Follow DI 13005.025 for FO development requirements when initiating a CDR. Record all development actions on a Report of Contact and save in eView, or for paper folders file the Report of Contact in the folder and store a copy in the Evidence Portal (EP).

Documentation must include:

• •

  Date of the initial written request (copies of the request letters must be retained in the folder, if not accessible in ORS);

• •

  Date the period to comply ended (including extensions);

• •

  If there are special handling considerations (for example, homeless or mental impairment) see DI 13005.025A for special handling considerations. Document a description of additional development efforts; and

• •

  Results of follow-up attempts.

Once the FO has taken the steps outlined in DI 13005.025, documented development actions, and determined that the streamlined FTC procedures apply as explained in DI 13015.001A, take the following steps to input the FTC suspension. The FTC suspension action cannot be earlier than 35 calendar days (45 days for special handling situations) from the date of the initial CDR notice.

IMPORTANT: For Title XVI CDRs, follow N20 suspension procedures in SI 02301.235. Only office management can establish the N20 suspension code after confirmation that required actions were taken.

Generally, offices use the Workload Action Center (WAC) to submit medical CDR FTC suspensions into the Disability Control File (DCF). Steps 1 and 2 below are the manual DCF steps if the action is not taken through WAC.

1. 1. 

   Record the FO FTC determination on the DCF by selecting #4 on the IFOA screen Failure to Cooperate and the FO of jurisdiction in the "Office Responsible for Next Action" field. Refer to DI 13010.620 CDR FO Input (IFOA) Screen, MSOM CDR 001.001 Disability Control File (DCF) Overview, and MSOM CDR 001.007 CDR FO Input Screen (IFOA) for detailed input procedures.

2. 2. 

   Enter the remark "MED CDR FTC" in the DCF remarks section, see MSOM CDR 001.009 CDR Remarks Input Screen (IRMK) for more information.

3. 3. 

   For Title II add a special message to the MBR: "MED CDR FTC LAF S0 suspension on mm/dd/yy"

4. 4. 

   For Title XVI enter the remark "N20 on mm/dd/yy- MED CDR FTC" by using the SSR Remarks screen (CRMK).

Allow two days for the transaction to process. The DCF FTC input places benefits in non-payment status (LAF S0 for Title II/ PS N20 for Title XVI).

If the FTC suspension processed correctly, the MBR or SSID will show "DEV CDR" and "Suspense Reason=FTC-Medical". With this coding present on the MBR or SSID, the termination should occur automatically in the 13th month. If the suspension action did not process, see instructions by title below.

If the beneficiary or recipient does not cooperate during the 12-month suspension period, disability benefits will terminate effective with the 13th month. The disability determination service (DDS) does not make a medical determination. Statutory benefit continuation does not apply.

Title II

Benefits automatically suspend (LAF S0) when the DCF input processes effective with the first month that does not cause an overpayment. If the DCF input fails to suspend benefits:

• •

  Do not attempt to re-enter the suspension. The DCF exception generates a Paperless action for the processing service center (PSC) to input a manual MACADE suspension action. Verify the Processing Center Action Control System (PCACS) has a suspension action pending for the PSC.

• •

  After 15 days, query the record to ensure the PSC's manual action processed and that notice was sent to the beneficiary. This may require a follow-up contact to the PSC via the Modernized Development Worksheet (MDW). Follow GN 01070.440D.2 for follow-up procedures.

Title XVI

• •

  If the DCF transaction did not suspend payments, input an N20 suspension in MSICCS to suspend effective with the first month that does not cause an overpayment. For more information on N20 suspension see SI 02301.235 Failure to Provide Information (N20), and

• •

  The suspension notice automatically generates to the beneficiary or recipient and Title II auxiliaries when the transaction processes. Always query ORS to verify that the transaction issued a notice. If a notice was not sent, send a manual notice.

If the FTC suspension processed correctly, the record will automatically terminate in the 13th month of suspension. Once the record terminates, close out the FTC CDR issue on DCF by entering 5=SSR/MBR/STOP CDR on the IFOA screen of DCF (for more information on DCF inputs see MS 00501.007 CDR FO Input Screen (IFOA)).

Review the case in the 14th month to confirm termination. If the record did not terminate, enter the termination manually via the SSR for Title XVI and for Title II, send an MDW to the PSC requesting action to terminate the record. See MS 03901.003 MDW Worksheet (MMDW) for instructions on establishing an MDW. Alert the PSC that the FTC termination did not process in the 13th month (MM/YY) and request record be updated to show FTC termination as of MM/YY. Also, request the PSC send a notice of termination to the claimant's last known mailing address.

The streamlined CDR process does not apply to extended Medicare cases where the beneficiary terminates due to work. These beneficiaries are eligible for the work incentive that extends his or her Medicare entitlement. The DDS must make a medical CDR determination to decide if entitlement to Medicare should continue.

The FO will:

• •

  Initiate the CDR per DI 13005.025 through DI 13005.030 and DI 81010.230 (select "paper" and do not select "key" to avoid edits at transfer);

• •

  Document efforts to contact the claimant per DI 13015.005A;

• •

  Input the transfer from the FO to the DDS in the DCF. Do not input FTC on the DCF. For information on the DCF CDR screens see, DI 13010.610 The Disability Review Establishment (DRES) Screen, DI 13010.620 The CDR FO Input (IFOA) Screen, MSOM CDR 001.016 Disability Review Establishment Screen, MSOM CDR 001.007 CDR FO Input Screen (IFOA));

• •

  Enter a remark on the DCF CDR Remarks Input Screen (IRMK) (MSOM CDR 001.009) such as "Medical CDR Determination needed by DDS for extended Medicare. Streamlined FTC process does not apply";

• •

  For electronic CDRs, include the following statement in EDCS Messages/Alerts, "Extended Medicare FTC Case- Need DDS Medical Determination. DO NOT RETURN TO FO, streamlined FTC process does not apply." For paper folder CDRs, annotate the same statement on the route slip attached to the front of the paper folder;

• •

  Transfer the eCDR or paper modular disability folder (MDF) to the DDS.

When both work and medical issues are involved, prepare a work issue determination whenever possible based on available evidence. If the work issue determination does not result in a termination of benefits, proceed with the medical CDR. If the beneficiary does not cooperate with the FO's request for information, take the necessary steps to place the beneficiary in suspense following the procedures in subsection B in this section.

If the beneficiary or recipient moves to another FO jurisdiction while in suspense (and continues to not respond to the FO's request), transfer the case on the DCF to the new FO. This transfer will not reinstate benefits.