Continuation of SSI Benefits for the Temporarily Institutionalized – Certification of Period and Need to Maintain Home

Screen Shots for MSSICS LINS Screen
When continued payments are payable for temporary institutionalization, SSA must receive the
physician's certification and home expenses statement by the recipient’s discharge date or 90
days from admission date (whichever is earlier). The SSA claims representative confirms that
the recipient and physician provided this required information by inputting the receipt dates in
fields 24-C and 25-C (the Facsimile 2 of the LINS screen below highlighted in yellow).
SSA does not use Fields 24-C and 25-C as a collection instrument. Rather, SSA uses Fields
24-C and 25-C to tell the SSI computer system that the claims representative obtained the
necessary documentation to determine that the SSI recipient is eligible for temporary
institutionalization benefits. If we do not complete these fields, the computer system will not
pay the temporary institutionalization benefits to the recipient. These fields serve as a safeguard
to prevent the issuance of incorrect payments to a recipient who does not meet the requirements
to receive temporary institutionalization benefits.

C.
MSSICS

FACSIMILE 1: LINS - INSTITUTION RESIDENCE DATA
INSTITUTION RESIDENCE DATA
[1-D]
SSSSS SSSSSSSSSS PERIOD BEGAN: SS/SS/SSSS

PAGE 1 OF LINS
[2-O]
TRANSFER TO: XXXX

SSS-SS-SSSS
[3-M]
INSTITUTION NAME: BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
[4-M]
ADDRESS: PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPP
[5-M]
[6-C]
[7-M]
CITY: PPPPPPPPPPPPPPPPPPPPPP
STATE: PP
ZIP: PPPPP
[8-C]
COUNTRY: XXXXXXXXXXXXXXXXXXXXXX
[9-O]
TELEPHONE: PPP PPP PPPP
[10-D]
[11-O]
ADMISSION DATE (MMDDYY): SS/SS/SS
DISCHARGE DATE (MMDDYY): 999999
[12-M]
VERIFIED (Y/N): X
[13-D]
DATE INSTITUTIONALIZATION BEGAN (MMDDYY): SS/SS/SS
[14-M]
[15-M]
INSTITUTION: 9
1=PUBLIC
CONFINEMENT REASON: 9 1=MEDICAL/PSYCH
2=PRIVATE
2=EDUCATION/VOC
3=EMERG SHELTER
4=PUB COMM RES
[16-C]
5=PRISONER
OVER 50% MEDICAID PAYMENTS (Y/N): B
6=OTHER

[17-C]
PRIVATE HEALTH INSURANCE
(Y/N): B
[18-C]
INSTITUTION FOR FOOD STAMP PURPOSES (Y/N): P
[19-O]
REMARKS (Y): X

D.
MSSICS

FACSIMILE 2: LINS - INSTITUTION RESIDENCE DATA
INSTITUTION RESIDENCE DATA
[1-D]
SSSSS SSSSSSSSSS PERIOD BEGAN: SS/SS/SSSS

PAGE 2 OF LINS
[2-O]
TRANSFER TO: XXXX

SSS-SS-SSSS
[20-M]
INSTITUTION TEMPORARY (Y/N): X
[21-M]
ELIGIBLE FOR AND CHOOSES SPECIAL INSTITUTIONAL PAYMENTS - 1619/1611E (Y/N): X
[22-C]
IF NO,
ELIGIBLE FOR AND CHOOSES CONTINUING PAYMENT - 9115 (Y/N): X
[23-C]
IF YES, TYPE OF CARE: 9
CARE OPTIONS
1=ACUTE CARE
2=INTERMEDIATE CARE (MENTAL)
3=INTERMEDIATE CARE (NON-MENTAL) 4=SKILLED NURSING CARE
[24-C]
HOME EXPENSE STATEMENT DATE FOR
SSSSS SSSSSSSSSS: 999999
HOME EXPENSE STATEMENT DATE FOR
SSSSS SSSSSSSSSS: 999999
[25-C]
PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS: 999999
PHYSICIAN'S CERTIFICATION DATE FOR SSSSS SSSSSSSSSS: 999999
[26-C]
IF NOT DISCHARGED, CONTINUED PAYMENT PERIOD ENDED (Y): X
[27-C]
WHICH MEMBER OF COUPLE: X 1=SSSSS SSSSSSSSS
2=SSSSS SSSSSSSSS
3=BOTH
[28-C]
IF NO, 9115 INELIGIBILITY DECISION CODE: X
[19-O]
REMARKS (Y): X
010.011 Batch run: 04/20/2009