TN 46 (01-17)
GN 00502.075 Child Beneficiary Becomes Entitled Based on Disability
Certain age attainment alerts will result in the filing of disability claims for minor children. The need for payee development may come to your attention at this time. Whenever possible you should take advantage of these early opportunities to initiate any necessary payee development.
B. Process for when a child beneficiary becomes entitled based on disability
1. Title II - Disability established at age 16
Five months before the last child in a spouse's care attains age 16, the system generates a notice to the spouse to determine if the spouse can remain entitled based on having a disabled child in care (see DI 10115.010A.). If the child files a disability claim and is found to be disabled, the Program Service Center (PSC) enters a date of entitlement to disability (DOED) code on the master beneficiary record (MBR) so that the child's benefits will automatically convert to childhood disability benefits (CDB) at age 18.
2. Title II - CDB conversion at age 18
When disability coding is not present on the MBR for a minor child, the system sends a notice at age 17-1/2 advising the child that benefits will terminate at age 18 unless he or she is disabled or qualifies as a full-time student.
When disability coding is present (if the PSC input a DOED code based on the age 16 alert), the system automatically converts the child to a CDB at age 18. When C produces the CDB award output, the Claims Authorizer (CA) or other designated technician reviews it.
3. Title XVI - Critical Birthday (KB) diary
A KB diary is set at the beginning of the fiscal year in which a recipient will attain age 18. We select a record with a KB diary for a scheduled redetermination (RZ); chosen in the month before the month the recipient will attain age 18. (See SI 02309.003 for development instructions.)
C. Procedure for addressing capability when a child beneficiary becomes entitled based on disability
1. Title II - Disability established at age 16
If the child is found disabled, the Field Office (FO) will request the PSC to establish a diary to mature at age 17-1/2.
When the diary matures, the PSC requests the FO to review the medical evidence to determine if the child is capable and to take the following actions: (For a discussion of when to develop for a payee, refer to GN 00502.003 through GN 00502.020.)
The FO should take the following steps:
If the CDB is capable - Obtain an SSA-11 from CDB.
If the CDB is incapable – If medical evidence in the file indicates that, the CDB may be incapable, develop capability following the instructions contained in GN 00502.020 through GN 00502.060.
CDB's capability unresolved – If medical evidence is not in the file, contact the payee to determine whether capability development or direct payment is in order. If necessary, conduct a face-to-face interview with the CDB to help you determine capability. In addition, FOs must:
verify custody and send advance notice in CDB cases where the payee of record will continue. (You do not need an SSA-11 in such cases.); and
complete an SSA-11 and provide advance notice if you are changing the payee. Process in the normal manner.
2. Title II - CDB conversions at age 18
If a child files a disability claim based on the letter received at age 17-1/2 and the claim is allowed, the FO reviews the medical evidence and follows the guidelines in GN 00502.075C.1.
The CA, or other designated technician, will take the following actions if a CDB conversion is received:
review the output to verify that the payee name and address reflect the FO determination regarding the need for a payee selection. If it does not, input the FO determination;
process using guidelines in GN 00502.075C.1. if the file indicates the capability issue was not previously addressed; and
ensure proper payee coding is on the MBR (see MS INTRANETERPS 019.005). If a custodial parent continues to serve as payee, verify correct payee coding is on the MBR. (Unless coding is present for a beneficiary over age 18, the case may miss selection for annual payee accounting.)
3. Title XVI
Use the information in the SSI folder to determine the appropriate method of payment following the guidelines in GN 00502.075C.1.b.
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 his or her 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 treatment;
payee has not been properly informed of the availability of treatment for the beneficiary;
payee's lack of transportation hinders him or her in getting the beneficiary to a treatment facility; and
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.