If the child’s parent or guardian does not provide evidence showing good cause for
FTFPT, follow established procedures specific to child cases before denying the claim
or ceasing benefits. If the parent, guardian, or child asserts that the child would
have followed prescribed treatment but for the actions of the child’s representative
payee, return the claim to the field office (FO) as a “no determination” (ND) and
ask the FO to pursue a new payee for the child. For more information about “no determination”
claims, see DI 81020.127 Processing "No Determination" (ND) Claims (electronic processing) or DI 32005.020 Disability Determination Services “No Determination” Routing – Paper Case Only.
The FO will defer adjudication on the claim. After establishing a new representative
payee, the FO will provide 6 additional months to allow the child time to follow the
prescribed treatment. After 6 months, the FO will return the claim to DDS for adjudication.
For more information about determining if a payee sought medically necessary and available
treatment, see DI 28005.031 Determining If a Representative Payee Sought Medically Necessary and Available Treatment
for the Child When Conducting a Continuing Disability Review (CDR) for a Title XVI
Disabled Child (DC) .
Refer child claims to the appropriate Vocational Rehabilitation (VR) agency or to
the appropriate State agency administering the State program under Title V of the
Act when medical evidence from a CE, MC, PC, or ME (but not from one of the child’s
own medical sources) indicates a specific treatment if followed would result in the
child no longer having marked or extreme limitations.
IMPORTANT: In States participating in the Ticket to Work Program (TWP), you are prohibited
from referring any adult to a VR agency. See DI 26520.010 Initial Referrals and Re-referrals to the Vocational Rehabilitation (VR) Agency and
Initial Referrals to Other Agencies and DI 55001.500 Repeal of Referral Authority for Rehabilitation Services after the Ticket to Work
Program was Implemented.