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

Screen Shots for MSSICS LINS Screen

When continued payments are payable for temporary institutionalization, the physician's certification and home expenses statement must be received by SSA by the recipient’s discharge date or 90 days from admission date (whichever is earlier). The SSA claims representative confirms that the recipient and physician provided this required information by inputting the receipt dates in fields 24-C and 25-C (the Facsimile 2 of the LINS screen below highlighted in yellow).

Fields 24-C and 25-C are not used as a collection instrument. Fields 24-C and 25-C are used to tell the SSI computer system that the claims representative has obtained the necessary documentation to determine that the SSI recipient is eligible for temporary institutionalization benefits. If these fields are not completed, the computer system will not pay the temporary institutionalization benefits to the recipient. These fields serve as a safeguard to prevent the issuance of incorrect payments to a recipient who does not meet the requirements to receive temporary institutionalization benefits.

C.              FACSIMILE 1:  LINS - INSTITUTION RESIDENCE DATA

MSSICS                    INSTITUTION RESIDENCE DATA           PAGE 1 OF LINS

                               [1-D]                      [2-O]

SSS-SS-SSSS  SSSSS SSSSSSSSSS  PERIOD BEGAN: SS/SS/SSSS   TRANSFER TO:  XXXX

[3-M]

INSTITUTION NAME: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

          [4-M]

          ADDRESS: PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP

                   PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP

           [5-M]                          [6-C]        [7-M]

           CITY: PPPPPPPPPPPPPPPPPPPPPP   STATE: PP    ZIP: PPPPP

           [8-C]

           COUNTRY: XXXXXXXXXXXXXXXXXXXXXX

           [9-O]

           TELEPHONE: PPP PPP PPPP

[10-D]                              [11-O]

ADMISSION DATE (MMDDYY): SS/SS/SS   DISCHARGE DATE (MMDDYY): 999999

         [12-M]

         VERIFIED (Y/N): X

[13-D]

DATE INSTITUTIONALIZATION BEGAN (MMDDYY):  SS/SS/SS

[14-M]                        [15-M]

INSTITUTION: 9   1=PUBLIC     CONFINEMENT REASON:  9  1=MEDICAL/PSYCH

                 2=PRIVATE                            2=EDUCATION/VOC

                                                      3=EMERG SHELTER

                                                      4=PUB COMM RES

[16-C]                                                5=PRISONER

OVER 50% MEDICAID PAYMENTS (Y/N): B                   6=OTHER

[17-C]

PRIVATE HEALTH INSURANCE   (Y/N): B

[18-C]

INSTITUTION FOR FOOD STAMP PURPOSES (Y/N): P

                                                             [19-O]

                                                             REMARKS (Y): X

D.              FACSIMILE 2:  LINS - INSTITUTION RESIDENCE DATA

MSSICS               INSTITUTION RESIDENCE DATA               PAGE 2 OF LINS

                               [1-D]                      [2-O]

SSS-SS-SSSS  SSSSS SSSSSSSSSS  PERIOD BEGAN: SS/SS/SSSS   TRANSFER TO:  XXXX

[20-M]

INSTITUTION TEMPORARY (Y/N): X

[21-M]

ELIGIBLE FOR AND CHOOSES SPECIAL INSTITUTIONAL PAYMENTS - 1619/1611E (Y/N): X

    [22-C]

    IF NO,

       ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 (Y/N): X

    [23-C]

    IF YES,  TYPE OF CARE: 9

       CARE OPTIONS   1=ACUTE CARE    2=INTERMEDIATE CARE (MENTAL)

                      3=INTERMEDIATE CARE (NON-MENTAL) 4=SKILLED NURSING CARE

             [24-C]

             HOME EXPENSE STATEMENT DATE FOR   SSSSS SSSSSSSSSS:  999999

             HOME EXPENSE STATEMENT DATE FOR   SSSSS SSSSSSSSSS:  999999

             [25-C]

             PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS:  999999

             PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS:  999999

             [26-C]

             IF NOT DISCHARGED, CONTINUED PAYMENT PERIOD ENDED (Y):  X

                 [27-C]

                 WHICH MEMBER OF COUPLE: X  1=SSSSS SSSSSSSSS

                                            2=SSSSS SSSSSSSSS

                                            3=BOTH

          [28-C]

          IF NO, 9115 INELIGIBILITY DECISION CODE: X

                                                               [19-O]

                                                               REMARKS (Y): X

010.011 -
Batch run: 04/20/2009