98-29276. 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  

  • [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]
    
    
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    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.
    
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    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
    
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    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.Streett@ssa.gov.
    
    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
    
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    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