To revise current policy to exclude publicly operated community residences which serve no more than 16 residents from the definition of public institution.
Section 1611(e)(1) of the Social Security Act, as amended by Public Law 94-566, Section 505(a); Regulations No. 16, Section 416.231.
Prior to the enactment of Public Law 94-566 on October 20, 1976, Section 1611(e)(1) of the Social Security Act provided that no person could be eligible to receive supplemental security income benefits for any month throughout which he or she was an inmate of a public institution.
This section of the act was amended effective October 1, 1976, to exclude publicly operated community residences serving no more than 16 residents from the definition of public institution. This action allows residents of such community residences, assuming other eligibility criteria are met, to be eligible to receive supplemental security income benefits. The underlying philosophy behind the need for "community services" is to provide a setting where not only life sustaining services of food and shelter can be provided, but also a home-like atmosphere of support for emotional growth and life enrichment activities.
The terms "community residences" and "family-like group homes" are ones used by advocates for the "deinstitutionalization" and "normalization" programs more closely associated with the mentally retarded and mentally disabled populations. Facilities used by aged, physically disabled, drug or alcohol addicts or criminal offenders as an alternative to institutional, hospital, or prison living may be classified as "community residences" if their aim is to provide a home while helping their residents to acclimate to community living and, where possible, easing their transition into independent living situations.
Community residences are meant to provide for basic needs and a home-like atmosphere while encouraging the integration of their residents into the services and programs available in the surrounding community. These community services may include formal education and vocational training opportunities, as well as developmental or ongoing work experience. Preferably, the emphasis is placed on "home" for the atmosphere of the community residence, while the emphasis on educational training of work experiences is focused on having these activities take place outside the community residence as a part of the community's services and programs available to all its citizens. This is in keeping with the normalization concept and allows for possible transition from a community residence back into independent living in the community.
The preceding statements regarding the desirability of separating "home" for living and "programs" for study or work as being provided by the outside community should not be construed to mean that community residences cannot be classified as residential facilities if they do provide some on-site programming. They can. A residential facility may also provide a resident work program and still retain its residential status. However, the availability of a resident work program is significant for supplemental security income purposes if it is one which causes a resident to become an employee of the facility or organization running the facility and raises the issue of earned income in the form of wages in cash or in kind.
Publicly operated community residences which serve no more than 16 residents are to be excluded from the definition of "public institution."
A community residence is defined as a residential setting providing some services which meet some need beyond the basic provision of food and shelter. The services provided by such facilities may include social services, training, assistance with personal living activities, and occasional or incidental medical or remedial care. The emphasis of the facility is on providing any of these services in an atmosphere of acceptance and support (for both physical and emotional needs of the residents) such as is to be found in a small residential setting rather than in "institutions." The primary focus is to provide an alternative arrangement to institutionalized living.
Varieties of community residents may include various levels of personal care of domiciliary care or congregate care. Community residences may be focused on several distinctly identified different groups of individuals; e.g., mentally disabled, physically handicapped, drug addicts and alcoholics, criminal offenders, runaway juveniles, etc. However, a residential setting is not a community residence if its primary purpose is to serve as a correctional or holding accommodation, provide educational or vocational training, or provide on-site medical or remedial care (as defined in title 45 of the Code of Federal Regulations, section 228.1). (A resident work program for some or all of its residents would not exclude the facility from the definition of residence.)
For purposes of this provision, the definition of "publicly operated" as provided in title 20 of the Code of Federal Regulations, section 416.231(b)(2), is applicable to community residences.
While a residential facility may be located in an urban, suburban, or rural area, if it is a part of a large institution or multiple purpose complex (for example, a cottage) located on the grounds of or immediately adjacent to said institution or complex, it shall be excluded from consideration as a community residence. This is because a community residence is intended as an alternative living arrangement outside of an institutional setting and as such must be located in the community away from the parent institution.
For purposes of this provision, a community residence is considered to "serve" no more than 16 residents if: the individual plan and design of the facility provides that the facility is intended to accommodate no more than 16 residents, or the plan and design was changed to serve no more than 16 residents; and no more are actually being served. In the planning, design, specifications and subsequent building or remodeling of a facility a basic decision has been made to accommodate a specified number of persons. Each facility has such plans. Therefore, they may serve as a basis for determining that a facility is designed to serve no more than 16 residents. There may be occasions when a facility designed to accommodate 16 or less residents will be serving more than 16 residents for short periods of time. In such situations, regardless of the design, the actual serving of more than 16 residents will result in failure to meet the definition of community residence. Similarly, if the facility is designed to accommodate in excess of 16 persons, this will always result in a finding that the facility does not meet the definition of community residence.
Verification that the residential setting meets the requirements for a publicly operated community residence.
Final regulations covering this policy were published in the Federal Register on November 28, 1978, at 43 FR 55379. The revised policy does not change existing policy with respect to the definition of institution, except to exclude publicly operated community residences which serve no more than 16 residents from such definition. The definition of an inmate of a public institution and other aspects of policy relating to a limitation on eligibility due to institutional status remain the same.
Claims Manual Section A12210.
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