SI 00835.520: Redetermination Guidelines for LA and ISM

changes
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~~Effective Dates: 04/24/2018 - Present~~
Effective Dates: 04/25/2018 - Present
TN 64 (03-10)
SI 00835.520 Redetermination Guidelines for LA and ISM
A. Introduction of redeveloping LA and ISM during redeterminations
This section provides instructions for redeveloping living arrangements (LA) and in-kind support and maintenance (ISM) during redeterminations.
This section supplements the development instructions in the following sections:
POMS Section
Reason
SI 00835.100 - SI 00835.200
LA Basis Instructions
SI 00835.340
Inside ISM instructions
SI 00835.350
Outside ISM instructions
SI 00835.400
ISM to One Person instructions
SI 00835.482,
Loans of ISM instructions
SI 00835.510
Changes in ISM instructions
SI 02305.001
Redetermination instructions
B. Policy for redeveloping LA and ISM in redeterminations
1. General rule
Do not redevelop LA and ISM determinations on record for the period of review unless:
* an undeveloped change is indicated at the redetermination; or
* allegations pertinent to the period of review do not support the information on the Supplemental Security Record (SSR) or on the MSSICS living arrangement screens.
2. Exceptions to the general rule
Redevelop the following issues as of the month the current redetermination is initiated. Redevelop these issues whether a redetermination is processed using a paper form or MSSICS:
* Outside ISM and ISM only to the claimant;
* Inside ISM;
* Sharing or earmarked sharing; and
* Value of One-Third Reduction (VTR).
3. Chart summary on when to redevelop LA and ISM
The following chart summarizes when redevelopment of ISM is required for redeterminations processed on paper forms and in MSSICS when seeding is not required. For the redevelopment procedures see sections SI 00835.520C and SI 00835.520D.
NOTE: If a MSSICS redetermination requires seeding for redevelopment requirements, see SI 00835.520E.
LA/ISM SITUATION ON SSR or MSSICS
IF RECIPIENT REPORTS....
REDEVELOPMENT PERIOD IS....
1. ISM based on a vendor charge
information that conflicts with SSR/MSSICS
redevelop for any months where information conflicts
2. "
he or she does not know the value of the ISM
redevelop for entire period of review
3. "
information that agrees with SSR/MSSICS
do not redevelop the ISM
4. ISM based on estimate of Current Market Value (CMV)/Current Market Rental Value (CMRV)
no changes
redevelop starting with the initiation month of the redetermination
5. "
a breakpoint
redevelop starting with the breakpoint effective month
6. ISM due to rental subsidy
no changes
redevelop starting with the initiation month of the redetermination
7. "
a breakpoint
redevelop starting with the breakpoint effective month
8. Inside ISM, Sharing, Earmarked Sharing, and the VTR
no breakpoints
redevelop starting with the initiation month of the redetermination
9. "
a breakpoint
redevelop starting with the breakpoint effective month
10. Continuing Loan of ISM
contributing towards household expenses; or
not contributing towards household expenses
develop living arrangement and ISM beginning the month after the loan period ended.
For information on developing loans of ISM see SI 00835.482C.
11. “
loan of ISM has not ended
develop whether a new bona fide loan exists beginning with the month after the previous loan ended (i.e., the month that SSI benefits started) If a bona fide loan does not exist, redevelop living arrangements beginning with first month of the redetermination review period.
For information on developing whether a loan is bona fide see SI 00835.482C.
C. Procedure for completing non-MSSICS redeterminations
1. Outside ISM and ISM only to the claimant
These types of ISM are generally discovered from direct allegation by the eligible individual. An individual is usually able to report that outside ISM or ISM only to the claimant to one person continued, began, or stopped over the period of review. Compare the individual's allegations on the redetermination forms with the SSR.
These types of ISM are generally discovered from direct allegation by the eligible individual. An individual is usually able to report that outside ISM or ISM only to the claimant continued, began, or stopped over the period of review. Compare the individual's allegations on the redetermination forms with the SSR.
a. ISM based on a vendor charge
If ISM is based on a vendor charge, compare the individual’s allegations on the redetermination forms with the SSR:
* Do not redevelop the ISM if the individual’s allegation of the vendor charge matches the SSR;
* Redevelop the ISM for any months the allegation of the vendor charge conflicts with the SSR (For information about computing outside ISM, see SI 00835.350. For information about ISM from vendor payments, see SI 00835.360);
* Redevelop the ISM for the period of review if the individual does not know the value of the ISM received and an actual value of ISM is on the SSR; and
* Offer rebuttal if the individual does not know the value of the ISM and the PMV is shown on the SSR. For information about rebuttal, see SI 00835.320.
b. ISM based on a CMV or CMRV estimate
When ISM is based on CMV or CMRV estimate:
* Redevelop the CMV or CMRV beginning with the month the redetermination is initiated and follow the instructions in SI 00835.350C.
EXAMPLE 1: The CR contacts the provider of rent-free shelter to redevelop the CMRV of the recipient's residence. The landlord indicates that the CMRV has gradually increased in value from $150 to $250 during the period of review. The CR uses the new CMRV as of the initiation month.
* Redevelop the CMV or CMRV as of the breakpoint effective month if a breakpoint occurred during the period of review which changed the CMV or CMRV. For breakpoints see SI 00835.510; and
EXAMPLE 2: The rent-free apartment occupied by a recipient is damaged by fire and the landlord has not repaired the damage. The abrupt change in the CMRV of this apartment is a breakpoint that is effective with the month of the fire (i.e., when the CMRV sharply declined). This change in the CMRV is a breakpoint belonging to the category “change in CMV of the household cost”. For information on outside ISM breakpoints see SI 00835.510B.2.).
EXAMPLE 3: A provider stops supplying meals to the recipient in a particular month. The change from separate consumption (a breakpoint) is effective the month it occurs.
* Do not redevelop the CMV or CMRV as of the initiation month if a new CMV or CMRV is obtained in connection with developing a breakpoint.
c. ISM due to a rental subsidy
When ISM is due to a rental subsidy:
* Redevelop rental subsidy for the month the redetermination is initiated if someone in the household is related to the landlord or landlord's spouse as a parent or child;
* Obtain a new CMRV from the landlord effective with the month that the redetermination is initiated (For information on developing rental prepayments, see SI 00835.380D);
* Redevelop rental subsidy as of the breakpoint effective month if a breakpoint is alleged which may affect rental subsidy during the review period. For example, someone who is related to the landlord moved in, or a new landlord took over, or the household changed its payment to the landlord, or there is a residence change; and
* Do not redevelop the CMRV estimate as of the redetermination initiation month if a CMRV estimate is obtained in connection with developing a breakpoint.
2. Inside ISM, sharing, earmarked sharing, and the VTR
a. No breakpoints reported
When no breakpoints are reported:
* Assume that the living arrangements and inside ISM shown for the period of review are correct if the individual reports no breakpoints; and
* Redevelop the LA and ISM as of the month the redetermination is initiated to uncover any changes in LA and ISM which may be due to gradual changes in average expenses or contributions since the last redetermination. For information on gradual changes in ISM see SI 00835.515.
NOTE: Follow the developmental requirements and curtailments in SI 00835.140 - SI 00835.170. When an SSA-8006 (Statement of Living Arrangements, In-Kind Support and Maintenance) is required see SI 00835.520C.3.
b. Breakpoint reported
When a breakpoint is reported:
* Develop a breakpoint reported at the redetermination if it was note developed previously (For information on breakpoints see SI 00835.510);
* Do not redevelop a breakpoint that occurred during the period of review if it was already developed. Assume that the determination made for a previously reported breakpoint was correct and redevelop LA and ISM as of the initiation month per SI 00835.520C.2.a.
NOTE: For non-MSSICS LA and ISM changes, it is sometimes difficult to determine whether a breakpoint was previously reported and developed. This is especially true if a previously reported breakpoint resulted in no change to LA or ISM. The claims representative must rely on the SSR as well as any prior files or development maintained at the field office. If, after reviewing these records, there is any doubt about the event having been developed, develop the breakpoint.
* Do not redevelop the LA and ISM as of the month the redetermination is initiated when a breakpoint is developed at the redetermination.
3. Loan of ISM
If a continuing loan of ISM is indicated by the last MSSICS living arrangement iteration or by the remarks on the SSR, fully develop the living arrangement, household operating expenses, and the individual’s contributions starting the first month of the redetermination review period to determine the individual’s living arrangement and ISM.
4. When to use an SSA-8006 (Statement of Living Arrangements, In-kind Support and Maintenance)
a. SSA-8203 is completed
Complete an SSA-8006 when an SSA-8203 (Statement for Determining Continuing Eligibility for Supplemental Security Income Payments) is completed and the household is not a public assistance household, and one of the following exists:
* the individual lives with someone other than a spouse, child (as defined in SI 00501.010), or a person whose income is deemable to the individual;
* the individual is an eligible child who lives with someone other than a parent (and children if present);
* the individual is the householder and alleges that someone is contributing to household expenses; or
* the individual lives only with children who have income, and there is either an indication of unstated income or, in the CR's judgment, a probability of inside ISM. For information for computing inside ISM see SI 00835.340B.
b. SSA-8202 is completed
Complete an SSA-8006 when an SSA-8202 (Statement for Determining Continuing Eligibility for Supplemental Security Income Payments) is completed for a Data Operations Center (DOC) exclusion redetermination (RZ) because ISM less than the PMV is posted on the SSR. NOTE: An SSA-8006 is not required when the redetermination is completed in MSSICS because any LA and ISM information provided by the eligible individual can be documented on the MSSICS screens. However, when needed, an SSA-8011 (Statement of Household Expenses and Contributions) or an SSA-L5061 (Letter to Landlord Requesting Rental Information) is still used in MSSICS to process redeterminations in order to document issues such as sharing and rental subsidy.
D. Procedure for MSSICS redeterminations when a pending file exists and seeding not required
For MSSICS redeterminations, redevelopment of LA and ISM is required for the same issues as for redeterminations processed on paper forms. Regardless of the redetermination profile (e.g., HEP, MEP, LEP), all MSSICS redeterminations are processed in one of two ways, full path redetermination or redetermination with RECAPS. The choice of whether to use the full path or the RECAP path is not based on the presence of any specific LA and ISM issue.
The following procedures apply to redeterminations for cases that already have an active MSSICS pending file (i.e., seeding is not required). If seeding is required to process the redetermination, see SI 00835.520E (in this section).
1. Procedures for developing LA and ISM redeterminations
Follow these procedures when developing LA and ISM in redeterminations:
* Assume, absent information to the contrary, that all prior living arrangement periods are correct. Therefore, the current living arrangement on MSSICS is usually the beginning point of the review;
* Review thoroughly all of the current LA and ISM information on the full path screens or RECAP screens with the recipient to determine whether the information is still correct and to detect breakpoints, if any;
* Develop a breakpoint by entering the date of the breakpoint on the LCHG screen to establish a new living arrangement period (LA iteration). Document the breakpoint and its effect on LA and ISM by completing the new living arrangement iteration provided by MSSICS;
* Curtail development of LA and ISM if no breakpoint occurred and all the LA and ISM information on the full path or RECAP screens is correct, unless one of the ISM issues requiring redevelopment is present; and
* Follow instructions in SI 00835.520D.2. and SI 00835.520D.3. (in this section) when an ISM issue requiring redevelopment is present.
2. Outside ISM and ISM only to the claimant
a. ISM based on a vendor charge
When ISM is based on a vendor charge:
* If the individual's allegation of the vendor charge matches the information on MSSICS or the SSR for non-MSSICS cases do not redevelop the ISM;
* If the individual's allegation conflicts with the MSSICS screen or the SSR for non-MSSICS cases, redevelop the ISM. Use the MSSICS Living Arrangement Change page to establish a new LA iteration starting with the month that the allegation and the information on the screens conflict; and
* If the individual does not know the value of the ISM received, redevelop the ISM. Use the MSSICS Living Arrangement Change page to establish a new LA iteration beginning from the first month where the value of the ISM is in question.
b. ISM based on a CMV or CMRV estimate
When the individual gets ISM based on a CMV or CMRV estimate:
* Redevelop the ISM. Establish a new LA iteration as of the first day of the initiation month of the redetermination.
NOTE: To establish a new LA iteration date as of the first day of the initiation month, input the last day of the prior month as the date of change on the Living Arrangement Change page.
* Redevelop the ISM if a breakpoint occurred during the period of review which changed the CMV or CMRV estimate. Establish a new LA iteration as of the date of the breakpoint.
* Do not redevelop the CMV or CMRV as of the initiation month if a new CMV or CMRV is obtained in conjunction with developing a breakpoint.
c. ISM due to a rental subsidy
When ISM is due to a rental subsidy:
* Redevelop rental subsidy if someone in the household is related to the landlord or the landlord's spouse as parent or child;
* Obtain a new estimate of the CMRV as of the redetermination initiation month;
* Establish a new LA iteration as of the first day of the month the redetermination review period begins. This is required even if the new estimate of the CMRV has not changed;
* Develop the breakpoint if a previously unreported breakpoint is uncovered which affects rental subsidy. Establish a new MSSICS LA iteration as of the date of the breakpoint; and
* Do not redevelop the CMRV as of the initiation month if a new CMRV estimate is obtained in conjunction with developing a breakpoint.
3. Inside ISM, sharing, earmarked sharing, and the VTR
Follow these procedures when developing inside ISM, sharing, earmarked sharing, and the VTR in redeterminations:
* If the individual reports no breakpoints, assume that the living arrangements and ISM for the period of review are correct.
* If any reported breakpoint was not developed previously, develop it at the redetermination. Establish a new LA iteration as of the date of the breakpoint.
* If no breakpoints are uncovered, establish a new LA iteration as of the first day of the initiation month of the redetermination to redevelop these LA and ISM issues and to uncover any gradual changes in expenses and contributions that may affect the LA and ISM determination.
* Do not redevelop the LA and ISM as of the initiation date when a breakpoint is developed as part of the redetermination.
4. Loan of ISM
If a continuing loan of ISM is indicated by the last MSSICS LA iteration or by the remarks on the SSR, fully develop the LA, household operating expenses, and the individual’s contributions starting the first month of the redetermination review period to determine the individual’s LA and ISM.
E. Procedure for MSSICS Redeterminations when seeding is required
Use the following procedures to redevelop ISM for MSSICS redeterminations that require seeding:
1. Seed living arrangements
When seeding is required:
* Retrieve living arrangement information from the Seed Living Arrangement page, see MS INTRANETSSI 010.005. View the Representative Payee information within MSSICS on the Mailing/Payment Address Comparison (CPAD) screen, see MS MSSICS 027.006.
* Assume, absent evidence to the contrary, that LA data on the SSR is correct.
* Select “full LA development” on the Seed Living Arrangement page starting with the LA in effect as of the redetermination initiation month. MSSICS establishes LA iteration as of the first day of that month.
* Develop prior LA periods only if the adjudicator determines that full development of prior LA period(s) is needed (e.g., there is an indication of previously unreported breakpoints or a continuing loan of ISM).
NOTE: If a change earlier than the selected period is discovered during the interview, the CR must select an earlier LA period for full development using the Period List and Living Arrangement Summary page. The Period List page allows selection of an earlier period and full LA development is requested on the appropriate Living Arrangement Summary page. To view the Period List page in MSOM see INTRANETSSI 010.006 and to view the Living Arrangement Summary page in MSOM see MS INTRANETSSI 010.002.
2. Completing the MSSICS living arrangement screens
When completing the MSSICS living arrangement screens:
* Begin with the earliest living arrangement period selected for full development and completely develop that living arrangement period (and subsequent periods if any) up through the current month;
* Contact the recipient (or payee) to obtain information so that all of the data on the screens can be completed and updated through the current month; and
* Complete all screens in the screen path for the living arrangement iteration(s).
NOTE: Full development of the appropriate living arrangement period(s), done in conjunction with seeding, takes the place of the redevelopment of ISM that is normally required for the redetermination. For documentation requirements see SI 00835.520F (in this section).
F. Procedures for documenting ISM redevelopment
1. When documentation is required
Whether the redetermination is processed on paper or on MSSICS, obtain the required documentation for the ISM issue that is being redeveloped.
Example 1: Non-MSSICS redetermination: rental subsidy
The CR is conducting a redetermination for an eligible individual who rents a house from his adult daughter. Rental subsidy must be redeveloped for the redetermination. Redevelopment requires contacting the landlord and documenting the new CMRV estimate on a report of contact (DROC) screen in MSSICS. For non-MSSICS cases use the SSA-L5061 (Letter to Landlord Requesting Rental Information). Fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically. For information on rental subsidy, see SI 00835.380.
Example 2: MSSICS redetermination: loan of ISM (Seeding not required)
The MSSICS LA screens indicate that the eligible individual has a continuing loan of ISM that covers his pro rata share of household operating expenses. In this case, MSSICS has no information about household expenses and contributions. Development of the household expenses and contribution is needed beginning with the first month of the review period to verify the individual is contributing and to determine the countable ISM amount, if any. See SI 00835.482I. for instructions on documenting loans of ISM. In certain sharing situations a statement from a knowledgeable household member verifying the household expenses and contributions is required on a DROC screen. Refer to SSA-8011, Statement of Household Expenses and Contributions, to ensure that all information is documented accordingly. For non-MSSICS cases use the SSA-8011 and fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically. For information on developing sharing see SI 00835.160.
Example 3: MSSICS redetermination: rental subsidy (Seeding required)
The CR is conducting a redetermination for an eligible individual who rents a house from a parent. By seeding MSSICS and contacting the individual, the CR obtains the information needed to complete the LA period. However, since rental subsidy is an issue that must be redeveloped for the redetermination, the CR must contact the landlord to obtain a new estimate of the CMRV as of the redetermination initiation month. Document the rental subsidy amount within MSSICS on a DROC screen. For non-MSSICS cases use the SSA-L5061 (Letter to Landlord Requesting Rental Information). Fax the paper form in the appropriate electronic folder. Do not retain the paper form after the issue is documented electronically.
2. When documentation is not required
Do not obtain documentation of LA and ISM issues when redevelopment is not required.
Example: Verification of rental liability not required
The CR is conducting a redetermination for an eligible individual who lives with two adult roommates and has rental liability. The CR seeds the case into MSSICS and contacts the individual to complete the LA screens. Although verification of rental liability is required if this was an initial claim, it is not necessary to redevelop rental liability for a redetermination. Therefore, the CR does not ask for verification of rental liability. The CR assumes, absent evidence to the contrary, that this issue was correctly developed in the past. On the MSSICS Rental Data (LRNT) screen the “RENTAL LIABILITY VERIFIED” question should be answered “yes.”
G. References
* SI 00835.320, Rebuttal Rule and Procedures - PMV
* SI 00835.340, Computation of In-Kind Support and Maintenance from Within Household
* SI 00835.350, Computation of In-Kind Support and Maintenance from Outside a Household (Including Vendor Payments by a Third Party Outside the Household)
* SI 00835.380, Rental Subsidies
* SI 00835.510, Breakpoints
* SI 00835.515, Gradual Changes in ISM
* MS INTRANETSSI 010.001, Living Arrangements - Overview

POMS Reference

SI 00835.520: Redetermination Guidelines for LA and ISM