Technical Updates to Applicability of the Supplemental Security Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical Treatment Facilities -- 416.708(k) What you Must Report

INTRANETSSI 010.009 Institution Residence Screen Shots

The Institution Residence Data (LINS) screen has changed to INTRANETSSI 010.009 Institution Screen due to MSSICS updated. When continued payments are payable for temporary institutionalization, the physician’s certification and home expenses statement must be received by SSA by the recipient’s discharge date or 90 days from admission date (whichever is earlier).

The SSA claims representative confirms that the recipient and physician provided this required information by inputting the receipt dates in fields 24-C and 25C (the Facsimile 2 of the INTRANETSSI 010.006 Institution Residence screen below). Fields 24-C and 25-C are not used as collection instrument. Fields C-24 and C-25 are used to tell the SSI computer system that the claims representative has obtained the necessary documentation to determine that SSI recipient is eligible for temporary institutional benefits. If these fields are not completed, the computer system will not pay the temporary institutionalization benefits to the recipient. These fields serve as a safe guard to prevent the issuance of incorrect payments to ta recipient who does not meet the requirements to receive temporary institutionalization benefits.

E.    FACSIMILE 1: INSTITUTION RESIDENCE (LEVINGS STATE)

[1-d]

period effective dates SS/SS/SSSS – SS/SS/SSSS

 

institution residence

*indicates required information

 

institution Favorites

select from favorites or type contact information

[2-O]

[+/-] show/hide favorites

 

institution Favorites

[3-O]                                                         [4-O]

[refresh]                                                     manage office level favorites

 

[5-d]                     [6-d]                 [7-d]           [8-O]

institution name          Address               phone           actions

ss[varies]SS              ss[varies]ss          ss[varies]ss   [Select]

 

[9-M]

*Institution Name  xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx    [ ] unknown

 

*address

[10-m]

*Country: --

[11-m]

*Street 1 pppppppppppppppppppppp

[12-o]                                      [13-o]

Street 2 pppppppppppppppppppppp             [+] add line

[14-O]

Street 3 pppppppppppppppppppppp

[15-o]

Street 4 pppppppppppppppppppppp

[16-m]                            [17-c]            [18-c]                        [19-c]     [20-c]

*City/Town:                       state/Territory / state/Province/region:        zip code / Postal Code

pppppppppppppppppppppp            --               PP[Maximum of 22 characters]pp ppppp      ppppppppppppppp

[21-o]

[ ] unknown

[22-o]

phone:  (X) U.S.     ( ) International

            [23-O]          [24-o]

            9999999999      999999999999999

            10-digit number/country code + number

[25-D]

date institutionalization began    ss/ss/ssss

[26-C]

*Medicaid, or Medicare Part A with state buy-in, pays more than 50%

( ) YES ( ) NO ( ) UNKNOWN

[27-c]

monthly charge  9999.99    [ ] unknown

[28-c]

Amount claimant pays  9999.99    [ ] unknwon

[29-c]

*Institution for Supplemental Nutrition Assistance Program (SNAP) purposes

( ) YES ( ) NO

[30-C]                       [31-o]

*Meets Levings requirements  more info

(X) YES ( ) NO ( ) decide later

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-O] [38-O]                                                          [39-O]

[next] [previous]                                                      [save & return to mainframe]

 

G.        FACSIMILE 2:  INSTITUTION RESIDENCE (MEETS LEVINGS REQUIREMENTS IS NO)

[1-d]

period effective dates SS/SS/SSSS – SS/SS/SSSS

 

institution residence

*indicates required information

 

institution Favorites

select from favorites or type contact information

[2-O]

[+/-] show/hide favorites

 

institution Favorites

[3-O]                                                        [4-O]

[refresh]                                                     manage office level favorites

 

[5-d]                     [6-d]                 [7-d]           [8-O]

institution name          Address               phone           actions

ss[varies]SS              ss[varies]ss          ss[varies]ss   [Select]

 

[9-M]

*Institution Name  xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx    [ ] unknown

 

*address

[10-m]

*Country: --

[11-m]

*Street 1 pppppppppppppppppppppp

[12-o]                                      [13-o]

Street 2 pppppppppppppppppppppp             [+] add line

[16-m]                             [17-c]            [18-c]                      [19-c]   [20-c]

*City/Town:                       state/Territory / state/Province/region:       zip code/Postal Code

pppppppppppppppppppppp            --                PP[Maximum of 22 characters]pp      ppppp    ppppppppppppppp

[21-o]

[ ] unknown

[22-o]

phone:  (X) U.S.     ( ) International

            [23-O]           [24-o]

            9999999999      999999999999999

            10-digit number/country code + number

[25-D]

date institutionalization began    ss/ss/ssss

[26-C]

*Medicaid, or Medicare Part A with state buy-in, pays more than 50%

( ) YES ( ) NO ( ) UNKNOWN

[27-c]

monthly charge  9999.99    [ ] unknown

[28-c]

Amount claimant pays  9999.99    [ ] unknwon

[29-c]

*Institution for Supplemental Nutrition Assistance Program (SNAP) purposes

( ) YES ( ) NO

[30-C]                       [31-o]

*Meets Levings requirements  more info

( ) YES (X) NO ( ) decide later

[40-d]                             [41-c]

admission date  ss/ss/ssss         *admission date verified

[42-o]                              ( ) YES ( ) NO

[X] discharged from the institution

[43-c]                             [44-c]

*Discharge date  99/99/9999        *discharge date verified

                 mm/dd/yyyy         ( ) YES ( ) NO

[45-c]

*institution type

( ) public ( ) private ( ) UNKNOWN

[46-c]

*confinement reason

[47-c]

*Private health insurance, or a combination of Private health insurance and Medicaid, is paying or is expected to pay more than 50 percent

( ) YES ( ) NO ( ) UNKNOWN

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-o] [38-o]                                                          [39-o]

[next] [previous]                                                      [save & return to mainframe]

I.                FACSMILE 3:  INSTITUTION RESIDENCE (NON-LEVINGS STATE)

[1-d]

period effective dates SS/SS/SSSS – SS/SS/SSSS

 

institution residence

*indicates required information

 

institution Favorites

select from favorites or type contact information

[2-O]

[+/-] show/hide favorites

 

institution Favorites

[3-O]                                                        [4-O]

[refresh]                                                     manage office level favorites

 

[5-d]                     [6-d]                 [7-d]           [8-O]

institution name          Address               phone           actions

ss[varies]SS              ss[varies]ss          ss[varies]ss   [Select]

 

[9-M]

*Institution Name  xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx    [ ] unknown

 

*address

[10-m]

*Country: --

[11-m]

*Street 1 pppppppppppppppppppppp

[12-o]                                      [13-o]

Street 2 pppppppppppppppppppppp             [+] add line

[16-m]                             [17-c]            [18-c]                      [19-c]   [20-c]

*City/Town:                       state/Territory / state/Province/region:       zip code/Postal Code

pppppppppppppppppppppp            --                PP[Maximum of 22 characters]pp      ppppp    ppppppppppppppp

[21-o]

[ ] unknown

[22-o]

phone:  (X) U.S.     ( ) International

            [23-O]           [24-o]

            9999999999      999999999999999

            10-digit number/country code + number

 

[25-D]

date institutionalization began    ss/ss/ssss

[29-c]

*Institution for Supplemental Nutrition Assistance Program (SNAP) purposes

( ) YES ( ) NO

 

[40-d]                              [41-c]

admission date  ss/ss/ssss         *admission date verified

[42-o]                               ( ) YES ( ) NO

[X] discharged from the institution

[43-c]                              [44-c]

*Discharge date  99/99/9999        *discharge date verified

                mm/dd/yyyy         ( ) YES ( ) NO

[45-c]

*institution type

( ) public ( ) private ( ) UNKNOWN

[46-c]

*confinement reason

[26-C]

*Medicaid, or Medicare Part A with state buy-in, pays more than 50%

( ) YES ( ) NO ( ) UNKNOWN

[47-c]

*Private health insurance, or a combination of Private health insurance and Medicaid, is paying or is expected to pay more than 50 percent

( ) YES ( ) NO ( ) UNKNOWN

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-o] [38-o]                                                           [39-o]

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K.             FACSIMILE 4:  SPECIAL 1619/1611 BENEFITS SELECTED

[48-c]

*institution temporary

(X) YES ( ) NO ( ) decide later

 

1619/1611E Special Benefits

 

Individuals with earnings at or over the substantial gainful activity (SGA) limit who become   institutionalized may be eligible for benefit continuation for up to the first two full months of institutionalization

[49-c]

*Earnings at or over the substantial gainful activity (SGA) limit but remains eligible for SSI payment or Medicaid under section 1619(a) or (b)

(X) YES ( ) NO ( ) decide later

[50-c]

*Eligible for SSI under section 1619(a) or (b) in the month prior to the first full month of institutionalization

(x) YES ( ) NO ( ) decide later

[51-c]

*Institution permits claimant to retain any SSI payment made under this provision

(x) YES ( ) NO ( ) decide later

[52-c]

*Eligible for and chooses up to 2 months of benefit continuation

(x) YES ( ) NO ( ) decide later

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-o] [38-o]                                                          [39-o]

[next] [previous]                                                      [save & return to mainframe]

M.            FACSIMILE 5:  TI BENEFITS SELECTED

[48-c]

*institution temporary

(X) YES ( ) NO ( ) decide later

 

1619/1611E Special Benefits

 

Individuals with earnings at or over the substantial gainful activity (SGA) limit who become   institutionalized may be eligible for benefit continuation for up to the first two full months of institutionalization

[49-c]

*Earnings at or over the substantial gainful activity (SGA) limit but remains eligible for SSI payment or Medicaid under section 1619(a) or (b)

(X) YES ( ) NO ( ) decide later

[50-c]

*Eligible for SSI under section 1619(a) or (b) in the month prior to the first full month of institutionalization

(x) YES ( ) NO ( ) decide later

[51-c]

*Institution permits claimant to retain any SSI payment made under this provision

(x) YES ( ) NO ( ) decide later

[52-c]

*Eligible for and chooses up to 2 months of benefit continuation

( ) YES (X) NO ( ) decide later

 

Temporary Institutionalization Benefits

 

Individuals in a public institution whose primary purpose is medical or psychiatric care or in a public or private Medicaid certified facility and whose stay is certified by a physician as not likely to exceed 3 months, may be eligible for continuing SSI benefits when receipt of benefits is necessary to maintain a living arrangement to which the individual may return

[53-c]

*Eligible for and chooses up to 3 months of temporary institutionalization benefits

(X) YES ( ) NO ( ) decide later

[54-c]

*care type --

[55-c]

*Which member of couple --

[56-c]

*Home expense statement date for (first name + last name) (SSN)     99/99/9999

[57-c]                                                              mm/dd/yyyy

*Physician certification date for (first name + last name) (SSN)    99/99/9999

[58-c]                                                               mm/dd/yyyy

[ ] *Temporary institutionalization benefit period ended

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

O.              FACSIMILE 6:  INELIGIBLE FOR TI BENEFITS

[48-c]

*institution temporary

(X) YES ( ) NO ( ) decide later

 

1619/1611E Special Benefits

 

Individuals with earnings at or over the substantial gainful activity (SGA) limit who become   institutionalized may be eligible for benefit continuation for up to the first two full months of institutionalization

[49-c]

*Earnings at or over the substantial gainful activity (SGA) limit but remains eligible for SSI payment or Medicaid under section 1619(a) or (b)

(X) YES ( ) NO ( ) decide later

[50-c]

*Eligible for SSI under section 1619(a) or (b) in the month prior to the first full month of institutionalization

(x) YES ( ) NO ( ) decide later

[51-c]

*Institution permits claimant to retain any SSI payment made under this provision

(x) YES ( ) NO ( ) decide later

[52-c]

*Eligible for and chooses up to 2 months of benefit continuation

( ) YES (X) NO ( ) decide later

 

Temporary Institutionalization Benefits

 

Individuals in a public institution whose primary purpose is medical or psychiatric care or in a public or private Medicaid certified facility and whose stay is certified by a physician as not likely to exceed 3 months, may be eligible for continuing SSI benefits when receipt of benefits is necessary to maintain a living arrangement to which the individual may return

[53-c]

*Eligible for and chooses up to 3 months of temporary institutionalization benefits

( ) YES (x) NO ( ) decide later

[59-c]                                                               [60-o]

Temporary institutionalization ineligibility reason                  List of Temporary Institutionalization Ineligibility Decision Codes

( ) Individual not in a medical facility

( ) Individual does not have home expenses that must continue to be paid

( ) Proof of home expenses not received(Obsolete)

( ) Proof of home expenses not submitted by required date

( ) Physician expects institutionalization to last over 90 days

( ) Physician certification not submitted by required date

( ) Physician's certification not prepared and dated by required date (Obsolete)

( ) Physician's certification not received (Obsolete)

( ) Individual not eligible for SSI payment in month prior to first month of institutionalization

( ) Individual does not have home expenses that must continue to be paid and physician certification not submitted by required date

( ) Proof of home expenses not received AND physician's certification not received by required date (Obsolete)

( ) Proof of home expenses not submitted by required date and physician certification not submitted by required date

( ) Physician expects institutionalization to last over 90 days and physician certification not submitted by required date

( ) Physician's certification not prepared and dated by required date AND physician's certification not received by required date (Obsolete)

( ) Individual not eligible for SSI payment in month prior to first month of institutionalization, and physician certification not submitted by required

( ) Decide later

 

[32-o]

[+/-] show/hide Person remarks

[33-o]

Person remarks (printed)

XX[maximum of 1000 characters]XX

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-o] [38-o]                                                          [39-o]

[next] [previous]                                                      [save & return to mainframe]

 

 

[34-o]

[+/-] show/hide file documentation notes

[35-o]

file documentation notes

XX[maximum of 1000 characters]Xx

 

[36-o]

[Clear page/Undo changes]

[37-o] [38-o]                                                          [39-o]

[next] [previous]                                                      [save & return to mainframe]