TN 60 (01-00)

DI 11070.010 Disability Redeterminations - Childhood (Under Age 18) and Over Age 18 Cases--General Instructions

A. Policy

1. Review Standard

Disability redeterminations under P.L. 104-193 are different from CDRs in that the impairment(s) is evaluated using the disability criteria used for initial claims, except for the SGA step of the sequential evaluation process. The MIRS is not applied.

2. FO Development

The Field Office (FO) must develop the information and evidence in the same manner as for initial claims except that an application will not be taken. Disability development forms required by DI 11005.151 will be used. Use the appropriate childhood forms for the childhood disability redeterminations and the adult forms for the age 18 disability redeterminations.

3. Timeliness of Disability Redetermination Actions

The law requires SSA to perform a disability redetermination for affected childhood disability beneficiaries within 18 months of enactment (i.e., by February 22, 1998) or as soon as practicable thereafter. The law also requires SSA to perform a disability redetermination for individuals attaining age 18 within one year of attainment of age 18 or in lieu of a CDR whenever the Commissioner determines that the individual is subject to a disability redetermination. FOs and DDSs must make every effort to complete the actions timely. However, FOs and DDSs must pursue development and disability redetermination decisions on any case that is determined to be subject to a disability redetermination.

NOTE: No individual is subject to an age 18 disability redetermination if the individual attained age 18 prior to August 22, 1996.

4. Concurrent Claims

The FO will not adopt any Title II disability determination to the Title XVI disability redetermination. The DDS will decide on all adoption issues regarding disability redeterminations.

In cases involving concurrent entitlement, the FO will forward the Title II folder to the DDS along with the Title XVI folder when initiating a disability redetermination. Similarly, when forwarding a Title XVI CDR where the individual was eligible in the month before the month of attainment of age 18, the FO will forward the Title II folder to the DDS. (Action on the Title II claim may be a consideration for determining whether a disability redetermination rather than a CDR is appropriate.) If the Title II folder is not available, the FO will provide the DDS with an explanation including the folder location and the reason the folder is unavailable.

B. Procedure - Folder Requests

Obtain the prior folder. However, do not delay scheduling interviews with the individuals and/or their representative payees while awaiting receipt of the folder. If a folder is not received within 30 days, do not delay initiating the disability redetermination.

If the folder is not received or cannot be found within 30 days, do not attempt to reconstruct the folder. (Because MIRS is not applicable to these cases, the prior folder is not essential as in CDRs.) However, if the folder is subsequently received, forward it to the DDS.

Forward the disability development forms and any medical evidence received to the DDS following the disability interview. Use a brown folder. Do not use the modular disability folder.

Current Folder Located in Other Offices

See SM 01201.225 regarding folder requests.

Do not request folders from the Office of Disability Adjudication and Review (ODAR) offices or from the DDS Disability Hearings Unit (DHU). If a reconsideration or a hearing is pending on the case, contact should be made with the ODAR hearing office or DHU having jurisdiction for the purposes of coordinating activities.

C. Procedure - Suspense or Non-payment Status Other Than 1619(b)

If the individual is in suspense or non-pay status for any reason other than 1619(b), FOs should use judgment to determine whether to initiate the disability redetermination.

1. Payments are Likely to Resume

If the FO believes that the suspense or non-payment status is temporary and that payments will resume shortly, initiate the disability redetermination. For example, the case may involve parental deeming or excess income which will cause only one month of non-pay status; or, the individual may be temporarily institutionalized.

2. Payments are Not Likely to Resume Shortly or are Likely to Terminate

For cases in which the FO believes that the suspense or non-payment is likely to result in the termination of benefits or payments are not expected to resume shortly, the FO should not initiate the disability redetermination.

FO should annotate both the “remarks” portion of the Disability Control File (DCF) and the Supplemental Security Record (SSR) to show that a disability redetermination is required if payments are resumed.

3. Payment Resumed

If payments are resumed, follow the instructions DI 11070.030 .

D. Procedure - Non-Citizen Cases

When the individual is a non-citizen whose eligibility status must be resolved, the FO should first determine the likelihood of the individual's eligibility continuing. (See SI 00502.001 ff. for how to develop eligibility for non-citizens.)

1. Status Does Not Preclude Benefits

Simultaneously resolve the non-citizen issue and initiate the disability redetermination. If at any point it is determined that the individual's eligibility will terminate, advise the DDS to curtail action on the disability issue.

2. Status Precludes Benefits

Defer initiating the disability redetermination until non-citizen status is resolved. (See DI 11070.010C.2.)

3. Eligibility Cannot Be Determined and Further Development is Needed

Defer the disability redetermination and resolve non-citizen status as quickly as possible. If there is a delay in resolving non-citizen status, the FO will follow the procedure in DI 11070.010C.2.

E. Procedure - Whereabouts Unknown and Failure to Cooperate Cases

Follow the instructions in DI 13015.001. In a childhood case, CDR or disability redetermination, the FO should always document the folder with the name of any known contact who might be able to assist the child in cooperating with the action.

NOTE: If the DDS is successful in getting the individual to cooperate, the DDS will request the FO to complete the disability redetermination interview.

F. Certain Age 18 MINE Cases

The age 18 disability redetermination workload contains cases involving the full spectrum of impairments. A disability redetermination is always required. However, for certain extremely severe permanent impairments (Medical Improvement Not Expected (MINE) cases, it is permissible to curtail development and forward the case to the DDS without completion of the usually required interview forms. Cases categorized as MINE cases may be sent to the DDS without additional development, if the file contains sufficient information for the DDS to identify current treating sources. The DDS will decide whether to utilize the curtailed development procedures or request the FO to fully develop.

The purpose of this procedure is to avoid inconveniencing individuals with very severe impairments and to avoid unnecessary FO development. This procedure cannot be utilized if the medical folder is not available. It is expected that a case would fit this category if the case involves a very severe impairment which could be considered a permanent impairment in terms of duration of the condition and the unlikelihood that medical improvement will occur (i.e., total deafness; total blindness; cases involving amputation of more than one limb, or amputation of a leg at the hip; a longstanding condition which has resulted in bed confinement or the need for a wheelchair, and walker or crutches).

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DI 11070.010 - Disability Redeterminations - Childhood (Under Age 18) and Over Age 18 Cases--General Instructions - 05/16/2017
Batch run: 05/16/2017