[Federal Register Volume 63, Number 211 (Monday, November 2, 1998)]
[Notices]
[Pages 58802-58804]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-29276]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION


Supplemental Security Income for the Aged, Blind and Disabled 
(SSI) Program Demonstration Project; Treatment of Cash Received and 
Conserved To Pay for Medical or Social Services

AGENCY: Social Security Administration.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Commissioner of Social Security will conduct a 
demonstration project to test how certain altered resources counting 
rules might apply in the SSI program. The SSI program is authorized by 
title XVI of the Social Security Act (the Act). The rules which will be 
tested are those that apply to the treatment of cash received and 
conserved to pay for medical or social services.
    Cash which is received for the purposes of payment for medical or 
social services is not counted as income to the beneficiary when 
received. If cash received for medical or social services which is not 
a reimbursement for these services already paid for by the beneficiary 
is conserved, it is not counted as a resource for the calendar month 
following the month of receipt, so long as it remains separately 
identifiable from other resources of the individual. Beginning with the 
second calendar month following the month of receipt, cash received for 
the payment of medical or social services becomes a countable resource 
used in the determination of SSI eligibility.
    The Health Care Financing Administration of the Department of 
Health and Human Services (DHHS) is collaborating with the States of 
Arkansas, Florida, New Jersey and New York and with the National 
Program Office at the University of Maryland's Center on Aging, the 
Robert Wood Johnson Foundation, the Office of the Assistant Secretary 
for Planning and Evaluation of the DHHS, the National Council on Aging 
and Mathematica Policy Research (the evaluator) on a demonstration 
project to provide greater autonomy to the consumers of personal 
assistance services. Personal assistance services are help with the 
basic activities of daily living, including bathing, dressing, 
transferring, toileting, and eating, and/or instrumental activities of 
daily living such as housekeeping, meal preparation, shopping, laundry, 
money management and medication management. Consumers of personal 
assistance services who participate in this demonstration will be 
empowered by purchasing the services they require (including medical 
and social services) to perform the activities of daily living. In 
order to accomplish the objective of the demonstration project, cash 
allowances and information services will be provided directly to 
persons with disabilities to enable them to choose and purchase 
services from providers which they feel would best meet their needs.
    Medicaid is the predominant source of public financing for personal 
assistance services programs for the aged, blind and disabled. The 
demonstration which will permit the States of Arkansas, Florida, New 
Jersey and New York to waive certain requirements under title XIX of 
the Act to participate in this ``Cash and Counseling'' demonstration is 
within the authority granted to the Secretary of Health and Human 
Services (HHS) by section 1115 of the Act. Medicaid beneficiaries who 
participate in this demonstration will be given cash to purchase the 
services they need from traditional and nontraditional providers as 
they deem appropriate. Counseling will be available for these 
beneficiaries to assist them in effective use of funds allotted for 
personal assistance services.
    Many of the Medicaid beneficiaries who participate in the Cash and 
Counseling demonstration will be SSI beneficiaries or belong to 
coverage groups using eligibility methodologies related to those of the 
SSI program under title XIX of the Act. The Commissioner of Social 
Security wishes to test the appropriateness of current SSI rules which 
require counting cash received for the purchase of medical or social 
services as resources if retained for more than one month after the 
month of receipt. The test will also be used to assist the Secretary of 
HHS in testing the possibility of providing greater autonomy to the 
consumers of personal assistance services by empowering them to 
purchase the services they require (including medical and social 
services) to perform their activities of daily living. In order to do 
so, the Commissioner will exercise his authority under section 1110(b) 
of the Act and waive SSI resources counting of cash received and 
conserved for future purchases of medical and social services. The 
beneficiaries for whom this waiver of resources counting rules is to 
apply reside in the States of Arkansas, Florida, New Jersey and New 
York and are participants in the Cash and Counseling demonstration 
project. The waiver of resources counting rules will continue to apply 
for the duration of their participation in that demonstration, so long 
as the cash provided for purchase of medical or social services is 
conserved in a form that is separately identifiable from other 
resources that may be countable or excludable under title XVI of the 
Act. The cash received for medical or social services and conserved 
towards payment for those services by SSI beneficiaries who participate 
in this demonstration will not be included in SSI countable resources 
only for so long as the individual continues to participate in the Cash 
and Counseling demonstration.
    Existing SSI resource-counting rules will be suspended only where 
application of such rules would adversely affect participation by SSI 
beneficiaries in the Cash and Counseling demonstration. That 
demonstration is anticipated to begin on or before January 1, 1999. 
This notice is published in accordance with the requirement in 20 CFR 
416.250(e).

EFFECTIVE DATES: This project will be effective for the period 
authorized by the Secretary of HHS for the Cash and Counseling 
demonstration project. The date anticipated by the Secretary for the 
Cash and Counseling demonstration to begin is on or before January 1, 
1999. According to the demonstration's plan, beneficiaries may 
participate throughout the period of the demonstration, up to five 
years. Thus, if the demonstration begins in all four States on January 
1, 1999, the anticipated ending date for all participants will be no 
later than December 31, 2003.
    Any cash for medical or social services received after an SSI 
beneficiary's participation in the demonstration has ended and which 
has been conserved for more than one month will be counted as 
resources. Any cash for medical or social services that is received 
during participation in

[[Page 58803]]

the demonstration and conserved subsequent to participation in the 
demonstration will be subject to regular SSI resources rules.

FOR FURTHER INFORMATION CONTACT: Craig Streett, Office of Program 
Benefits, 3-M-1 Operations Building, 6401 Security Boulevard, 
Baltimore, MD 21235, (410) 965-9793, or through the Internet at 
Craig.S[email protected].

SUPPLEMENTARY INFORMATION: Section 1612(a) of the Act defines what is 
income for purposes of the SSI program; section 1612(b) of the Act 
specifies exclusions from income. As explained in the regulation 
located at 20 CFR 416.1102, income counted for the purposes of the SSI 
program includes anything an individual receives in cash or in kind 
that can be used to meet needs for food, clothing, and shelter. 
Regulations at 20 CFR 416.1103(a)(3) and (b)(1) explain that assistance 
provided in cash or in kind under a Federal, State, or local government 
program, whose purpose is to provide medical care or services or social 
services, including vocational rehabilitation, is not income. The 
regulations at 20 CFR 416.1103(a)(5) and (b)(3) also explain that cash 
provided by any nongovernmental medical care or medical services 
program or under a health insurance policy or by a nongovernmental 
social services program (except cash to cover food, clothing or 
shelter) is not income if it is either repayment for program-approved 
services for which the individual has already paid or a payment 
restricted to the future purchase of a program-approved service.
    Section 1613 of the Act addresses the exclusions from resources for 
purposes of the SSI program. As explained in regulations at 20 CFR 
416.1201(a), resources are cash or other liquid assets or any real or 
personal property that an individual (or spouse) owns and could convert 
to cash to be used for support and maintenance. Regulations at 20 CFR 
416.1207(d) explain that items received in cash or in kind during a 
month are evaluated first under the income counting rules. If they are 
retained until the first moment of the following month, they then are 
subject to the rules for counting resources.
    However, regulations at 20 CFR 416.1201(a)(3) also explain that 
except for cash reimbursement of medical or social services expenses 
already paid for by the beneficiary, cash received for medical or 
social services that is not income under 20 CFR 416.1103(a) or (b) or a 
retroactive cash payment which is income that is excluded from deeming 
under 20 CFR 416.1161(a)(16) is not a resource for the calendar month 
following the month of its receipt if it is separately identifiable 
from other resources. Cash received for medical or social services that 
is retained after that time is a countable resource whether or not it 
is separately identifiable from other resources.
    SSI regulations recognize that cash payments made specifically to 
enable people to pay for medical or social services are not income for 
SSI purposes, because they are assumed not to be available for support 
and maintenance. Recognizing that the recipient is not always able to 
use the cash for payment for medical or social services in the month of 
receipt, SSI regulations provide for not counting as resources any cash 
received to pay for medical and social services which is retained one 
full calendar month following the month of receipt, so long as it is 
separately identifiable from other resources. The rule permitting not 
counting such cash as resources does not encompass cash received as 
reimbursement for medical or social service bills the individual has 
already paid. The rule which permits not counting cash as resources if 
retained into the month following the month of receipt is consistent 
with the purpose of the SSI program, which is to meet the current needs 
of beneficiaries for food, clothing and shelter.
    The Cash and Counseling collaborative demonstration project is 
designed to provide greater autonomy to the consumers of personal 
assistance services by empowering them to purchase the services they 
require (including medical and social services) to perform their 
activities of daily living. In order to accomplish the objectives of 
the demonstration project, cash allowances and information services 
will be provided directly to persons with disabilities to enable them 
to choose and purchase services from providers which they feel would 
best meet their needs.
    Many of the consumers of personal assistance services are SSI 
beneficiaries. However, under current SSI regulations, some SSI 
beneficiaries would not be able to participate in the Cash and 
Counseling demonstration project without risk to their continuing SSI 
eligibility due to the possibility that participants may receive cash 
to be conserved towards the future purchase of services. Unless the 
Commissioner exercises his authority under section 1110(b) of the Act 
to waive certain requirements, conditions, or limitations of title XVI 
of the Act necessary to conduct experimental, pilot or demonstration 
projects, the remainder of cash received for future purchases of 
services by SSI beneficiaries who choose to participate in the 
demonstration will become countable resources two months following the 
month of receipt.
    The consent of an SSI beneficiary to participate in this 
demonstration project is required under section 1110(b) of the Act. 
Each of the four States collaborating with the Secretary in the Cash 
and Counseling demonstration will obtain written consent from every 
participant who is an SSI beneficiary, which consent provides that his 
or her participation is voluntary and that he or she can revoke 
participation at any time. Existing SSI rules for counting cash 
received for the purchase of medical or social services as countable 
resources beginning with the second calendar month following the month 
of receipt will be waived for an individual participating in the 
demonstration as explained above only where the application of existing 
rules would adversely affect the individual's SSI eligibility. 
Accordingly, an individual's participation in the Cash and Counseling 
project will not affect participants' eligibility for SSI or benefit 
amounts.
    The objectives of SSA in conducting this demonstration project are 
to:
     Test the appropriateness of current SSI rules which 
require counting cash received for the purchase of medical or social 
services as resources if retained for more than one month after the 
month of receipt;
     Facilitate the ability of the Secretary, DHHS, and 
collaborators to engage in the Cash and Counseling demonstration 
project;
     Permit the Secretary, DHHS, and collaborators to determine 
if cost savings can be realized from the Cash and Counseling 
demonstration project; and
     Empower participants in the Cash and Counseling 
demonstration project to demonstrate greater autonomy by allowing them 
to purchase their own personal assistance services.
    Measurements involving these objectives will be obtained for the 
Social Security Administration by the Secretary, DHHS and collaborators 
in the Cash and Counseling demonstration.
    The Commissioner's demonstration project will involve no or minimal 
new or additional program costs to the Federal government under title 
XVI of the Act or to the four State participants under section 1616 of 
the Act. SSI beneficiaries who choose to participate in this 
demonstration will purchase services which would ordinarily be provided 
by Medicaid and other Federal

[[Page 58804]]

and State services programs at a potentially greater cost. If the 
Commissioner decided not to exercise his authority under section 
1110(b) of the Act to waive certain resources rules for participants in 
the Cash and Counseling demonstration, SSI beneficiaries could choose 
not to participate in the Secretary's demonstration and continue to 
receive services directly, rather than through the beneficiary's 
purchase. Continued SSI eligibility for beneficiaries who choose to 
participate in the demonstration project is not a new or additional 
cost related to the Commissioner's demonstration project.
    SSI beneficiary participation in the Cash and Counseling 
demonstration should not affect SSI benefit amounts even if the 
beneficiary employs an ineligible spouse or ineligible parent as a 
provider of services, unless the beneficiary is an alien who employs 
the sponsor to provide these services. Although the income and 
resources of an eligible spouse or eligible child is deemed to include 
a portion of the income and resources of the ineligible spouse or 
parent under sections 1614(f)(1) and (2) of the Act, the Commissioner 
has exercised his discretion permitted under those provisions to 
exclude from deeming the income of an ineligible spouse or ineligible 
parent paid under a Federal, State or local government program to 
provide the eligible spouse or eligible child with chore, attendant or 
homemaker services as described in regulations at 20 CFR 
416.1161(a)(16). However, the Commissioner has no similar discretionary 
authority for deeming from a sponsor to an alien.
    If an SSI beneficiary chooses to employ his or her ineligible 
spouse or ineligible parent as a provider of services, and the 
ineligible spouse or parent conserves all or part of those funds, the 
retained portion of those funds will become deemable resources to the 
eligible spouse or child the month after the month of receipt as 
described in regulations at 20 CFR 416.1202. SSA routinely explains the 
SSI resources limits and the rules concerning the deeming of resources 
to affected SSI beneficiaries. Instructions to SSA field offices in the 
four States collaborating in this demonstration will reinforce the need 
to explain to affected, participating beneficiaries how payment to the 
ineligible spouse or ineligible parent could lead to an increase in 
deemable resources.
    The four States collaborating in the demonstration project will 
experience no or minimal new or additional costs under section 1616 of 
the Act for SSI beneficiaries who participate in the Cash and 
Counseling demonstration project. The demonstration project will not 
add new beneficiaries to either the SSI or State supplementary payments 
rolls, or artificially extend the eligibility of beneficiaries, or 
increase payment amounts of SSI or State supplementary payments to 
participants.
    Statutory and Regulatory Provisions Waived: The Commissioner waives 
for the duration of an individual's participation in the Cash and 
Counseling demonstration project certain SSI resources counting rules 
where application of those rules would otherwise affect the eligibility 
of an individual for SSI. The specific statutory and regulatory 
provisions waived are those described in the preceding section.

    Authority: Section 1110(b) of the Social Security Act.

(Catalog of Federal Domestic Assistance Programs No. 96.006-
Supplemental Security Income)

    Dated: October 26, 1998.
Kenneth S. Apfel,
Commissioner of Social Security.
[FR Doc. 98-29276 Filed 10-30-98; 8:45 am]
BILLING CODE 4190-29-P