By Ken Brown New SSA POMS on SSI Trusts: - PowerPoint Presentation

1. By Ken Brown New SSA POMS on SSI Trusts:Everything You Need to Know

2. DisclaimerThe Program Operations Manual System (POMS) rewrites under discussion were issued by the Social Security Administration (SSA) on April 30, 2018. Some of the policies presented here are new and may be subject to different interpretation.Also be aware that some local SSA offices may have interpretations that differ from the national instructions. If these negatively impact your client, you should always follow the rules for reconsideration and appeal.

3. Outline of Today’s PresentationBrief introduction to POMS, its scope and authoritySection-by-section in-depth analysis of the new POMS and changesPractical impact for establishing and administering trustsTips, tricks and tonics for your practice

4. IntroductionAccording to the SSA website:“The Program Operations Manual System (POMS) is a primary source of information used by Social Security employees to process claims for Social Security benefits. The public version of POMS is identical to the version used by Social Security employees except that it does not include internal data entry and sensitive content instructions.”(https://secure.ssa.gov/poms.nsf/Home?readform)

5. Sources of Law for the Supplemental Security Income (SSI) ProgramStatutory – Title XVI [42 U.S.C. 1381 et. seq.] of the Social Security Act  Trusts - Sec. 1613(e) [42 U.S.C. 1382b(e)] Regulatory - SSI, in general, 20 CFR Part 416 Income rules - 20 CFR Part 416, Subpart K Resource rules - 20 CFR Part 416, Subpart LNOTE: There are currently no specific regulations on trusts for the SSI program.Sub-regulatory - The Program Operations Manual System (POMS)

6. SSI Trust POMSThe Program Operations Manual System (POMS)In general, Part 5 (SI) Supplemental Security IncomeChapter 011 – ResourcesSubchapter 20 – Identifying ResourcesIn general, Part 10 (PS) Title XVI Regional Chief Counsel PrecedentsChapter 018 – Program Requirements – ResourcesSubchapter - PS 01825: TrustsSections – PS 01825.000 – PS 01825.146 (sections are State-specific, but not all States are represented)

7. Why Are the POMS Important?The SSI statute at Section 1613(e) consists of a few brief paragraphs. Neither SSA, nor CMS have issued regulations to implement agency policy.There is a lack of significant case law on the subject. Explicit congressional grant of authority to SSA to prescribe standards.Breadth of SSA’s instructions on the subject (between 100 and 200 pages interpreting several paragraphs of statutory law). The status of POMS becomes evident as the sole detailed agency policy statement and interpretation of the law on the subject.

8. Why Are the POMS Important?Almost all courts have granted deference to agency interpretations in POMS under Skidmore v. Swift, 323 U.S. 134 (1944).Under Skidmore, the weight of an agency interpretation “will depend upon the thoroughness evident in its consideration, the validity of its reasoning, its consistency with earlier and later pronouncements, and all those factors which give it power to persuade, if lacking power to control.” 323 U.S. at 140.For a good discussion, see Draper v. Colvin, 779 F.3d 556 (2015).

9. Scope of the Trust POMS RewriteThe POMS sections covered in the April 2018 rewrite are:SI 01120.200: Information on Trusts, Including Trusts Established Prior to January 01, 2000, Trusts Established with the Assets of Third Parties, and Trusts Not Subject to Section 1613(e) of the Social Security ActSI 01120.201: Trusts established with the assets of an individual on or after 1/1/00SI 01120.202: Development and Documentation of Trusts Established on or After 01/01/00SI 01120.203: Exceptions to Counting Trusts Established on or after 1/1/00

10. Scope of the Trust POMS RewritePOMS sections not changed include:SI 01120.195: Trusts Established under the Indian Gaming Regulatory Act (IGRA) for Minor Children and Legally Incompetent Adults (IGRA Trusts)(Revised TN 55, October 17, 2018)SI 01120.199: Early Termination Provisions and TrustsSI 01120.204: Notices for Trusts Established on or after 1/1/00SI 01120.225: Pooled Trusts Management ProvisionsSI 01120.227: Null and Void Clauses in Trust Documents

11. Additional Consideration – ABLE ActEffective March 8, 2018, SSA issued a revision to SI 01130.740: Achieving a BetterLife Experience (ABLE) Accounts.The interplay between trusts and ABLE accounts can very important to yourclients and therefore very important for you to understand.We will cover more on this later.

12. POMS Effective DatesIssuance or reissuance (major change) of a whole POMS section is called a transmittal, indicated by “TN ## (MM-YY)” in the upper right hand corner of the first page. This often indicates a major change such as legislation, regulations, a significant court case or a rewrite of the section.A “revision” indicated by the last line on the last page of the POMS, generally indicates that this POMS has been revised to make a smaller policy change, clarify policy, or to correct spelling, grammatical or simple errors. For example, POMS SI 01120.200 has TN 51 (04-18), but an Effective Date of 06/07/18 because it was subject to minor revision (correction).

13. POMS Effective DatesUnder standard operating procedure, the effective date of POMS is the date of issuance unless another specific date is stated. These POMS were initially issued on April 30, 2018. SI 01120.199, .200, .201 and .203 have since been revised with a new effective date. However, POMS SI 01120.200K.2.a, SI 01120.201K.2.a. and K.2.b. state an effective date for a specific policy change to the 90 day amendment period as April 27, 2018, prior to the issuance of POMS. I do not foresee any problems, just note an anomaly.

14. Medicaid Trust DeterminationsStates are divided into three primary categories based on who makes the Medicaid eligibility decision and which methodology is used:“Section 1634” states – 34 states plus D.C. & NMI. “SSI Criteria” states - AK, ID, KS, NE, NV, OR, UT“Section 209b” states - CT, HI, IL, MN, MO, NH, ND, OK, VANOTE: Pennsylvania is a Section 1634 state.

15. Medicaid Trust DeterminationsHowever, for all Medicaid trust determinations, the State makes the trust eligibility determination.SI 01120.202G.1.If the individual resides in a section 1634 State (in which SSA makes Medicaid determinations on behalf of the State), do not attempt to make a Medicaid eligibility determination since the Medicaid determination regarding the trust may differ from the SSI eligibility determination. For a discussion of Section 1634 States, see SI 01715.010A.3.In all States, SSA sends a copy of the trust information to the State.

16. Information On Trusts, Including Trusts Established Prior To January 01, 2000, Trusts Established With The Assets Of Third Parties, And Trusts Not Subject To Section 1613(e) Of The Social Security ActAnalysis of Changes to SI 1120.200

17. SI 01120.200L. - Trust review processThis section was updated to reflect the centralized trust review procedure under the SSI Trust Management System (SSITMS).

18. Trust Review Process - SSITMSThree-tiered review processField Office TechnicianInitial determinationClaim documentationa copy of the trust document (original not required), along with trust attachments, amendments (if any), and exhibits; copies of any assignment agreements;records of payments from the trust; any other pertinent documents, such as court orders; and a copy of the trust resource determination.

19. Trust Review Process - SSITMSThree-tiered review processRegional Trust Reviewer Mandatory case and decision reviewreview the trust and associated information;provide feedback in SSITMS;document the concurrence decision;indicate “agree” or “disagree” with the Claims Specialist’s trust resource determination;submit the response to the Claims Specialist.Additionally, TRs refer:trusts back to the Claims Specialist when the case needs further development; andtrusts established outside their region to RTL.

20. Trust Review Process - SSITMSThree-tiered review processRegional Trust LeadReviews decisions for all pooled trusts, reconsiderations, appeals, IGRA trustsConsults with Regional Chief Counsel/Central Office, referrals to other regionsDevelops pooled trust and other precedents

21. SI 01120.200K - Posteligibility ChangesPrior POMSSI 01120.200J.7. Post-eligibility change in resource statusIf a trust was previously determined not to be a resource, but because of policy clarifications you now determine that it is a resource (or vice versa), reopen the prior determination subject to the rules of administrative finality. (See the overpayment waiver rules in SI 02260.001.)New POMSSI 01120.200K.2.a.If due to a change in policy, a policy clarification, or reopening of a prior erroneous determination, a trust that was previously determined not to be a resource under SI 01120.200 is now determined to be a resource, offer a 90-day amendment period.

22. 90-Day Amendment PeriodNow applies to trusts previously meeting the requirements to be excepted from counting as a resource under SI 01120.200Does not apply to new or previously undisclosed trusts.One 90-day amendment period.Permits a good cause extension. (FO discretion to provide reasonable time based on situation.)Trust not counted as a resource during amendment period.If problem is not fixed, trust may count as a resource retroactively (subject to administrative finality).

23. SI 01120.200 - Miscellaneous Changes Added definitions in Subsection B.Indian Gaming Revenue Act trusts can be trusts containing assets of a third party (if meets requirements of SI 01120.195).ABLE accounts are not trusts (Subsection C.1.c.)Subsection G. (assignment) - SSI payments are non-assignable by law - SSI payments do not count as income for SSI purposes. - SSA considers assignment of payments by court orders to be irrevocable. - U.S. Military Service Benefit Plan payments are assignable.

24. Trusts Established With The Assets Of An Individual On Or After 01/01/00Analysis of Changes to SI 01120.201

25. POMS SI 011201F. – The Sole Benefit RuleThe Statutory BasisThis subsection shall not apply to any of the following trusts:A trust containing the assets of an individual … which is established for the benefit of such individual…. Section 1917(d)(4)(A) of the Social Security Act.POMS InterpretationUnder the special needs trust exception, the trust must be established and used for the benefit of the disabled individual. SSA has interpreted this provision to require that the trust be for the sole benefit of the individual, as described in SI 01120.201F.[1]. POMS SI 01120.203B.6.

26. POMS SI 011201F. – The Sole Benefit RuleThe general rule remains unchanged.SI 01120.201F.1. - General rule regarding trusts established for the sole benefit of an individualConsider a trust established for the sole benefit of an individual if the trust benefits no one but that individual, whether at the time the trust is established or at any time for the remainder of the individual's life.

27. POMS SI 011201F. – The Sole Benefit RuleSI 01120.201F.1. continuedExcept as provided in SI 01120.201F.3. [third party payments] in this section and SI 01120.201F.4. [administrative expenses] in this section, do not consider a trust that provides for the trust corpus or income to be paid to or for a beneficiary other than the SSI applicant/recipient to be established for the sole benefit of the individual.

28. SI 01120.201F.3. – Exceptions to the Sole Benefit Rule for Third Party PaymentsWhile the sole benefit rule remains unchanged, there is new guidance on interpreting the exceptions for third party payments (which are considered for the sole benefit).Payments to a third party that result in the receipt of goods or services by the trust beneficiaryPayment of third party travel expenses to accompany the trust beneficiary and provide services or assistance that is necessary due to the trust beneficiary’s medical condition, disability, or agePayment of third party travel expenses to visit a trust beneficiary

29. SI 01120.201F.3.a. - Third Party PaymentsPrior Exception - SI 01120.201F.2.b.Payments to a third party that result in the receipt of goods or services by the trust beneficiary.New – SI 01120.201F.3.a.Clarifications:Primary benefitRegistration and titlingWho can be a service provider and requirementsCompanion servicesIncidental expenses

30. SI 01120.201F.3.a. - Third Party PaymentsKey - When the trust makes a payment to a third party for goods or services, the goods or services must be for the primary benefit of the trust beneficiary. You should not read this so strictly as to prevent any collateral benefit to anyone else. Example - If the trust buys a house for the beneficiary to live in, that does not mean that no one else can live there, or if the trust purchases a television, that no one else can watch it.Caution - It would violate the sole benefit rule if the trust purchased a car for the beneficiary’s grandson to take her to her doctor’s appointments twice a month, but he was also driving it to work every day.

31. SI 01120.201F.3.a. – Titling and RegistrationKey - Purchased goods that require registration or titling, for example a car or real property, must be titled or registered in the name of the beneficiary or the trust(ee) unless State law does not permit it. (minor or an individual without a valid driver’s license) Also Okay - Some State Medicaid agencies may permit a car to be titled in a third party’s name if the trustee holds a lien on the car that guarantees that the trust receives the value of the car if it is sold.Caution - Even if a third party is listed on the title of the purchased good, it must still be used for the sole benefit of the trust beneficiary.

32. SI 01120.201F.3.a. – Service ProvidersKey - A third party service provider can be a family member, a non-family member, or a professional services company. The policy is the same for all.Companion Services - Payment for companion services can be a valid expense. Family members may normally do some of these things without compensation, but that does not prohibit the trust from paying for these services. Examples - An Alzheimer’s patient may need a sitter, a beneficiary may need a driver or assistance with grocery shopping.

33. SI 01120.201F.3.a. – Service ProvidersIncidental Expenses - Incidental expenses for the companion can be payable. Example - If the trust pays a companion to take the beneficiary to a museum, the trust can pay for the admission of the companion to the museum, as this cost is part of providing the service. Caution – Travel expenses are not incidental expenses.

34. SI 01120.201F.3.a. – Requests for EvidenceSSA staff should not:Request evidence of medical training or certification for family members who receive payment to provide care.Request income tax information or similar evidence from a service provider to establish a business relationship.Routinely question the reasonableness of a service provider’s compensation.Note – If income is subject to deeming, evidence must be provided. If there is a reason to question the reasonableness of the compensation, SSA will consider the time and effort involved and the prevailing rate for similar services in the geographic area.

35. SI 01120.201F.3.b. - Third Party TravelPrior Exception – SI 01120.201 F.2.b.Payment of third party travel expenses which are necessary in order for the trust beneficiary to obtain medical treatment.New – SI 01120.201F.3.b.Payment of third party travel expenses to accompany the trust beneficiary and provide services or assistance that is necessary due to the trust beneficiary’s medical condition, disability, or age.

36. SI 01120.201F.3.b. - Third Party TravelKey - The service or assistance provided by the third party must be necessary to permit the trust beneficiary to travel.Definitions:Travel expenses are transportation, lodging, and food.Providing services or assistance necessary due to the trust beneficiary’s age means that the beneficiary is a minor and cannot travel unaccompanied.

37. SI 01120.201F.3.b. - Third Party TravelEvidence - Absent evidence to the contrary, SSA will accept a statement from the trustee that the service or assistance provided is necessary to permit the trust beneficiary to travel. SSA should not normally: request a physician statement concerning medical necessity. request evidence of medical training or certification for the person accompanying the trust beneficiary.

38. SI 01120.201F.3.b. - Third Party TravelThe Test - Use a reasonableness test in evaluating the number of people the trust is paying to accompany the beneficiary. Example - It is reasonable for a trust to pay for other individuals, such as parents or caretakers, to accompany a disabled minor child on vacation to provide supervision and assistance. Caution - It would violate the sole benefit rule if the trust paid for other individuals who are not providing services or assistance necessary for the beneficiary to travel.The fact that the parents or caretakers cannot afford to pay for their other children’s trip, or cannot leave them at home, is not relevant to the sole-benefit requirement.

39. SI 01120.201F.3.c. - Third Party Travel Expenses to Visit a Trust BeneficiaryPrior Exception - SI 01120.201F.2.b.Payment of third party travel expenses to visit a trust beneficiary who resides in an institution, nursing home, or other long-term care facility (e.g., group homes and assisted living facilities) or other supported living arrangement in which a non-family member or entity is being paid to provide or oversee the individual’s living arrangement. The travel must be for the purpose of ensuring the safety and/or medical well-being of the individual.

40. SI 01120.201F.3.c. - Third Party Travel Expenses to Visit a Trust BeneficiaryNew Exception - SI 01120.201F.3.c.The following travel expenses to ensure the safety or medical well-being of the trust beneficiary are allowable and do not violate the sole-benefit rule:Travel for a service provider to oversee the trust beneficiary’s living arrangements when the beneficiary resides in an institution, nursing home, other long-term care facility (for example, group homes and assisted living facilities), or other supported living arrangements.Travel for a trustee, trust advisor named in the trust, or successor to exercise his or her fiduciary duties or to ensure the well-being of the beneficiary when the beneficiary does not reside in an institution.

41. SI 01120.201I.1.c. and h. – Distributions to an ABLE AccountFunds transferred from the trust into an account established by the trust beneficiary under the Achieving a Better Life Experience (ABLE) Act are excluded from income to the trust beneficiary.SI 01130.470C.1.b. ABLE Accounts (03/18)A transfer of funds from a trust, of which the ABLE beneficiary is the beneficiary and which is not a resource, to the beneficiary’s ABLE account generally will be considered a third party contribution for ABLE purposes because the contribution is made by a person or entity other than the designated beneficiary (namely, the trustee) and because the designated beneficiary does not legally own the trust.

42. SI 01120.201I.1.e. - Administrator-Managed Prepaid CardsAdministrator-managed prepaid cards, such as True Link cards, are a type of restricted debit card that can be customized to block the cardholder’s access to cash, specific merchants, or entire categories of spending. Typically, the trustee is the account owner and administrator, and the trust beneficiary is the cardholder. To evaluate the income and resource implications of trust disbursements to administrator-managed prepaid cards, SSA will determine who owns the prepaid card account.

43. SI 01120.201I.1.e. - Administrator-Managed Prepaid CardsIf the trustee is the owner of the prepaid card account:Whether the trust beneficiary receives income from trust disbursements depends on the type of purchase reflected in the card statement. Treat purchases in the following manner:If the administrator-managed prepaid card is used to obtain cash, such as at an ATM, the withdrawal counts as unearned income.If the administrator-managed prepaid card pays for food or shelter items, such as charges at a restaurant, the individual will generally be charged with ISM up to the PMV. 

44. SI 01120.201I.1.e. - Administrator-Managed Prepaid CardsTreat purchases in the following manner:If the administrator-managed prepaid card pays for non-food, non-shelter items, such as for clothing at a department store, the individual usually does not receive income unless the item received would not be a totally or partially excluded non-liquid resource the following month.The administrator-managed prepaid card is not the trust beneficiary’s resource.

45. SI 01120.201I.1.e. - Administrator-Managed Prepaid CardsIf the trust beneficiary is the owner of the prepaid card account:  Count all disbursements from the trust onto the card as unearned income; andCount any unspent balance on the card as a resource as of the beginning of the month after funds are loaded onto the card.

46. SI 01120.201K.2 - Posteligibility ChangesEffective 04/27/18, if due to: a change in policy, a policy clarification, or the reopening of a prior erroneous trust determination, a trust that was previously determined to be exempt from resource counting under Section 1917(d)(4)(A) or (C) is determined to be a resource, SSA will offer a 90-day amendment period.Does not apply to new or previously undisclosed trusts.

47. SI 01120.201K.2 - Posteligibility ChangesPrior to 04/27/18, there were only four instances where you could get a 90-day amendment period:Early Termination Provisions and Trusts (SI 01120.199.);Sole Benefit Requirement and Third Party Travel Expenses (SI 01120.201F.2.);Pooled Trusts Management Provisions (SI 01120.225.); andNull and Void Clauses in Trusts Documents (SI 01120.227.).In other cases, the trust was subject to resource counting subject to administrative finality.

48. SI 01120.201K.2.d. – 90-Day Amendment PeriodOnly eligible for one 90-day amendment period.Now permits a good cause extension upon request and providing evidence. (Field Office has discretion to provide reasonable time based on the situation.)Trust is not counted as a resource during amendment period.If problem is not fixed, trust may count as a resource retroactively (subject to administrative finality).

49. SI 01120.201 - Miscellaneous ChangesDebit cards - Trust disbursements to a trust beneficiary’s personal debit card are the same as cash disbursements. (SI 01120.201I.)Added instruction on how to treat assignment of U.S. Military Survivor Benefit Plans. (SI 01120.J.1.e.)Treatment of Direct Deposit of SSI benefits to trusts. (SI 01120.201J.1.f.)

50. Development And Documentation Of Trusts Established On Or After 01/01/00Analysis of Changes to SI 01120.202

51. SI 01120.202A.1.f. – Reopening Trust Determinations The field office may receive a request by any party to the determination, including SSA, questioning the correctness of the trust determination. The request to reopen a determination must be:in writing, and within the applicable time limit.See SI 04070.015 Reopening SSI Determinations

52. SI 01120.202A.1.g. – Manual NoticesIncorporates EM-16012 (03/12/16) - Guidelines on issuing manual notices for individuals determined ineligible because of excess resources that include a countable trust When applicable, SSA will issue a manual notice for trusts as required per SI 01120.204. For such notices, SSA will specify each reason the trust is countable (why it does not meet the exception or other requirements). The notice must cite:the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue; the POMS citation that contains the policy requirements on that subject; andwhere the POMS can be found on-line.

53. SI 01120.202B. – Posteligibility EventsIncorporates policy in AM-15032 (May 28, 2016).For posteligibility (PE) events, do not reevaluate trusts that have a resource determination, unless there is: an amendment to the trust, a change of or clarification in policy that affects the resource determination,a request for reopening, ora situation where you become aware of a prior erroneous determination. For resource status changes in PE events, see SI 01120.20[1]K.

54. SI 01120.202C. – Pooled Trust PrecedentsIncorporates EM-16006 (02/12/16) - Guidelines on Reviewing and Establishing Pooled Trust PrecedentsProvides guidelines on how to establish pooled trust precedents in the SSI Trust Management System (SSITMS) and clarifies policy regarding the review of pooled trusts for SSI purposes. The instructions provide that, in many cases, SSA personnel can use an established precedent when making a determination regarding a pooled trust.

55. Exceptions To Counting Trusts Established On Or After January 1, 2000Analysis of Changes to SI 01120.203

56. SI 01120.203C. and I.2.Self-Settled Special Needs TrustsIncorporates EM-16053 (12/13/16) regarding a change in SSI trust policy as a result of the 21st Century Cures Act (P.L. 114-255).Effective with special needs trusts established on or after December 13, 2016, an individual may establish a special needs trust and have that trust excepted from resource counting under Section 1917(d)(4)(A) of the Social Security Act.

57. SI 01120.203B.8. - Court-established TrustsRewrite incorporates AM 15-032 on when a trust is considered to be ordered by a court. Creation of the trust must be required by a court order for the exception in section 1917(d)(4)(A) of the Act to apply. Court may approve petitions and establish trust by court order, so long as trust is not created before court order is issued.An individual is permitted to petition a court for the present establishment of a trust or may use an agent to do so. The court order establishes the trust, not the individual’s petition. Petitioning a court to establish a trust is not establishment by an individual.

58. SI 01120.203B.8. - Court-established TrustsCourt approval of of an already created special needs trust is not sufficient.Court must specifically establish trust or order establishment of the trust.

59. SI 01120.203 – Additional Clarifications Power of Attorney (SI 01120.203B.9., C.2.a., C.3., D.6.)SSA considers a trust established with the disabled individual’s power of attorney (POA) to be established through the actions of the disabled individual.A third party can use the POA for the trust beneficiary as the legal authority to transfer assets of the beneficiary into a trust.Disability (SI 01120.203B.4. and D.2.)To qualify for a 1917(d)(4) exceptions, the individual whose assets were used to establish the trust must be disabled for SSI purposes under section 1614(a)(3) of the Act at the time the trust was established.