[Federal Register Volume 72, Number 57 (Monday, March 26, 2007)]
[Proposed Rules]
[Pages 14053-14056]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-5134]
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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: Notice of proposed rulemaking.
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SUMMARY: We propose to revise our regulations to codify two provisions
of 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: To be sure that we consider your comments, we must receive them
by May 25, 2007.
ADDRESSES: You may give us your comments: by Internet through the
Federal eRulemaking Portal at http://www.regulations.gov; by e-mail to
regulations@ssa.gov; by telefax to (410) 966-2830; or by letter to the
Commissioner of Social Security, PO Box 17703, Baltimore, MD 21235-
7703. You may also deliver them to the Office of Regulations, Social
Security Administration, 107 Altmeyer Building, 6401 Security
Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and 4:30 p.m. on
regular business days. Comments are posted on our Internet site. You
also may inspect the comments on regular business days by making
arrangements with the contact person shown in the preamble.
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 or TTY (410) 966-5609, 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,
[[Page 14054]]
Social Security Online, at http://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 http://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 (Public Law 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 are
proposing to 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 (Public Law 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
(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 a provision 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) of 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 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 Proposed Changes
We propose to make 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 propose to revise 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
[[Page 14055]]
facilities when Medicaid pays more than 50 percent of the cost of their
care.
We propose to revise 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 propose to amend 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 propose to amend 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.''
Clarity of These Regulations
Executive Order 12866, as amended by Executive Order 13258,
requires each agency to write all rules in plain language. In addition
to comments you may have on these proposed rules, we also invite your
comments on how to make these rules easier to understand. For example:
Have we organized the material to suit your needs?
Are the requirements in the rules clearly stated?
Do the rules contain technical language or jargon that is
unclear?
Would a different format (grouping and order of sections,
use of headings, paragraphing) make the rules easier to understand?
Would more (but shorter) sections be better?
Could we improve clarity by adding tables, lists, or
diagrams?
What else could we do to make the rules easier to
understand?
Regulatory Procedures
Executive Order 12866, as Amended by Executive Order 13258
We have consulted with the Office of Management and Budget (OMB)
and determined that these proposed rules meet the criteria for a
significant regulatory action under Executive Order 12866, as amended
by Executive Order 13258. Thus, they were reviewed by OMB.
Regulatory Flexibility Act
We certify that these proposed 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 proposing to revise 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.
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Average burden Estimated
Title/section & collection description Annual number Frequency of per response annual burden
of respondents response (minutes) (hours)
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What you must report 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...............
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An Information Collection Request has been submitted to OMB for
clearance.
We are soliciting comments on the burden estimate; the need for the
information; its practical utility; ways to enhance its quality,
utility and clarity; and on ways to minimize the burden on respondents,
including the use of automated collection techniques or other forms of
information technology. Comments should be sent to OMB by fax or by
email to: Office of Management and Budget, Attn: Desk Officer for SSA,
Fax Number: 202-395-6974, Email address: OIRA--Submission@omb.eop.gov.
Comments can be received for up to 60 days after publication of
this notice and will be most useful if received within 30 days of
publication. This does not affect the deadline for the public to
comment to SSA on the proposed regulations. These information
collection requirements will not become effective until approved by
OMB. When OMB has approved these information collection requirements,
SSA will publish a notice in the Federal Register.
To receive a copy of the OMB clearance package, your staff 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).
Dated: December 13, 2006.
Jo Anne B. Barnhart,
Commissioner of Social Security.
For the reasons set out in the preamble, we propose to amend
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]
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.
[[Page 14056]]
268 (48 U.S.C. 1681 note); sec. 2, Pub. L. 99-643, 100 Stat. 3574
(42 U.S.C. 1382h note).
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]
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:
a. Section 416.201 in the definitions of ``Medical care facility''
and ``Public emergency shelter for the homeless''; and
b. Section 416.211(b) and (c)(5)(iv).
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]
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).
6. Section 416.414 is amended by revising the section heading and
paragraph (c) to 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.
Sec. 416.414 [Amended]
7. In addition to the amendment set forth above, in 20 CFR part
416, subpart D, remove the words ``medical facility'' and ``medical
care facility'' and add in their place the words ``medical treatment
facility'' in Sec. 416.414(a), (b)(2), and (b)(3)(i) through (ii).
Subpart E--[Amended]
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]
9. In 20 CFR part 416, subpart E, remove the words ``medical
facility'' wherever they appear and add in their place the words
``medical treatment facility'' in Sec. 416.571.
Subpart G--[Amended]
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).
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]
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. Sec. 416.1149, 416.1165 and 416.1167 [Amended]
13. In 20 CFR part 416, subpart K, remove the words ``medical
facility'' and ``medical care facility'' and add in their place the
words ``medical treatment facility'' in the following places:
a. Section 416.1149(a)(1) and (c)(1)(i) through (ii);
b. Section 416.1165(g)(6) and (i)(1); and
c. Section 416.1167(a)(2).
Subpart L--[Amended]
14. 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]
15. In 20 CFR part 416, subpart L, remove the words ``medical
facility'' and ``medical care facility'' and add in their place the
words ``medical treatment facility'' in Sec. 416.1202(b)(2)(i).
[FR Doc. E7-5134 Filed 3-23-07; 8:45 am]
BILLING CODE 4191-02-P