TN 47 (07-99)

Citations:

Regulations, 20 CFR 416.1145

A. Introduction

A private for-profit residential care institution is a facility that provides food, shelter, and some services to its residents. Often this type of facility is referred to as a rest home, a domiciliary care home, or a retirement home. It is not a penal, educational, vocational, or medical treatment facility.

ISM for an individual in this type of institution is determined using the policy instructions in SI 00835.706, the procedures in SI 00835.707, and the following additional instructions pertaining to a “payment in full” agreement.

B. Policy

Individual Liable For “Payment In Full” To Institution

The regulations state that when an individual lives in a private for-profit residential care institution, there is no countable ISM when the individual:

• makes some payment which the institution accepts as payment in full, even though its usual charge or actual cost may be higher; or

• has written legal indebtedness to the institution for the food and shelter regardless of whether the amount owed represents full market value, and the institution accepts the amount of the debt plus the individual's payment, if any, as payment in full.

C. Procedure

Developing And Documenting “Payment In Full”

If, when contacting the individual or the institution, or reviewing the precedent, there is an indication that the individual and the institution have either a “payment in full” or “legal indebtedness” agreement:

• Determine whether such an agreement exists by contacting the institution; and

• Document the file with a copy of the agreement or record information about the agreement on the evidence screen (EVID). You may also use a report of contact with the institution which summarizes the written agreement (DROC screen on MSSICS); and

• Determine that there is no countable ISM and document the file with this determination (DROC screen on MSSICS).

• If it is determined that such an agreement does not exist, follow the general procedures in SI 00835.707 to determine whether the individual gets ISM from the institution and to compute the monthly value.

D. Examples

EXAMPLE 1: Payment Accepted by Institution as Full Payment

An eligible individual, Mr. Robertson, resides in a private for-profit retirement home during 03/99. He tells the CR that he pays the home $425 per month and there is no third party payment. The CR believes that $425 is less than the CMV so she contacts the home for further information. The administrator tells the CR that the charges are higher sometimes, but that the home accepts $425 as payment in full for Mr. Robertson. The CR determines that no ISM is countable for the food and shelter provided by the home. The CR does not develop or document the file with the CMV of the food and shelter since it is immaterial.

EXAMPLE 2: Legal Indebtedness as Payment for Institution's Charges

Ms. Kelly, an aged individual, lives in a private for-profit adult care home which customarily charges $800 per month, of which $400 represents the CMV of the food and shelter. At the time of her application for SSI, Ms. Kelly has no cash income. The CR contacts the care home and learns that Ms. Kelly signed a document by which the home extends her credit (i.e., accepts her debt) in the amount of $350 per month. The administrator states that no other payment is to be made, either by Ms. Kelly or anyone on her behalf. Since the home accepts this legal indebtedness to pay $350 as payment in full, the CR determines that the food and shelter provided by the home is not income and puts a copy of the agreement in the file. (If the CMV of the food and shelter had been unknown, there would be no need to develop the value because it is immaterial.)