitable donation or a third party payment for food and shelter, contact the institution and determine the nature of the funds in question.

3. c. 

   Accept the institution's allegation without further development and document the file, using the Report of Contact page in the SSI Claims System or, for non-MSSICS cases, the paper SSA-5002 (Report of Contact).

EXAMPLE: Donations to a private nonprofit institution

Frank, an eligible individual, lives at the Mount Royal Retirement Home. A religious organization operates the home and it is tax-exempt under section 501(c) of the Internal Revenue Code.

During the interview, Frank tells the claims specialist (CS) that several of Frank's relatives send money regularly to Mount Royal.

The CS contacts Mount Royal and learns that neither Frank nor any third party pays for their food and shelter.

Upon admission, the retirement home informs relatives of the residents that it costs $500 per month per resident and asks them to contribute whatever they can afford to the facility. NOTE:The facility does not send bills to the relatives and the facility does not maintain billing accounts for the individual residents.

The CS determines that the funds provided by Frank's relatives are donations as defined in SI 00835.710B.3. Therefore, such payments are not countable as ISM.

Since neither Mr. Stone nor any third party pays for Frank's food and shelter, the CS must determine whether to count the food and shelter provided by the institution as ISM or to exclude it under the criteria for the “Church amendment” or under the SMA exclusion in SI 00830.605.

Determine whether an individual or a representative of the institution has an express obligation to provide support and maintenance using the following criteria.

1. a. 

   There is an express obligation to provide full support and maintenance because of either:

   • •

     a lump-sum payment, or

   • •

     membership in an organization.

2. b. 

   If the contact alleges that an express obligation exists, accept the allegation and determine that the exclusion does not apply.

3. c. 

   If the contact alleges that no such obligation exists, verify the arrangement by obtaining a copy of an appropriate document (e.g., membership certificate, entrance agreement, organizational constitution, bylaws, etc.).

4. d. 

   If the document establishes that an express obligation exists, the ISM exclusion does not apply. ISM provided by the institution is countable unless otherwise excluded (e.g., under the SMA exclusion in SI 00830.605).

5. e. 

   If you obtain a document to verify the express obligation issue, put a copy in the file Evidence Portal (EP) or Certified Electronic Folder (CEF) or record the pertinent information on a Report of Contact page in the SSI Claims System.

6. f. 

   If the development establishes that there is no express obligation, the ISM exclusion may apply. Develop for the institution's tax-exempt status.

Use the following steps to document whether the institution received payment to provide support and maintenance:

1. a. 

   Contact the institution to determine if the institution provides support and maintenance for which it does not receive payment.

2. b. 

   Document the file with the response of the institution on a Report of Contact page within the SSI Claims System or an SSA-5002 for a non-MSSICS case.

3. c. 

   Determine that the exclusion does not apply if the institution does not provide at least some support for which it does not receive payment.

4. d. 

   Determine that the exclusion applies if the institution provides at least some support for which it does not receive payment and meets the two other criteria.

NOTE: If the individual or a third party makes some payment for the individual's food and shelter, the unpaid portion provided by the institution is still excludable if the institution meets all three requirements listed in SI 00835.712B.1. through SI 00835.712B.3. in this section.

EXAMPLE: Individual makes a partial payment

Henry , an eligible individual, resides in St. Joseph's Retirement Home, a nonprofit residential care institution. A charitable organization operates the home and the organization is tax-exempt, and a precedent is on file with the FO. St. Joseph's provides Henry with support and maintenance. In return, Henry agreed to turn over all current assets and to surrender all or part of any additional income or property Henry may receive in the future. The CS obtains a copy of the agreement from the institution.

The CS determines that the institution provides some support and maintenance without payment because the value of the support and maintenance exceeds what Henry can pay. The support and maintenance provided is not due to membership in an organization nor due to a lump-sum prepayment given to St. Joseph's to provide lifetime care. Henry, in accordance with the written agreement, must make further payments should Henry become financially able to do so in the future. The CS determines that St. Joseph's does not have an express obligation to provide support and maintenance. Therefore, because the institution meets all three requirements, the CS determines that the support and maintenance provided by the institution is not ISM because the “Church amendment” exclusion applies.