N.Y. Comp. Codes R. & Regs. tit. 18 § 398-2.1

Current through Register Vol. 46, No. 25, June 18, 2024

Section 398-2.1 - Definitions

The following words and terms, when used in this Part, shall have the following meanings, unless the context clearly indicates otherwise:

(a)Active receipt of SSI.Active receipt of SSI shall mean an individual or couple for whom SSA has established an eligible federal SSI payment status code as defined in this Part, who is in current pay status for federal SSI benefits, or who would be in current pay status for federal SSI benefits except for countable income. Such individual or couple must also meet all other State eligibility criteria for current ongoing SSP benefit issuances as of the time that the federal SSA electronic data file containing such individual's or couple's relevant SSI eligibility determination is transmitted to NYS via the SDX with federal payment status codes as defined in section 398-2.1 of this Part.

(b)Adequate notice. An adequate notice is a notice of action that is sent no later than the effective date of the action and complies with section 358-2.2(a)(2)-(13) of this Title.

(c)Aged person. An aged person is a person who is 65 years of age or older.

(d)Aid continuing.Aid continuing means the right to have SSP benefits or SSPNA continue unchanged until a fair hearing decision is issued. Specific criteria for aid continuing are listed in 398-10.2 of this Part.

(e)Blind person. A blind person is a person determined blind in accordance with federal regulations at 20 CFR part 416, subpart I, and as defined pursuant to pursuant to section 208 of the Social Services Law. (Code of Federal Regulations, title 20, part 416, subpart I, sections 416.901 - 416.999d; U.S. Government Printing Office, 732 North Capitol Street, NW, Washington, DC 20401-0001. An electronic location is available from the U.S. Government Printing Office at http://www.gpo.gov/fdsys/pkg/CFR-2014-title20-vol2/pdf/CFR-2014-title20-vol2-part416-subpartI.pdf. Copies may be obtained from the Office of Temporary and Disability Assistance, Public Information Office, 40 North Pearl Street, Albany, NY 12243-0001.)

(f)Congregate care. Congregate care is a shared living environment designed to serve individuals who are unable to function with complete independence. There are three levels of congregate care settings. Level 1 is "receiving family care" as defined in section 209(3)(c) of the Social Services Law. Level 2 is "receiving residential care" as defined in section 209(3)(d) of the Social Services Law. Level 3 is "receiving enhanced residential care" as defined in section 209(3)(e) of the Social Services Law. Congregate care does not include nursing homes or medical care facilities.

(g)Countable income.Countable income is all of a person's income, in cash or in kind, earned and unearned, which is not excluded by federal law or regulation in determining eligibility for SSI. The restoration of any SSP benefit and/or SSPNA to an individual eligible for current ongoing SSP benefits and or SSPNA on account of an underpayment shall not be considered countable income for purposes of SSP or SSPNA eligibility.

(h)Countable resources.Countable resources are cash, or other liquid assets, or any real or personal property that an individual, or couple owns and could convert to cash to be used for support and maintenance which is not excluded by federal law or regulation in determining eligibility for SSI. The restoration of any SSP benefit and/or SSPNA to an individual eligible for current ongoing SSP benefits and or SSPNA on account of an underpayment shall not be considered a countable resource for purposes of SSP and/or SSPNA in the month of receipt and in the nine calendar months following the month in which the individual receives the benefits.

(i)Designated representative. A designated representative is a person or organization authorized to perform certain specified functions associated with receiving information regarding an individual or couple, or the management of the recipient's SSP benefit issuances. A designated representative may only access case-specific information for periods where they are clearly listed in the SSP system as the recipient's designated representative.

(j)Disabled person. A disabled person is a person who is disabled in accordance with federal regulations at 20 CFR part 416, subpart I, and as defined by § 208 of the Social Services Law. (Code of Federal Regulations, title 20, part 416, subpart I, sections 416.901 - 416.999d; U.S. Government Printing Office, 732 North Capitol Street, NW, Washington, DC 20401-0001. An electronic location is available from the U.S. Government Printing Office at http://www.gpo.gov/fdsys/pkg/CFR-2014-title20-vol2/pdf/CFR-2014-title20-vol2-part416-subpartI.pdf. Copies may be obtained from the Office of Temporary and Disability Assistance, Public Information Office, 40 North Pearl Street, Albany, NY 12243-0001.)

(k)Earned income.Earned income is wages and earnings, including earnings from self-employment, in accordance with federal law and regulations.

(l)Eligible couple. An eligible couple consists of two persons, both of whom the SSA has established with an eligible federal SSI payment status code as defined in section 398-2.1 of this Part, who are in active receipt of SSI as defined in this Part, live together in the same residence, and are legally recognized as married under the laws of NYS, or are unmarried but are administratively recognized by the SSA as married.

(m)Eligible individual. An eligible individual is a person whom SSA has established with an eligible federal SSI payment status code as defined in section 398-2.1 of this Part, who is in active receipt of SSI as defined in section 398-2.1 of this Part.

(n)Eligible spouse. An eligible spouse is a person who: meets all eligibility criteria of the SSP or SSPNA program; is the spouse of an SSP-eligible individual; and is living in the same household with that person. The individual must be legally recognized as married under the laws of NYS or be unmarried but administratively recognized by the SSA as married.

(o)Federal Benefit Rate (FBR). The FBR is the maximum amount of SSI payable to an individual or couple with no countable income.

(p)Federal payment status codes potentially eligible for SSP benefits.

Those federal payment status codes potentially eligible for SSP benefits, as defined herein, shall be the exclusive federal payment status codes reviewed for participation in SSP provided by the SSA to New York State via the SDX:

(1) C01 - Current pay

(2) E01 - Eligibility for federal and/or state benefits based on the eligibility determination, but no payment is due

(3) E02 - Eligible for benefits but not payable in the first month

(4) M02 - Force Payment

(5) N01 - Non-pay - recipient countable income exceeds Title XVI federal benefit rate

(q)Good cause.Good cause for failure or refusal to comply, as set forth in Subpart 398-7 of this Part, includes, but is not limited to, circumstances beyond the SSP recipient's control.

(r)Interim assistance reimbursement (IAR) process. Section 1631 of the Social Security Act establishing IAR authorizes the recovery of assistance benefits issued to individuals from State and local funds for basic needs while their applications for SSI are pending, or whose SSI benefits are retroactively reinstated after a period of suspension or termination from the individual's initial retroactive payment of SSI benefits. The IAR process is set forth in Part 353 of this Title.

(s)Medical Assistance Program. The Medical Assistance Program, administered by the New York State Department of Health, provides medical assistance payments for medically necessary services and supplies for needy persons pursuant to title 11 of article 5 of the Social Services Law and Part 360 of this Title.

(t)Minor Child. A minor child is a person under age 18, or under age 22 and a student regularly attending school, college, or vocational training and who is neither married nor a head of a household.

(u)Notice of action. A notice of action is a communication from the Office advising a recipient of SSP benefits or SSPNA of any action that the Office intends to take, or has taken, with respect to a currently-eligible individual's SSP or SSPNA case.

(v)Office. The Office is the New York State Office of Temporary and Disability Assistance.

(w)Overpayment. An overpayment is the difference between the actual amount of SSP benefits or SSPNA issued to or on behalf of the recipient and the lesser amount of benefits that the recipient was eligible to receive in any given month.

(x)Parental control.Parental control is the authority of the parent(s) to make decisions on the minor child's behalf, regardless of whether or not such control is actually exercised.

(y)Public institution. A public institution is an institution that is operated or controlled by the federal or state government, or a political subdivision of the State such as a city or county. The term public institution does not include a publicly operated community residence which serves 16 or fewer residents.

(z)Representative payee. A representative payee is an individual or organization appointed by SSA to receive SSI benefits for a person who cannot manage their benefits.

(aa)Retroactive benefits.Retroactive benefits are SSP benefits, or SSPNA, issued for specific past period(s) of eligibility for which the recipient received SSI benefits between the month of initial federal SSI eligibility and active receipt of SSI as defined in section 398-2.1 of this Part or for any period in which the SSP or SSPNA benefit is reinstated after a period of suspension or termination. Retroactive SSP benefits, or SSPNA, may only be issued to an individual or couple currently eligible for SSP benefits or SSPNA. Retroactive benefits may not be issued to, or assigned on behalf of, deceased individuals, their payees, relatives, heirs, estates, or on behalf of any debt, including any debt owed to a congregate care facility where such individual may have been provided room and board, or any other private or public entities to whom the deceased SSP recipient may owe any debt or legal obligation.

(ab)Social Security Administration (SSA). The SSA is the federal agency that administers the SSI program.

(ac)State benefit rate. The State benefit rate is equal to the State standard of need for the recipient's applicable State Living Arrangement minus the FBR or a recipient's monthly Countable Income, whichever is greater.

(ad)State Living Arrangements.State Living Arrangements are categories of community living situations or congregate care settings which are criteria used to establish SSP eligibility and the SSP benefit level of individuals or couples. Where an SSP recipient receives both SSP and Supplemental Nutrition Assistance Program (SNAP) benefits and there is an observed discrepancy between the living arrangement information reported to SSP by the SSP recipient and the SNAP case record, the information as regards household composition contained in the SNAP record shall be determinative for SSP purposes.

(ae)State standard of need. The State standard of need is the maximum level of countable income that an individual or couple may have and still be eligible to receive State benefit issuances as set forth in section 209 of the Social Services Law. The term as used in this Part applies solely to the program of State benefit issuances and has no application to any other federal or State program or benefit.

(af)State Supplement Program (SSP).SSP is the NYS benefit issuance program by which SSP benefits and SSPNA are administered and issued.

(ag)State Supplement Program benefit. The SSP benefit is provided in accordance with NYS law and rules to individuals or couples, for whom SSA has established with an eligible federal SSI payment status code as defined in this Part, and who are in active receipt of federal SSI benefits or who would be in active receipt of federal SSI benefits except for countable income, and who meet all other State eligibility criteria for receipt of prospective SSP benefits as of the time the SSA electronic data file containing such individual or couple's SSI eligibility determination is transmitted to NYS via the SDX with federal payment status codes as defined in section 398-2.1 of this Part.

(ah)State Supplement Program benefit levels.State Supplement Program benefit levels are the various levels of SSP benefit issuances based on State Living Arrangement, county of residence and whether the recipient is an individual or a member of a couple.

(ai)State Supplement Program benefit issuances.State Supplement Program benefit issuances are paid by NYS to aged, blind, or disabled persons who are in active receipt of SSI as defined in 398-2.1 of this Part.

(aj)SSP-only recipient. An SSP-only recipient is an individual or couple who is ineligible for federal SSI benefits solely because their countable income equals or exceeds the FBR but who is eligible to receive SSP benefits based on the State standard of need and who meets all other State criteria in order to participate in the SSP.

(ak)State Supplemental Personal Needs Allowance (SSPNA).SSPNA is a monthly State benefit to help address personal needs of individuals who are in active receipt of federal SSI benefits and who otherwise meet the State criteria necessary in order to receive SSPNA and who are residing in a residential health care facility regulated pursuant to the provisions of article 28 of the Public Health Law.

(al)Supplemental Security Income (SSI) application effective date. An individual's SSI application effective date is the first day of the month following the later of the date the: SSI application is filed; or the individual becomes eligible for such benefits.

(am)Supplemental Security Income (SSI) program.SSI is a federally-funded program which provides benefits to aged, blind and disabled individuals based on uniform federal eligibility standards and a national base payment level pursuant to title XVI of the Federal Social Security Act and which is administered by the SSA.

(an)Temporary absence. A temporary absence is any absence from NYS that does not exceed three consecutive months, provided that the recipient does not leave the United States for an entire calendar month during such three consecutive months and does not evidence intent to establish residence elsewhere. A minor child may be temporarily absent without time limit if he or she is away from their permanent residence to attend school and intends to return to their permanent living arrangement during the summer or extended holidays, or upon graduation or completion of training and remains under parental control.

(ao)Timely notice. A timely notice is a notice of action issued by the Office that is sent at least 10 days before the effective date of the proposed action.

(ap)Timely reporting.Timely reporting means the reporting of change in circumstances and/or any factors which effect eligibility and benefit amount, as listed in section 398-5.2 of this Part, to the Office by SSP or SSPNA recipients, or their designated representatives, payees, or other parties authorized to provide such information in a time period not to exceed 10 days after the change occurred.

(aq)Underpayment. An underpayment is the difference between the amount of benefits that the recipient was eligible to receive while in active pay status for SSP or SSPNA and the lesser amount of benefits which were actually issued to or on behalf of the recipient. Restored SSP benefits on account of underpayments may only be issued to eligible individuals in active receipt of SSP benefits. SSP underpayments may not be issued to, or assigned on behalf of, deceased individuals, their payees, relatives, heirs, estates or on behalf of any debt, including any debt owing to a congregate care facility where such individual may have been provided room and board, or any other private or public entities to whom the deceased recipient may owe a debt or legal obligation.

(ar)Unearned income.Unearned income is all income, other than that defined as earned income, in accordance with federal law and regulation.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 398-2.1

Adopted by New York State Register September 24, 2014/Volume XXXVI, Issue 38, eff. 10/1/2014.

Amended New York State Register January 13, 2021/Volume XLIII, Issue 02, eff. 1/13/2021