[Federal Register Volume 59, Number 45 (Tuesday, March 8, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-4910]
[[Page Unknown]]
[Federal Register: March 8, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Social Security Administration
20 CFR Part 416
RIN 0960-AC98
Supplemental Security Income for the Aged, Blind, and Disabled;
Elimination of Waiting Period for Termination of Couple Status
AGENCY: Social Security Administration, HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule implements section 8012(a) of the Omnibus
Budget Reconciliation Act changed the definition of the term ``eligible
spouse'' as it is used in the supplemental security income (SSI)
program. Under the former definition of ``eligible spouse,'' members of
an SSI eligible couple who began living apart could not be treated as
individuals for SSI eligibility and payment purposes during the first 6
months following the month in which they began living apart. The
statutory change eliminated the 6-month waiting period. The proposed
rule would revise the definition of ``eligible spouse'' contained in
the regulations as well as make a number of other conforming changes.
Finally, the rule would eliminate provisions in the regulations
pertaining to eligible couples living apart.
DATES: To be sure that your comments are considered, we must receive
them no later than May 9, 1994.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, Department of Health and Human Services, P.O. Box
1585, Baltimore, Maryland 21235, sent by telefax to (410) 966-0869 or
delivered to the Office of Regulations, Social Security Administration,
3-B-1 Operations Building, 6401 Security Boulevard, Baltimore, Maryland
21235, between 8 a.m. and 4:30 p.m. on regular business days. Comments
may be inspected during these same hours by making arrangements with
the contact person shown below.
FOR FURTHER INFORMATION CONTACT: Irving Darrow, Legal Assistant, Office
of Regulations, Social Security Administration, 6401 Security
Boulevard, Baltimore, MD 21235, telephone (410) 966-0512.
SUPPLEMENTARY INFORMATION: Section 1614(b) of the Social Security Act
(the Act), as in effect until October 1, 1990, defined an eligible
spouse as ``an aged, blind, or disabled individual who is the husband
or wife of another aged, blind, or disabled individual and who has not
been living apart from such other aged, blind, or disabled individual
for more than six months.'' One effect of this definition was to create
a 6-month waiting period before the members of an eligible couple, who
began living apart, could be treated as individuals for SSI purposes.
Section 8012 of Public Law 101-239 (the Omnibus Budget
Reconciliation Act of 1989) eliminated the 6-month waiting period by
revising the definition of an eligible spouse. Effective October 1,
1990, ``eligible spouse'' means an aged, blind, or disabled individual
who is the husband or wife of another aged, blind, or disabled
individual and who is living with that eligible individual on the first
day of the month, or, in any case in which either spouse files an
application for benefits or requests restoration of eligibility under
the SSI program during the month, at the time the application or
request is filed.
The proposed rule revises the definition of ``eligible spouse'' in
Secs. 416.120(c)(14) and 416.1801(c) to reflect section 8012 of Public
Law 101-239.
The legislative history does not indicate that Congress intended to
treat couples who are temporarily separated as individuals. Therefore,
the rule also provides in Sec. 416.1801(c) that an individual is
considered to be living with an eligible spouse during temporary
absences as defined in Sec. 416.1149 and while receiving continued
benefits under section 1611(e)(1) (E) or (G) of the Act.
In addition to revising the definition of ``eligible spouse'' in
Secs. 416.120(c)(14) and 416.1801(c), a number of other sections in the
regulations are being revised to eliminate provisions which refer to
the prior rule for terminating eligible couple status based on a 6-
month period of living apart. These sections are as follows:
Section 416.305(b)(1) is being revised to remove language
regarding the eligible spouse living apart from the eligible individual
for a period of 6 months.
Section 416.412 is being amended by using more precise
language in the first sentence when referring to a member of an
eligible couple temporarily residing in a medical care facility.
Section 416.414 is being revised to specify that the
computations in paragraphs (b)(2) and (b)(3) are applicable only when
one or both members of an eligible couple are temporarily absent from
home per Sec. 416.1149(c)(1). As their absence is temporary, they are
not separated.
Section 416.430, which deals with essential person
increments, is being revised by removing language regarding when the
members of an eligible couple live apart and adding language to explain
how to pay a couple when one member is temporarily absent and subject
to the $30 payment limit while an inpatient at a medical facility where
Medicaid is paying more than half the cost of care. The reference to
Sec. 416.531 is also being changed to Sec. 416.413.
In Sec. 416.432, a portion of the introductory language
and paragraphs (a) and (b) are being removed. The removed material
concerns members of an eligible couple who have separated.
Section 416.532(e), which provides for essential person
increments when members of an eligible couple live apart, is being
removed.
In Sec. 416.554, the last sentence of the text and example
three regarding separated members of an eligible couple are being
revised.
In Sec. 416.1130(c), the last sentence, which refers to
members of an eligible couple who have different living arrangements,
is being removed.
In Sec. 416.1147, paragraphs (a) and (d) are being removed
and the remaining paragraphs are being revised and redesignated (a),
(b), (c), and (d) respectively. The deleted material deals with
valuation of in-kind support and maintenance for a member of an
eligible couple who is separated from his or her spouse.
Section 416.1802(b) is being revised to remove language
referring to computation of benefits for separated members of an
eligible couple.
Section 416.1806 is being revised to contain rules on who
will be considered the individual's spouse, if more than one person
would qualify.
Section 416.1811 is being removed as a result of the
revision to Sec. 416.1806. The cross-reference to Sec. 416.1811 in
Sec. 416.1101 (definition of ``spouse'') is also being removed.
Section 416.1830(a)(1) is being revised to provide that,
if the members of an eligible couple begin living apart, they will be
treated as individuals beginning with the month following the calendar
month they stopped living together.
In Sec. 416.1832(c) and (d), the cross-references to
Sec. 416.1806(b) and (c) respectively are being revised to refer to
Sec. 416.1806(a)(2) and (a)(3) respectively. This change is
necessitated by the revision we are making to Sec. 416.1806.
Section 416.1832(d) is being revised to provide that, if a
marital relationship has been found to exist solely because a man and
woman are living together and leading others to believe that they are
husband and wife, such marital relationship will be considered to end
as of the date the man and woman stop living together.
Enactment of section 8012(a) of Public Law 101-239 has made the
following Social Security Rulings (SSRs) obsolete: 76-28, 76-41, and
88-11c.
Regulatory Procedures
Regulatory Flexibility Act
We certify that this proposed regulation, if promulgated, will not
have a significant economic impact on a substantial number of small
entities because it will affect only individuals and States. Therefore,
a regulatory flexibility analysis as provided in Public Law 96-354, the
Regulatory Flexibility Act, is not required.
Paperwork Reduction Act of 1980
This proposed regulation imposes no additional reporting and
recordkeeping requirements necessitating clearance by the Office of
Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.807,
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.
Dated: January 13, 1994.
Shirley Chater,
Commissioner of Social Security.
Approved: February 22, 1994.
Donna E. Shalala,
Secretary of Health and Human Services.
Part 416 of chapter III of title 20 of the Code of Federal
Regulations is amended as follows:
PART 416--[AMENDED]
1. The authority citation for subpart A is revised to read as
follows:
Authority: Secs. 1102 and 1601-1634 of the Social Security Act;
42 U.S.C. 1302 and 1381-1383c; sec. 212 of Pub. L. 93-66, 87 Stat.
155 and sec. 502(a) of Pub. L. 94-241, 90 Stat. 268.
2. In Sec. 416.120, paragraph (c)(14) is revised to read as
follows:
Sec. 416.120 General definitions and use of terms.
* * * * *
(c) Miscellaneous. * * *
(14) ``Eligible spouse'' means an aged, blind, or disabled
individual who is the husband or wife of another aged, blind, or
disabled individual and who is living with that individual (see
Sec. 416.1801(c)).
* * * * *
3. The authority citation for subpart C continues to read as
follows:
Authority: Secs. 1102, 1611 and 1631(a), (d), and (e) of the
Social Security Act; 42 U.S.C. 1302, 1382, 1383(a), (d), and (e).
4. In Sec. 416.305, paragraph (b) introductory text is republished
and paragraph (b)(1) is revised to read as follows:
Sec. 416.305 You must file an application to receive supplemental
security income benefits.
* * * * *
(b) Exceptions. You need not file a new application if--
(1) You have been receiving benefits as an eligible spouse and are
no longer living with your husband or wife;
* * * * *
5. The authority citation for subpart D continues to read as
follows:
Authority: Secs. 1102, 1611(a), (b), (c), and (e), 1612, 1617,
and 1631 of the Social Security Act; 42 U.S.C. 1302, 1382(a), (b),
(c), and (e), 1382a, 1382f, and 1383.
6. Section 416.412 is revised to read as follows:
Sec. 416.412 Amount of benefits; eligible couple.
The benefit under this part for an eligible couple, neither of whom
is temporarily residing in a medical care facility as described in
Sec. 416.1149(c)(1) nor is a qualified individual (as defined in
Sec. 416.221), shall be payable at the rate of $6,048 per year ($504
per month) after rounding, effective for the period beginning January
1, 1986. This rate is the result of a 3.1 percent cost-of-living
adjustment (see Sec. 416.405) to the December 1985 rate. For the period
January 1, 1985, through December 31, 1985, the rate payable, as
increased by the 3.5 percent cost-of-living adjustment, was $5,856
($488 per month). For the period January 1, 1984, through December 31,
1984, the rate payable, as increased by the 3.5 percent cost-of-living
adjustment, was $5,664 per year ($472 per month). For the period July
1, 1983, through December 31, 1983, the rate payable was $5,476.80 per
year ($456.40 per month), as provided by the Social Security Amendments
of 1983 (Pub. L. 98-21, Section 401). For the period July 1, 1982,
through June 30, 1983, the rate, as increased by the 7.4 percent cost-
of-living adjustment, was $5,116.80 yearly ($426.40 monthly). The
monthly rate is reduced by the amount of the couple's income which is
not excluded pursuant to subpart K of this part.
7. In Sec. 416.414, the paragraph headings for paragraphs (b)(2)
and (b)(3) are revised to read as follows:
Sec. 416.414 Amount of benefits; eligible individual or eligible
couple in a medical care facility.
* * * * *
(b) * * *
(2) Eligible couple both of whom are temporarily absent from home
in medical care facilities as described in Sec. 416.1149(c)(1). * * *
(3) Eligible couple with one spouse who is temporarily absent from
home as described in Sec. 416.1149(c)(1). * * *
* * * * *
8. Section 416.430 is revised to read as follows:
Sec. 416.430 Eligible individual with eligible spouse; essential
person(s) present.
(a) When an eligible individual with an eligible spouse have an
essential person (Sec. 416.222) living in his or her home, or when both
such persons each has an essential person, the increase in the rate of
payment is determined in accordance with Secs. 416.413 and 416.532. The
income of the essential person(s) is included in the income of the
couple and the payment due will be equally divided between each member
of the eligible couple.
(b) When one member of an eligible couple is temporarily absent in
accordance with Sec. 416.1149(c)(1) and Sec. 416.222(c) and either one
or both individuals has an essential person, add the essential person
increment to the benefit rate for the member of the couple who is
actually residing with the essential person and include the income of
the essential person in that member's income. See Sec. 416.414(b)(3).
9. Section Sec. 416.432 is revised to read as follows:
Sec. 416.432 Change in status involving a couple; eligibility
continues.
When there is a change in status which involves the formation or
dissolution of an eligible couple (for example, marriage, divorce), a
redetermination of the benefit amount shall be made for the months
subsequent to the month of such formation or dissolution of the couple
in accordance with the following rules:
(a) When there is a dissolution of an eligible couple and each
member of the couple becomes an eligible individual, the benefit amount
for each person shall be determined individually for each month
beginning with the first month after the month in which the dissolution
occurs. This shall be done by determining the applicable benefit rate
for an eligible individual with no eligible spouse according to
Sec. 416.410 or Sec. 416.413 and Sec. 416.414 and applying
Sec. 416.420(a). See Sec. 416.1147a for the applicable income rules
when in-kind support and maintenance is involved.
(b) When two eligible individuals become an eligible couple, the
benefit amount will be determined for the couple beginning with the
first month following the month of the change. This shall be done by
determining which benefit rate to use for an eligible couple according
to Sec. 416.412 or Sec. 416.413 and Sec. 416.414 and applying the
requirements in Sec. 416.420(a).
10. The authority citation for subpart E continues to read as
follows:
Authority: Secs. 1102, 1601, 1602, 1611(c), and 1631 (a), (b),
(d), and (g) of the Social Security Act; 42 U.S.C. 1302, 1381,
1381a, 1382(c), and 1383 (a), (b), (d), and (g).
Sec. 416.532 [Removed]
11. In Sec. 416.532, paragraph (e) is removed.
12. Section 416.554 is revised to read as follows:
Sec. 416.554 Waiver of adjustment or recovery--against equity and good
conscience.
We will waive adjustment or recovery of an overpayment when an
individual on whose behalf waiver is being considered is without fault
(as defined in Sec. 416.552) and adjustment or recovery would be
against equity and good conscience. Adjustment or recovery is
considered to be against equity and good conscience if an individual
changed his or her position for the worse or relinquished a valuable
right because of reliance upon a notice that payment would be made or
because of the incorrect payment itself. In addition, adjustment or
recovery is considered to be against equity and good conscience for an
individual who is a member of an eligible couple that is legally
separated and/or living apart, on a 6-month trip, for that part of an
overpayment not received, but subject to recovery under Sec. 416.570.
Example 1: Upon being notified that he was eligible for
supplemental security income payments, an individual signed a lease
on an apartment renting for $15 a month more than the room he had
previously occupied. It was subsequently found that eligibility for
the payment should not have been established. In such a case,
recovery would be considered ``against equity and good conscience.''
Example 2: An individual fails to take advantage of a private or
organization charity, relying instead on the award of supplemental
security income payments to support himself. It was subsequently
found that the money was improperly paid. Recovery would be
considered ``against equity and good conscience.''
Example 3: Mr. and Mrs. Smith--members of an eligible couple--
separate in July. Later in July, Mr. Smith receives earned income
resulting in an overpayment to both. Mrs. Smith is found to be
without fault in causing the overpayment. Recovery from Mrs. Smith
of Mr. Smith's part of the couple's overpayment is waived as being
against equity and good conscience. Whether recovery of Mr. Smith's
portion of the couple's overpayment can be waived will be evaluated
separately.
13. The authority citation for subpart K is revised to read as
follows:
Authority: Secs. 1102, 1602, 1611, 1612, 1613, 1614(f), 1621,
and 1631 of the Social Security Act; 42 U.S.C. 1302, 1381a, 1382,
1382a, 1382b, 1382c(f), 1382j, and 1383; sec. 211 of Pub. L. 93-66,
87 Stat. 154.
Sec. 416.1110 [Amended]
14. In Sec. 416.1101, the parenthetical reference in the definition
of ``Spouse'' which reads ``(See Secs. 416.1806 through 416.1811)'' is
revised to read ``(See Sec. 416.1806).''
15. In Sec. 416.1130, paragraph (c) is revised to read as follows:
Sec. 416.1130 Introduction.
* * * * *
(c) How we value in-kind support and maintenance. Essentially, we
have two rules for valuing the in-kind support and maintenance which we
must count. The one-third reduction rule applies if you are living in
the household of a person who provides you with both food and shelter
(Secs. 416.1131 through 416.1133). The presumed value rule applies in
all other situations where you are receiving countable in-kind support
and maintenance (Secs. 416.1140 through 416.1145). If certain
conditions exist, we do not count in-kind support and maintenance.
These are discussed in Secs. 416.1141 through 416.1145.
16. Section 416.1147 is revised to read as follows:
Sec. 416.1147 How we value in-kind support and maintenance for a
couple.
(a) Both members of a couple live in another person's household and
receive food and shelter from that person. When both of you live in
another person's household through-out a month and receive food and
shelter from that person, we apply the one-third reduction to the
Federal benefit rate for a couple (Sec. 416.1131).
(b) One member of a couple lives in another person's household and
receives food and shelter from that person and the other is in a
medical institution. If one of you is living in the household of
another person who provides you with both food and shelter and the
other is temporarily absent from the household as provided in
Sec. 416.1149(c)(1) (in a medical institution that receives Medicaid
payments for his or her care (Sec. 416.211(b)), we compute your
benefits as if you were separately eligible individuals (see
Sec. 416.414(b)(3)). This begins with the first full calendar month one
of you is in the medical institution. The one living in another
person's household is eligible at an eligible individual's Federal
benefit rate and one-third of that rate is counted as income not
subject to any income exclusions. The one in the medical institution
cannot receive more than the rate described in Sec. 416.414(b)(3)(i).
(c) Both members of a couple are subject to the presumed value
rule. If the presumed value rule applies to both of you, we value any
food, clothing, or shelter you and your spouse receive at one-third of
the Federal benefit rate for a couple plus the amount of the general
income exclusion (Sec. 416.1124(c)(12)), unless you can show that their
value is less as described in Sec. 416.1140(a)(2).
(d) One member of a couple is subject to the presumed value rule
and the other is in a medical institution. If one of you is subject to
the presumed value rule and the other is temporarily absent from the
household as provided in Sec. 416.1149(c)(1) (in a medical institution
that receives Medicaid payments for his or her care (Sec. 416.211(b)),
we compute your benefits as if you were separately eligible individuals
(see Sec. 416.414(b)(3)). This begins with the first full calendar
month that one of you is in the medical institution (Sec. 416.211(b)).
We value any food, clothing, or shelter received by the one outside of
the medical institution at one-third of an eligible individual's
Federal benefit rate, plus the amount of the general income exclusion
(Sec. 416.1124(c)(12)), unless you can show that their value is less as
described in Sec. 416.1140(a)(2). The one in the medical institution
cannot receive more than the rate described in Sec. 416.414(b)(3)(i).
17. The authority citation for subpart R continues to read as
follows:
Authority: Secs. 1102, 1614(b), (c), and (d), and 1631(d)(1) and
(e) of the Social Security Act; 42 U.S.C. 1302, 1382c (b), (c), and
(d), and 1383 (d)(1) and (e).
18. In Sec. 416.1801(c), the definition of ``eligible spouse'' is
revised to read as follows:
Sec. 416.1801 Introduction
* * * * *
(c) * * *
Eligible spouse means a person--
(1) Who is eligible for SSI,
(2) Whom we consider the spouse of another person who is eligible
for SSI, and
(3) Who was living in the same household with that person on--
(i) The date of filing an application for benefits (for the month
of an application);
(ii) The date a request for reinstatement of eligibility is filed
(for the month of such request); or
(iii) The first day of the month, for all other months.
An individual is considered to be living with an eligible spouse during
temporary absences as defined in Sec. 416.1149 and while receiving
continued benefits under section 1611(e)(1) (E) or (G) of the Act.
* * * * *
19. In Sec. 416.1802, paragraph (b) is revised to read as follows:
Sec. 416.1802 Effects of marriage on eligibility and amount of
benefits.
* * * * *
(b) If you have an eligible spouse--(1) Counting income. If you
apply for or receive SSI benefits and have an eligible spouse as
defined in Sec. 416.1801(c), we will count your combined income and
calculate the benefit amount for you as a couple. Section 416.412 gives
a detailed statement of the amount of benefits and subpart K of this
part explains how we count income for an eligible couple.
(2) Counting resources. If you have an eligible spouse as defined
in Sec. 416.1801(c), we will count the value of your combined resources
(money and property), minus certain exclusions, and use the couple's
resource limit when we determine your eligibility. Section 416.1205(b)
gives a detailed statement of the resource limit for an eligible
couple.
* * * * *
20. Section 416.1806 is revised to read as follows:
Sec. 416.1806 Whether you are married and who is your spouse.
(a) We will consider someone to be your spouse (and therefore
consider you to be married) for SSI purposes if--
(1) You are legally married under the laws of the State where your
and his or her permanent home is (or was when you lived together);
(2) We have decided that either of you is entitled to husband's or
wife's Social Security insurance benefits as the spouse of the other
(this decision will not affect your SSI benefits for any month before
it is made); or
(3) You and an unrelated person of the opposite sex are living
together in the same household at or after the time you apply for SSI
benefits, and you both lead people to believe that you are husband and
wife.
(b) If more than one person would qualify as your husband or wife
under paragraph (a) of this section, we will consider the person you
are presently living with to be your spouse for SSI purposes.
Sec. 416.1811 [Removed]
21. Section 416.1811 is removed.
22. In Sec. 416.1830, paragraph (a) is revised to read as follows:
Sec. 416.1830 When we stop considering you and your spouse an eligible
couple.
* * * * *
(a) The calendar month after the month you stopped living with your
eligible spouse, or
* * * * *
23. In Sec. 416.1832, paragraphs (c) and (d) are revised to read as
follows:
Sec. 416.1832 When we consider your marriage ended.
* * * * *
(c) We decide that either of you is not a spouse of the other for
purposes of husband's or wife's social security insurance benefits, if
we considered you married only because of Sec. 416.1806(a)(2); or
(d) You and your spouse stop living together, if we considered you
married only because of Sec. 416.1806(a)(3).
[FR Doc. 94-4910 Filed 2-7-94; 8:45 am]
BILLING CODE 4190-29-P
