TN 3 (02-02)

A. Procedure - reinstating benefits to NGRIs

Reinstate NGRI benefits when, the inmate is no longer under the care and supervision of an institution and the institution no longer provides the inmate with their basic living needs.

1. Criteria required for reinstatement of NGRIs

The specific requirements for reinstatement are:

a. Care and Supervision

Care and supervision means that the individual requires continual supervision and monitoring by the institution. Reinstate benefits to a beneficiary if he/she is no longer under the "care and supervision" of the institution. Also, reinstate benefits if the institution grants the individual an official "conditional" release. A conditional release provides that an individual is subject to some degree of supervision or monitoring as a condition of release. A beneficiary qualifies for reinstatement if the institution grants the individual a conditional release and the institution no longer provides the individual's basic living needs.

b. Basic living needs

Basic living needs means the institution provides the inmate with food, clothing and shelter. Reinstate benefits when the individual is no longer under the care and supervision of the institution and the institution no longer is providing the individual with food, clothing and shelter (basic living needs).

c. The institution

The term "the institution" refers to the facility where the individual is physically confined. Reinstate benefits when the individual is "officially" released from confinement in the facility, unconditionally (set free completely) or conditionally (released from confinement but still subject to supervision and monitoring rules). Transferring the inmate from one facility to another does not qualify as an "official" release from the institution.

Reinstate benefits if the beneficiary is on "official" conditional release and resides in a group home in the community. (The fact that the group home may receive a subsidy from the State mental health agency is not material to the decision to reinstate benefits.)

2. Effective date for reinstating benefits

Reinstate benefits to a beneficiary effective with the next month after the individual's confinement is completed; i.e., the individual is on "official" conditional release and resides in a group home in the community, or permanent unconditional release.

B. Procedure – processing the reinstatement action

1. FO Instructions For Reinstating Benefits to NGRIs, Incompetent to Stand Trial Individuals or Sexually Dangerous Persons--Inmate Officially Released or Conditionally Released

a. Closely review the inmate's official release documents from the institution.

• Secure copies of all release documents to ensure that the individual has been "officially released" from the institution, either conditionally or unconditionally. (See GN 02607.850A.1. for conditions of release from an institution.) (See GN 02607.850B.1.b. for the contents of the official release documents.)

• Where an individual is residing in a group home operated directly by the institution or State mental health agency, determine whether the individual is officially released from the institution or merely transferred from confinement in one institution to confinement in another. (See GN 02607.850A.1.c.)

• Verify that the institution no longer meets his/her basic living needs. (See GN 02607.850A.1.b.)

b. The official release papers should contain as much information as possible about the inmate, including:

· the inmate's name, social security number, inmate number given at the institution (if any), date of birth, inmate's address, father or mother's maiden name or other descriptive information that would lead you to believe the individual presenting the release paper is the same individual who was committed; and

• the name of the institution where the inmate was released; e.g., the document has the institution's name and address on the letterhead;

• the date of the release and time of the release;

  NOTE: The time of the release is mandatory if the date of the release is on the first day of the month; and,

• signature of an official from the institution authorizing the release.

  NOTE (1): For conditional release situations, the document must contain the inmate's conditions for release; e.g., amount of supervision the inmate will receive from the institution once he/she is released; the amount and type of medicines the inmate may be required to receive when released; where the inmate will reside when released, etc. (The inmate/representative payee and an institution official usually sign this document.) (See GN 02607.850A for information about conditional release situations.)

  NOTE (2): The released inmate is responsible for providing his/her release documents to SSA for reinstatement of benefits. If the individual needs assistance in obtaining the documents, see GN 02607.850B.2. for processing.

c. If the release papers do not contain information to clearly show the individual and the inmate are the same person:

• Verify the authenticity of the official release document with the institution that is shown on the letterhead. You need to determine if the inmate and the beneficiary are the same person.

• Contact the institution to corroborate the beneficiary's information concerning his/her release (conditional release) from the institution (e.g., time and date released).

2. FO instructions when the beneficiary cannot provide release documents to SSA

Ask the beneficiary where he/she was last committed. Compare this information with the PUPS record to see if the report is accurate.

• If the report is accurate and the beneficiary is capable, tell the beneficiary to contact the institution to obtain his/her release (conditional release) papers.

• If the report is accurate and the beneficiary needs assistance in obtaining his/her release documents, contact the institution. Ask them to supply proof of release of this individual under their letterhead and have them provide the release (conditional release) information for the inmate per GN 02607.850B.1.a. The release document must contain a signature from an institution official where the inmate was released. Ask the institution to fax the letter to your FO or mail it to the FO address.

  NOTE: If the institution will not provide a release document for the inmate, contact the institution and obtain the information in GN 02607.850B.1.b. and document it on a report of contact. Sign the document and place in the file. Add a remark on PUPS that you did not obtain an official release document but you did contact and verify the identity of the inmate and the release information with correctional institution over the phone.

• If the report is inaccurate, resolve the discrepancy. Ask the beneficiary for his/her places of commitment since he/she was confined. Update PUPS to reflect the additional periods of commitment or incarceration, if necessary. After the discrepancy is resolved, obtain the release document per GN 02607.850B.

  NOTE: Instances may arise where the FO should contact the institution or the releasing official to verify the release of the individual even though the individual provided a discharge document. If a discharge document appears obscure, fraudulent, or not reliable, contact the institution or releasing official to verify its authenticity and verify its contents.

C. Procedure - review factors of eligibility before beginning payments

You must review and determine if the beneficiary meets all factors of entitlement and eligibility before paying benefits; e.g., work deductions, no child in care deductions, etc.

See GN 02602.005 for factors that may affect eligibility to title II benefits. See GN 02602.040 for instructions on the resumption of title II benefits after a period of suspension.

D. Procedure – processing the reinstatment action

Process the reinstatement action through POS/PUPS per the instructions in GN 02607.860.

E. Procedure – instructions for reinstating benefits to NGRIS

1. FO instructions- reinstating benefits to NGRIs

If the FO receives a request for reinstatement, take the following actions:

• Reinstate benefits to the NGRI individual only if:

  • he/she is released from the care and supervision of the institution, and

  • the institution no longer meets his/her basic living needs.

  (See GN 02607.850A.1. for instructions on determining if reinstatement applies.)

• Secure copies of all documents bearing on the issue of reinstatement; i.e., release documents, an order directing the individual's supervised release, etc., court orders, remand documents, commitment orders (civil or voluntary). See GN 02607.850B for information on the release documents.

• You must review and determine if the beneficiary meets all factors of entitlement and eligibility before paying benefits; e.g., work deductions, no child in care deductions, etc. See GN 02602.005 for factors that may affect eligibility to title II benefits. See GN 02602.040 for instructions on the resumption of title II benefits after a period of suspension.

• Process the reinstatement action through POS/PUPS, if applicable, per GN 02607.860.

2. PC/OCO-ODO instructions--reinstating benefits to NGRIs

If the PC/OCO-ODO receives a request for reinstatement, take the following actions:

• Reinstate benefits to the NGRI individual only if:

  • he/she is released from the care and supervision of the institution, and

  • the institution no longer meets his/her basic living needs.

  (See GN 02607.850A.1. for instructions on determining if reinstatement applies. See GN 02607.850B for instructions on determining if the release documents provided by the beneficiary are acceptable for reinstatement of benefits.)

If the beneficiary meets the requirements for reinstatement and all evidence is valid and complete, process the reinstatement action per GN 02607.860.

• If further development is needed to make a decision about the beneficiary's reinstatement, forward the information to the FO for development and subsequent processing. The FO will continue processing the reinstatement request to completion.