POMS Reference

SI 02305: Redeterminations of Eligibility and/or Payment Amount

TN 54 (11-06)

A. Introduction

This section provides procedures for developing recipient allegations about periods of institutionalization during the RZ interview.

B. Description Of RZs Completed On MSSICS Screens

Opening a “REDETERMINATION with or without RECAPs” event creates a MSSICS “path” which guides the interviewer to the appropriate screens to document allegations and evidence relating to institutionalization, as necessary.

C. Description of Form SSA-8202-BK - Question 2

Question 2 on the SSA-8202-BK — Since the date above, have you spent a full calendar month in a hospital, nursing home, or any place other than where you live? (Also include trips outside the U.S.)

D. Description of SSA-8203-BK - Question 4

Question 4 on the SSA-8203-BK — Since the date above, have you spent a full calendar month in a hospital, nursing home, or other institution?

E. Procedure - General

Develop allegations about institutionalization as follows:

  1. If the recipient alleges no institutionalization and other information in SSA records agrees, do not develop institutionalization further.

  2. If the recipient alleges institutionalization and other information in SSA records indicates that the institution is the individual's permanent residence, do not develop institutionalization further.

  3. If the recipient alleges institutionalization and no FLA-D or PSY-NO2 is on the SSR and other information in SSA records indicates that this was a temporary institutionalization (TI) case, do not develop unless the period of confinement was 4 or more full months. In such cases, develop per POMS in SI 00520.140.

  4. If the recipient alleges institutionalization and no FLA-D or PSY-N02 is on the SSR and no other information in SSA records indicates that this was a TI case (regardless of allegation about receiving a TI letter), contact FO parallel to the institution to determine if this was a 9115 case and develop, as necessary, per POMS in SI 00520.140.

  5. If the recipient alleges institutionalization and FLA-D or PSY-N02 is on the SSR, document the name and address of the institution and the dates of confinement in spaces provided. If the recipient lived in a public institution for more than a month, consider proration for the month of release (see SI 02005.007F).

  6. If the recipient alleges institutionalization or no institutionalization and other information in SSA records conflicts, develop, as necessary, per SI 00520.140.

F. Procedure - Section 1619

See SI 02302.030B.SI 02302.030C. and SI 00520.130 - SI 00520.131 for instructions on processing section 1619 recipients who become institutionalized.

G. References