[Federal Register Volume 62, Number 152 (Thursday, August 7, 1997)]
[Rules and Regulations]
[Pages 42411-42412]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-20741]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Part 416
[Regulation No. 16]
RIN 0960-AE61
Reduction in Supplemental Security Income (SSI) Payable to
Institutionalized Children Whose Medical Costs Are Covered by Private
Insurance
AGENCY: Social Security Administration.
ACTION: Final rules.
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SUMMARY: The interim final rules published at 62 FR 1053, on January 8,
1997, are adopted as final without change. These rules implement an
amendment to section 1611(e)(1)(B) of the Social Security Act (the Act)
made by section 214 of Pub. L. 104-193, the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996.
DATES: These rules are effective beginning January 8, 1997.
FOR FURTHER INFORMATION CONTACT: Daniel T. Bridgewater, Legal
Assistant, Division of Regulations and Rulings, Social Security
Administration, 6401 Security Boulevard, Baltimore, MD 21235, (410)
965-3298 for information about these rules. For information on
eligibility or claiming benefits, call our national toll-free number,
1-800-772-1213.
SUPPLEMENTARY INFORMATION:
Background
Section 1611(e)(1)(A) of the Act generally precludes eligibility
for SSI benefits when a claimant is a resident of a public institution
throughout a month. However, section 1611(e)(1)(B) provided an
exception to that bar. Under that section, payments could be made at
the reduced Federal benefit rate to individuals in institutions
``receiving payments (with respect to such individual or spouse) under
a State plan approved under title XIX * * *'' This language was
implemented through regulations to mean that individuals in
institutions would receive only the reduced benefit amount when
``Medicaid (title XIX of the Social Security Act) pays a substantial
part (more than 50 percent) of the cost of'' the claimant's care
(Sec. 416.211(b)).
Section 214 of Pub. L. 104-193, effective for benefits beginning
with the month of December 1996, amends section 1611(e)(1)(B) of the
Act by extending applicability of the reduced SSI benefit rate to
children under age 18 in medical care facilities receiving payments on
their behalf under a health insurance policy issued by a private
provider (hereinafter referred to as private health insurance). Prior
to the enactment of section 214, children under the age of 18 in
private institutions with private health insurance generally could be
eligible for a full SSI payment. Section 214 now restricts the SSI
payment for such children to the Federal reduced benefit rate. Also,
prior to this legislation, individuals in public institutions not
receiving substantial Medicaid payments on their behalf generally were
ineligible for SSI. However, as a result of this legislation, children
under age 18 in public institutions receiving private health insurance
on their behalf now are eligible for SSI payments at the reduced
Federal benefit amount.
The final rules apply the reduced Federal benefit amount to
children under age 18 with private health insurance when it, either
alone or in combination with Medicaid, pays a substantial part (more
than 50 percent) of the cost of their care in the institution.
Regulatory Changes
During the public comment period, we received two comments within
the scope of this rulemaking. One commenter, representing a major
advocacy group for retarded citizens, expressed agreement with the
Social Security Administration's interpretation of the provision
regarding the amount of private insurance payments required in order
for the reduced Federal SSI benefit rate to apply. Another commenter
asked that we add a clarification specifying that Health Maintenance
Organizations (HMOs) are
[[Page 42412]]
considered to be private health insurance providers within the meaning
of this provision. However, the constantly evolving variety of
innovative funding sources for institutional care precludes any attempt
to specifically address each possible situation in these regulations.
Our administrative issuances provide guidance to adjudicators in
determining whether particular HMOs, or other kinds of insurers, may or
may not be considered private health insurance providers. We also
received several other comments, but they were not within the scope of
this rulemaking.
Therefore, the interim final rules are adopted as final without
change.
Dated: July 28, 1997.
John J. Callahan,
Acting Commissioner for Social Security.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Accordingly, the interim final rules amending 20 CFR part 416 which
were published at 62 FR 1053 on January 8, 1997, are adopted as final
without change.
[FR Doc. 97-20741 Filed 8-6-97; 8:45 am]
BILLING CODE 4190-29-P
