Use the information in the SSI folder to determine the appropriate method of payment
following the guidelines in GN 00502.075C.1.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L.
104-193, includes a provision which requires a payee to present evidence at the time
of the CDR that shows the child is, and has been, receiving treatment to the extent
considered medically necessary and available for their disabling condition. This requirement
does not apply if the Social Security Administration (SSA) determines that such evidence
would be inappropriate or unnecessary considering the nature of the child's impairment(s).
Evidence of compliance with the treatment requirement may include, but is not limited
to, doctor's receipts; name and telephone number of the treatment source for FO verification,
appointment slips, or cancelled checks. In situations where the payee refuses to cooperate
or submits unacceptable evidence of treatment, consider a change of payee, if you
cannot establish good cause for failure to cooperate. Some examples of “good cause”
for failure to obtain treatment for the child include:
physical limitations of the beneficiary which preclude the payee from obtaining necessary
payee has not been properly informed of the availability of treatment for the beneficiary;
payee's lack of transportation hinders them in getting the beneficiary to a treatment
the payee's employment conflicts with the hours designated for required treatment.
Even if you may have found “good cause”, the payee remains responsible for seeking
treatment for the child. Make every effort to assist the payee in conforming to the
treatment requirement. If the payee still does not obtain appropriate treatment for
the beneficiary, consider a payee change since the payee's suitability is in question.