Technical Updates to Applicability of the Supplemental Security Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical Treatment Facilities, 50871-50875 [E7-17403]

Agencies

• Social Security Administration

[Federal Register Volume 72, Number 171 (Wednesday, September 5, 2007)]
[Rules and Regulations]
[Pages 50871-50875]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-17403]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Part 416

[Docket No. SSA-2006-0103]
RIN 0960-AF99


Technical Updates to Applicability of the Supplemental Security 
Income (SSI) Reduced Benefit Rate for Individuals Residing in Medical 
Treatment Facilities

AGENCY: Social Security Administration (SSA).

ACTION: Final rules.

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SUMMARY: We are revising our regulations to reflect two provisions of

[[Page 50872]]

the Balanced Budget Act of 1997 that affect the payment of benefits 
under title XVI of the Social Security Act (the Act). One of the 
provisions extended temporary institutionalization benefits to children 
receiving SSI benefits who enter private medical treatment facilities 
and who otherwise would be ineligible for temporary 
institutionalization benefits because of private insurance coverage. 
The other provision replaced obsolete terminology in the Act that 
referred to particular kinds of medical facilities and substituted a 
broader, more descriptive term.

DATES: These final rules are effective October 5, 2007.

FOR FURTHER INFORMATION CONTACT: Curt Dobbs, Social Insurance 
Specialist, Office of Income Security Programs, Social Security 
Administration, 252 Altmeyer Building, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 965-7963, for information about this 
notice. For information on eligibility or filing for benefits, call our 
national toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or 
visit our Internet site, Social Security Online, at https://
www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION: 

Electronic Version

    The electronic file of this document is available on the date of 
publication in the Federal Register at https://www.gpoaccess.gov/fr/
index.html.

Background

    The basic purpose of the SSI program is to ensure a minimum level 
of income to individuals who are age 65 or older, or blind or disabled, 
and who have limited income and resources. The Balanced Budget Act of 
1997 (Pub. L. 105-33), enacted August 5, 1997, contained two provisions 
that affected the payment of SSI benefits to certain SSI beneficiaries 
who are institutionalized. One of the provisions extended temporary 
institutionalization benefits to children who enter private medical 
treatment facilities and who otherwise would be subject to a reduced 
benefit because of private insurance coverage. The other provision 
removed obsolete terminology in the Act that referred to particular 
categories of inpatient medical facilities and substituted the broader, 
more descriptive term ``medical treatment facility.'' This change in 
terminology permits us to correct an unintended inequity in the amount 
of SSI benefits that were payable to certain children under the 
obsolete terminology.

Extending Temporary Institutionalization Benefits to Children Under Age 
18 in Private Institutions

    Residents of public institutions generally are ineligible to 
receive SSI payments. However, there are some exceptions to this 
general rule. One exception in section 1611(e)(1)(B) of the Act 
provides that residents of medical treatment facilities (which we 
define as a facility licensed or otherwise approved by a Federal, 
State, or local government to provide inpatient medical care and 
services) may be eligible for SSI if Medicaid pays a substantial part 
(more than 50 percent) of the cost of the beneficiary's care. In such 
cases, SSI payments to the resident of the medical treatment facility 
are limited to a maximum of $30 a month.
    Another exception in section 1611(e)(1)(G) of the Act allows 
payment of full SSI benefits for up to 3 full months after entering a 
public facility if a physician certifies that the recipient's stay in 
the facility is likely not to exceed 3 months and we determine the 
recipient needs to continue to maintain and provide for the expenses of 
the home to which he or she may return. These benefits are referred to 
as ``temporary institutionalization benefits.''
    The Personal Responsibility and Work Opportunity Reconciliation Act 
of 1996 (Pub. L. 104-193), enacted August 22, 1996, amended section 
1611(e)(1)(B) of the Act to allow children under age 18 who are in 
medical treatment facilities and who have private health insurance to 
receive the reduced SSI payment ($30). However, Public Law 104-193 did 
not amend the statutory provision on temporary institutionalization to 
extend such benefits to children with private health insurance. 
Consequently, children who were temporarily in private medical 
facilities could not be eligible for 3 months of full benefits if 
private health insurance, or a combination of Medicaid and private 
health insurance, paid more than 50 percent of the cost of their care. 
Payments to these children were limited to the reduced benefit amount 
of no more than $30 a month beginning with their first full month of 
institutionalization.
    Section 5522(c) of Public Law 105-33 revised section 1611(e)(1)(G) 
of the Act to correct this omission. Prior to this revision, section 
1611(e)(1)(G) specified that the recipient must be an inmate of either 
a public institution whose primary purpose is to provide medical or 
psychiatric care, or a hospital, extended care facility, nursing home, 
or intermediate care facility that receives payments under a State plan 
approved under title XIX. As a result of Public Law 105-33, and subject 
to SSI eligibility and benefit computation rules, those children in 
private medical facilities for whom private health insurance, or a 
combination of Medicaid and private health insurance was paying more 
than 50 percent of the cost of care, now can be eligible for 
continuation of their full SSI benefits for up to 3 months under 
section 1611(e)(1)(G) of the Act. For example, when a child who is 
receiving SSI while living at home goes into a medical treatment 
facility, and private insurance through the parent's employment pays 
for more than 50 percent of the cost of care, the child can continue to 
receive SSI benefits during a temporary institutionalization of up to 3 
months. Providing SSI benefits during a temporary period of 
institutionalization is designed to enable SSI beneficiaries (adult or 
child) to provide for the expenses of the home where they live and to 
reduce the risk of losing their place of residence due to a sudden loss 
of SSI benefits during a temporary period of institutionalization.

Revised Terminology for Inpatient Providers

    Section 5522(c) of Public Law 105-33 also replaced outdated 
terminology in section 1611(e)(1)(B) the Act. Prior to this statutory 
change, section 1611(e)(1)(B) specified certain categories of inpatient 
providers used in the Medicaid program. In the early years of the SSI 
program, the terminology ``hospital, extended care facility, nursing 
home, or intermediate care facility'' provided a comprehensive list of 
all possible inpatient settings as defined by the Medicaid program. 
However, as Medicaid dropped or renamed some of those coverage 
categories and added new categories, the list in section 1611(e)(1)(B) 
became obsolete and was no longer used. As a result, prior to Public 
Law 105-33, children in certain kinds of inpatient facilities were 
subject to the reduced benefit amount of no more than $30, while 
children in other kinds of Medicaid covered inpatient facilities could 
receive the full SSI benefit. For example, Medicaid created the new 
coverage category of Psychiatric Residential Treatment Facility (PRTF) 
for individuals under age 21. PRTFs can receive substantial Medicaid 
payments, including the room and board payment. Before Public Law 105-
33 made this technical amendment, children residing in a PRTF received 
full SSI benefits because that kind of facility was not listed in 
section 1611(e)(1)(B) as a facility whose residents would be

[[Page 50873]]

subject to the $30 payment limit. For many PRTF residents, Medicaid was 
paying all of their expenses, and yet Public Law 104-193 required 
payment of the full SSI benefit rate. This situation created an 
inequity between those children and children in other kinds of Medicaid 
covered inpatient facilities. This change in terminology now allows for 
similarly situated children (i.e., children residing in medical 
treatment facilities where Medicaid is providing for more than 50 
percent of the cost of their care) to be paid the same amount of SSI 
benefits.

Explanation of Changes

    We are making the following changes to our rules to codify 
provisions of Public Law 105-33 that affect the payment of benefits 
under title XVI of the Act to individuals who are in institutions:
     We are revising Sec.  416.212(b)(1) by adding ``or 
private'' to the introductory text to reflect the provision that gives 
full temporary institutionalization benefits to children who enter 
private medical treatment facilities when Medicaid pays more than 50 
percent of the cost of their care.
     We are revising Sec. Sec.  416.201 and 416.414(c) to 
remove the definition for ``medical care facility'' and replace it with 
a new definition for ``medical treatment facility.''
     We are amending Sec. Sec.  416.201, 416.211(b) and 
(c)(5)(iv), 416.414(a), (b)(2) and (3)(i)-(ii), 416.571, 416.1149(a)(1) 
and (c)(1)(i)-(ii), 416.1165(g)(6) and (i)(1), 416.1167(a)(2), and 
416.1202(b)(2)(i) by eliminating the obsolete terms ``medical 
facility'' and ``medical care facility'' and replacing them with the 
term ``medical treatment facility.''
     We are amending Sec.  416.708(k) by eliminating the terms 
``hospital,'' ``skilled nursing facility,'' and ``intermediate care 
facility'' and replacing them with the term ``medical treatment 
facility.''
    On March 26, 2007, we published proposed rules in the Federal 
Register at 72 FR 14053 and provided a 60-day comment period. We did 
not receive any comments. Therefore, we are publishing the text of the 
proposed rules unchanged in these final rules.

Regulatory Procedures

Executive Order 12866

    The Office of Management and Budget (OMB) determined that the 
proposed rules on which these final rules are based, published on March 
26, 2007 at 72 FR 14053, met the criteria for a significant regulatory 
action under Executive Order 12866, as amended. Therefore, they were 
subject to OMB review. We received no public comments on the proposed 
rules and are publishing these final rules exactly as proposed. For 
this reason, OMB determined that it did not need to review the final 
rules. We have also determined that these final rules meet the plain 
language requirement of Executive Order 12866, as amended.

Regulatory Flexibility Act

    We certify that these final rules will not have a significant 
economic impact on a substantial number of small entities as they 
affect individuals only. Therefore, a regulatory flexibility analysis 
as provided in the Regulatory Flexibility Act, as amended, is not 
required.

Paperwork Reduction Act

    In order to codify two provisions of the Balanced Budget Act of 
1997, we are revising our regulations that affect the payment of 
benefits under title XVI of the Act. One of the provisions extended 
temporary institutionalization benefits to children who enter private 
medical treatment facilities and who otherwise would be subject to a 
reduced benefit because of private insurance coverage. The other 
provision replaced obsolete terminology in the Act that referred to 
particular kinds of medical facilities and substituted a broader, more 
descriptive term.
    As a result, we are amending the terminology in Sec.  416.708 (k) 
by eliminating the terms ``hospital,'' ``skilled nursing facility,'' 
and ``intermediate care facility'' and replacing them with the term 
``medical treatment facility.'' As outlined below, this section 
contains specific public reporting requirements that require clearance 
under the Paperwork Reduction Act of 1995. Respondents to this 
collection are SSI recipients who are admitted to, or discharged from, 
a medical treatment facility or other public or private institution.

----------------------------------------------------------------------------------------------------------------
                                                                                Average  burden     Estimated
   Title/section & collection description      Annual  number    Frequency of    per  response    annual burden
                                              of  respondents      response        (minutes)         (hours)
----------------------------------------------------------------------------------------------------------------
What you must report Sec.   416.708(k)
Admission to or discharge from:
    (1) A medical treatment facility........          34,200                1                7            3,990
    (2) A public institution, or
    (3) A private institution.
----------------------------------------------------------------------------------------------------------------

    In the publication of the proposed rules on March 26, 2007, we 
solicited comments on the burden estimate; the need for the 
information; its practical utility; ways to enhance its quality, 
utility and clarity; and ways to minimize the burden on respondents, 
including the use of automated collection techniques or other forms of 
information technology. We received no public comments in response to 
this solicitation.
    On April 4, 2007, OMB filed comment in accordance with 5 CFR 
1320.11(c), requiring us to review public comments in response to the 
proposed rules and address any such comments in the preamble of the 
final rules. As a result, we have submitted a new clearance package for 
OMB review and approval.
    These information collection requirements will not become effective 
until approved by OMB. When OMB has approved these information 
collection requirements, we will publish a notice in the Federal 
Register.
    To receive a copy of the OMB clearance package, you may call the 
SSA Reports Clearance Officer on 410-965-0454.

(Catalog of Federal Domestic Assistance Program No. 96.006, 
Supplemental Security Income)

List of Subjects in 20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).


[[Page 50874]]


    Dated: August 28, 2007.
Michael J. Astrue,
Commissioner of Social Security.

0
For the reasons set out in the preamble, we are amending subparts B, D, 
E, G, K, and L of part 416 of chapter III of title 20 of the Code of 
Federal Regulations as follows:

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart B--[Amended]

0
1. The authority citation for subpart B of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1110(b), 1602, 1611, 1614, 1619(a), 
1631, and 1634 of the Social Security Act (42 U.S.C. 902(a)(5), 
1310(b), 1381a, 1382, 1382c, 1382h(a), 1383, and 1383c); secs. 211 
and 212, Pub. L. 93-66, 87 Stat. 154 and 155 (42 U.S.C. 1382 note); 
sec. 502(a), Pub. L. 94-241, 90 Stat. 268 (48 U.S.C. 1681 note); 
sec. 2, Pub. L. 99-643, 100 Stat. 3574 (42 U.S.C. 1382h note).


0
2. Section 416.201 is amended by removing the definition of ``Medical 
care facility'' and adding a definition of ``Medical treatment 
facility'' in alphabetical order to read as follows:


Sec.  416.201  General definitions and terms used in this subpart.

* * * * *
    Medical treatment facility means an institution or that part of an 
institution that is licensed or otherwise approved by a Federal, State, 
or local government to provide inpatient medical care and services.
* * * * *


Sec. Sec.  416.201 and 416.211  [Amended]

0
3. In 20 CFR part 416, subpart B, remove the words ``medical facility'' 
and ``medical care facility'' each time they appear and add in their 
place the words ``medical treatment facility'' in the following places:
0
a. Section 416.201 in the definitions of ``Medical care facility'' and 
``Public emergency shelter for the homeless''; and
0
b. Section 416.211(b) and (c)(5)(iv).

0
4. Section 416.212 is amended by revising the introductory text in 
paragraph (b)(1) to read as follows:


Sec.  416.212  Continuation of full benefits in certain cases of 
medical confinement.

* * * * *
    (b) * * *
    (1) Subject to eligibility and regular computation rules (see 
subparts B and D of this part), you are eligible for the benefits 
payable under section 1611(e)(1)(G) of the Social Security Act for up 
to 3 full months of medical confinement during which your benefits 
would otherwise be suspended because of residence in a public 
institution or reduced because of residence in a public or private 
institution where Medicaid pays a substantial part (more than 50 
percent) of the cost of your care or, if you are a child under age 18, 
reduced because of residence in a public or private institution which 
receives payments under a health insurance policy issued by a private 
provider, or a combination of Medicaid and a health insurance policy 
issued by a private provider, pay a substantial part (more than 50 
percent) of the cost of your care if--
* * * * *

Subpart D--[Amended]

0
5. The authority citation for subpart D of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1611(a), (b), (c), and (e), 1612, 
1617, and 1631 of the Social Security Act (42 U.S.C. 902(a)(5), 
1382(a), (b), (c), and (e), 1382a, 1382f, and 1383).


0
6. Section 416.414 is amended by:
0
a. Revising the section heading;
0
b. Removing the words ``medical care facilities'' and adding ``medical 
treatment facilities'' in their place in paragraphs (a) and (b)(2);
0
c. Removing the words ``medical care facility'' and adding ``medical 
treatment facility'' in their place in paragraphs (b)(3)(i) and (ii); 
and
0
d. Revising paragraph (c).
    The revisions read as follows:


Sec.  416.414  Amount of benefits; eligible individual or eligible 
couple in a medical treatment facility.

* * * * *
    (c) Definition. For purposes of this section, a medical treatment 
facility means an institution or that part of an institution that is 
licensed or otherwise approved by a Federal, State, or local government 
to provide inpatient medical care and services.

Subpart E--[Amended]

0
7-8. The authority citation for subpart E of part 416 continues to read 
as follows:

     Authority: Secs. 702(a)(5), 1147, 1601, 1602, 1611(c) and (e), 
and 1631(a)-(d) and (g) of the Social Security Act (42 U.S.C. 
902(a)(5), 1320b-17, 1381, 1381a, 1382(c) and (e), and 1383(a)-(d) 
and (g)); 31 U.S.C. 3720A.


Sec.  416.571   [Amended]

0
9. In Sec.  416.571, remove the words ``medical facility'' in the last 
sentence and add in their place the words ``medical treatment 
facility''.

Subpart G--[Amended]

0
10. The authority citation for subpart G of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1611, 1612, 1613, 1614, and 1631 of 
the Social Security Act (42 U.S.C. 902(a)(5), 1382, 1382a, 1382b, 
1382c, and 1383); sec. 211, Pub. L. 93-66, 87 Stat. 154 (42 U.S.C. 
1382 note), sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 U.S.C. 902 
note).

0
11. Section 416.708 is amended by revising paragraph (k) to read as 
follows:


Sec.  416.708  What you must report.

* * * * *
    (k) Admission to or discharge from a medical treatment facility, 
public institution, or private institution. You must report to us your 
admission to or discharge from--
    (1) A medical treatment facility; or
    (2) A public institution (defined in Sec.  416.201); or
    (3) A private institution. Private institution means an institution 
as defined in Sec.  416.201 which is not administered by or the 
responsibility of a governmental unit.
* * * * *

Subpart K--[Amended]

0
12. The authority citation for subpart K of part 416 continues to read 
as follows:

     Authority: Secs. 702(a)(5), 1602, 1611, 1612, 1613, 1614(f), 
1621, 1631, and 1633 of the Social Security Act (42 U.S.C. 
902(a)(5), 1381a, 1382, 1382a, 1382b, 1382c(f), 1382j, 1383 and 
1383b); sec. 211, Pub. L. 93-66, 87 Stat. 154 (42 U.S.C. 1382 note).


Sec.  416.1149  [Amended]

0
13. In Sec.  416.1149, remove the words ``medical care facility'' and 
add ``medical treatment facility'' in their place in paragraphs (a)(1) 
and (c)(1)(i) and (ii).


Sec.  416.1165  [Amended]

0
14. In Sec.  416.1165, remove the words ``medical care facility'' and 
add ``medical treatment facility'' in their place in paragraph (g)(6) 
and remove the words ``medical facility'' and add ``medical treatment 
facility'' in their place in paragraph (i)(1).


Sec.  416.1167  [Amended]

0
15. In Sec.  416.1167, remove the words ``medical care facility'' and 
add ``medical treatment facility'' in their place in paragraph (a)(2).

[[Page 50875]]

Subpart L--[Amended]

0
16. The authority citation for subpart L of part 416 continues to read 
as follows:

    Authority: Secs. 702(a)(5), 1602, 1611, 1612, 1613, 1614(f), 
1621, 1631 and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 
1381a, 1382, 1382a, 1382b, 1382c(f), 1382j, 1383 and 1383b); sec. 
211, Pub. L. 93-66, 87 Stat. 154 (42 U.S.C. 1382 note).


Sec.  416.1202  [Amended]

0
17. In Sec.  416.1202(b)(2)(i), remove the words ``medical facility'' 
and add in their place the words ``medical treatment facility''.

[FR Doc. E7-17403 Filed 9-4-07; 8:45 am]
BILLING CODE 4191-02-P