Continuation of SSI Benefits for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home

Social Security Administration

§ 416.212

tjames on PRODPC75 with CFR

(3) Serving no more than 16 residents. A
community residence serves no more
than 16 residents if—
(i) It is designed and planned to serve
no more than 16 residents, or the design and plan were changed to serve no
more than 16 residents; and
(ii) It is in fact serving 16 or fewer
residents.
(4) Publicly operated. A community
residence is publicly operated if it is
operated or controlled by the Federal
government, a State, or a political subdivision of a State such as a city or
county.
(5) Facilities which are not a publicly
operated community residence. If you live
in any of the following facilities, you
are not a resident of a publicly operated community residence:
(i) A residential facility which is on
the grounds of or next to a large institution or multipurpose complex;
(ii) An educational or vocational
training institution whose main function is to provide an approved, accredited, or recognized program to some or
all of those who live there;
(iii) A jail or other facility where the
personal freedom of anyone who lives
there is restricted because that person
is a prisoner, is being held under court
order, or is being held until charges
against that person are disposed of; or
(iv) A medical treatment facility (defined in § 416.201).
(d) Exception for residents of public
emergency shelters for the homeless. For
months after December 1987, if you are
a resident of a public emergency shelter for the homeless (defined in
§ 416.201) you may be eligible for SSI
benefits for any 6 months throughout
which you reside in a shelter in any 9month period (defined in § 416.201). The
6 months do not need to be consecutive
and we will not count as part of the 6
months any prior months throughout
which you lived in the shelter but did
not receive SSI benefits. We will also
not count any months throughout
which you lived in the shelter and received SSI benefits prior to January
1988.
Example: You are receiving SSI benefits
when you lose your home and enter a public
emergency shelter for the homeless on
March 10, 1988. You remain a resident of a
shelter until October 10, 1988. Since you were

not in the shelter throughout the month of
March, you are eligible to receive your benefit for March without having this month
count towards the 6-month period. The last
full month throughout which you reside in
the shelter is September 1988. Therefore, if
you meet all eligibility requirements, you
will also be paid benefits for April through
September (6 months during the 9-month period September 1988 back through January
1988). If you are otherwise eligible, you will
receive your SSI benefit for October when
you left the shelter, since you were not a
resident of the shelter throughout that
month.
[47 FR 3103, Jan. 22, 1982, as amended at 50
FR 51518, Dec. 18, 1985; 51 FR 13492, Apr. 21,
1986; 51 FR 17332, May 12, 1986; 51 FR 34464,
Sept. 29, 1986; 54 FR 19164, May 4, 1989; 61 FR
10277, Mar. 13, 1996; 62 FR 1055, Jan. 8, 1997; 64
FR 31972, June 15, 1999; 72 FR 50874, Sept. 5,
2007]

§ 416.212 Continuation of full benefits
in certain cases of medical confinement.
(a) Benefits payable under section
1611(e)(1)(E) of the Social Security Act.
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)(E)
of the Social Security Act for up to 2
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—
(1) You were eligible under either section 1619(a) or section 1619(b) of the Social Security Act in the month before
the first full month of residence in an
institution;
(2) The institution agrees that no
portion of these benefits will be paid to
or retained by the institution excepting nominal sums for reimbursement of

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§ 416.214

20 CFR Ch. III (4–1–09 Edition)

the institution for any outlay for a recipient’s personal needs (e.g., personal
hygiene items, snacks, candy); and
(3) The month of your institutionalization is one of the first 2 full months
of a continuous period of confinement.
(b) Benefits payable under section
1611(e)(1)(G) of the Social Security Act. (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—
(i) You were eligible for SSI cash
benefits and/or federally administered
State supplementary payments for the
month immediately prior to the first
full month you were a resident in such
institution;
(ii) The month of your institutionalization is one of the first 3 full months
of a continuous period of confinement;
(iii) A physician certifies, in writing,
that you are not likely to be confined
for longer than 90 full consecutive days
following the day you entered the institution, and the certification is submitted to SSA no later than the day of
discharge or the 90th full day of confinement, whichever is earlier; and
(iv) You need to pay expenses to
maintain the home or living arrangement to which you intend to return
after institutionalization and evidence
regarding your need to pay these expenses is submitted to SSA no later
than the day of discharge or the 90th
full day of confinement, whichever is
earlier.
(2) We will determine the date of submission of the evidence required in
paragraphs (b)(1) (iii) and (iv) of this

section to be the date we receive it or,
if mailed, the date of the postmark.
(c) Prohibition against using benefits
for current maintenance. If the recipient
is a resident in an institution, the recipient or his or her representative
payee will not be permitted to pay the
institution any portion of benefits payable under section 1611(e)(1)(G) excepting nominal sums for reimbursement of
the institution for any outlay for the
recipient’s personal needs (e.g., personal hygiene items, snacks, candy). If
the institution is the representative
payee, it will not be permitted to retain any portion of these benefits for
the cost of the recipient’s current
maintenance excepting nominal sums
for reimbursement for outlays for the
recipient’s personal needs.
[61 FR 10277, Mar. 13, 1996, as amended at 62
FR 1055, Jan. 8, 1997; 72 FR 50874, Sept. 5,
2007]

§ 416.214 You are disabled and drug
addiction or alcoholism is a contributing factor material to the determination of disability.
(a) If you do not comply with treatment
requirements. If you receive benefits because you are disabled and drug addiction or alcoholism is a contributing
factor material to the determination of
disability (see § 416.935), you must avail
yourself of any appropriate treatment
for your drug addiction or alcoholism
at an approved institution or facility
when this treatment is available and
make progress in your treatment. You
are not eligible for SSI benefits beginning with the month after the month
you are notified in writing that we determined that you have failed to comply with the treatment requirements.
If your benefits are suspended because
you failed to comply with treatment
requirements, you will not be eligible
to receive benefits until you have demonstrated compliance with treatment
for a period of time, as specified in
§ 416.1326. The rules regarding treatment for drug addiction and alcoholism
are in subpart I of this part.
(b) If you previously received 36 months
of SSI or Social Security benefits. You are
not eligible for SSI benefits by reason
of disability on the basis of drug addiction or alcoholism as described in
§ 416.935 if—

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