The FO should contact the payee and advise the individual of the facts as described
by the DDS on the SSA-883-U3 when:
-
•
medically necessary treatment prescribed by a MS is available that could improve or
restore the child's functioning, and without good cause, the child either did not
receive it or did not receive it as prescribed, or
-
•
if there is no MS, medically necessary treatment is available that could improve or
restore the child's functioning.
Remind the payee that we previously notified them that, when the child's claim required
a review, they might be required to show proof that the child is and has been receiving
treatment to the extent considered medically necessary and available for the condition(s)
that was the basis for awarding benefits. Also, explain to the payee that, in the
evidence in the initial claim and the CDR about the child's condition(s):
-
•
there is no proof that the child is or has been receiving treatment for the medical
condition(s) that formed the basis for their disability;
-
•
there is evidence that a MS prescribed treatment, but it was not obtained for the
child; or
-
•
the child was not being given the treatment as prescribed, depending on the particular
circumstances of the case. If there is no MS and you are providing information based
on the DDS's discussion of medically necessary and available treatment, be careful
to explain to the payee that SSA does not prescribe treatment but that it appears
that treatment as described or similar treatment should be sought.
State that, while we have found that the child's disability continues, we must decide
whether it is in the best interests of the child to:
-
•
select another payee, at which time the child's record may be placed in administrative
suspense until another payee can be found, or
-
•
pay the child directly if the payee does not obtain the treatment described by the
DDS or provide good cause for not seeking the treatment.
Have the payee provide:
-
•
proof that the prescribed treatment or, when there is no MS, that the medically necessary
and available treatment identified by the DDS on an SSA-883-U3 is being received,
and
-
•
the name and address of the health care provider who prescribed it.
If the child still is not receiving medically necessary treatment, the payee must
provide an explanation why the treatment is not being received.