[Federal Register Volume 72, Number 57 (Monday, March 26, 2007)]
[Proposed Rules]
[Pages 14053-14056]
From the Federal Register Online via the Government Publishing 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 
[email protected]; 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)
----------------------------------------------------------------------------------------------------------------
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...............
----------------------------------------------------------------------------------------------------------------

    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: [email protected].
    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