TN 60 (01-00)
DI 11070.030 Disability Redeterminations - Age 18 Cases
A. Process - General
1. Informational Notices
To ensure that individuals subject to disability redeterminations in the months immediately following passage of P.L. 104-193 were aware of the provisions, SSA sent informational notices on or after January 21, 1997 to individuals and their representative payees who had attained age 18 or would attain age 18 during the period of August 22, 1996 (date of enactment) through September 30, 1997.
Initial Identification for First Year - In November 1996, age 18 legislation cases were downloaded into the Continuing Disability Review File (CDRCF) which is now incorporated into the Disability Control File (DCF) (see MSOM CDR 001.001 ). In February 1997, additional cases were downloaded. Each RO received a list of cases that were loaded on the CDRCF/DCF.
Ongoing Identification - FOs will identify individuals subject to an age 18 disability redetermination using the Post Entitlement Operational Data Store (PE ODS) system; i.e., if an individual is on the PE ODS for an age 18 IR RZ, the FO will need to conduct the age 18 disability redetermination interview at the same time as the IR RZ interview.
FOs can determine when the critical birthday RZ is scheduled for an individual who is also due for an age 18 disability redetermination by checking the DIAR segment of an SSR query for a KB diary.
3. Coordination of Workloads
SSI policy requires that a non-medical redetermination (RZ) of living arrangements, income, and resource issues be completed for certain beneficiaries attaining age 18. (See SI 02309.001.) When possible, FOs should coordinate the interviews. That is, conduct the age 18 disability redetermination interview when the non-medical redetermination interview is due.
B. Process - Use of the DCF and PE ODS for Current Actions
FOs will coordinate the processing of title XVI age 18 disability redetermination and critical birthday cases in the PE ODS system. If the individual is on the PE ODS for an age 18 critical birthday redetermination, FOs will conduct the age 18 disability redetermination interview at the same time. FOs can also refer to the “DIAR” segment of the SSID for a “KB” diary as an indication of a critical birthday. All cases in which a “KB” diary is present due to attainment of age, will require a disability redetermination by the DDS.
Age 18 cases are reflected in the DCF as a type 1 (medical CDR), with the category legend of “age 18/DDS”, and an event legend of “direct release”.
The DCF may occasionally contain cases that are found not to meet the non-medical criteria for a disability redetermination. FOs should enter a code 7 (SSR/MBR condition) and apply their current screenout criteria with the exception of“...a fully developed CDR by the DDS/ALJ done within the last 12 months.”
The law requires SSA to conduct a disability redetermination within a year of the title XVI disability beneficiary's 18th birthday or in lieu of a CDR whenever it is determined that a disability redetermination is appropriate. FOs should make every effort to initiate the age 18 disability redeterminations prior to age 19. However, the disability redetermination may be initiated at a later date if an age 18 disability redetermination was not initiated prior to age 19. The interview should be timed so that the medical and non-medical interviews can be coordinated, when possible, and so that the DDS will receive the case on or after the date that the individual attains age 18. In addition, some cases forwarded to the DDS as CDRs may be determined by the DDS to require a disability redetermination instead. These will be individuals who were first entitled as children, attained age 18 on or after August 22, 1996, and had never been subject to a disability redetermination or its' equivalent as determined by the DDS after attaining age 18. (See DI 23570.010B.1.b)
NOTE: The determination of whether or not a CDR was done under the adult criteria will be made by the DDS. However, if the FO recognizes that an individual should have been subject to an age 18 disability redetermination, the disability redetermination may be initiated by the FO.
2. Check the DCF
If the case is identified in the category field with the entry “Age 18,” the disability redetermination should be initiated.
3. Initiating and Processing the Disability Redetermination
Send the Age 18 Notice of Disability Redetermination to the title XVI disability beneficiary and his or her representative payee (See DI 11070.105 Exhibit).
NOTE: When initiating an age 18 disability redetermination involving a concurrent claim, advise the individual that an unfavorable determination on the disability redetermination would trigger a CDR on the title II claim.
The age of the beneficiary at the time of FO initiation affects how the case will be processed. Check the age of the beneficiary before sending the “Notice of Disability Redetermination.” Cases should not be initiated prior to the month before the month the individual attains age 18. An age 18 disability redetermination should never be initiated if the individual was not eligible in the month before the month of attainment of age 18.
Document the file with a copy of the “Notice of Disability Redetermination.”
Update the transfer date on the CDR FO Input (IFOA) screen of the DCF to record the date the FO mails the “Notice of Disability Redetermination.”
The update is accomplished by entering through the IFOA screen item #6 (transfer direct release CDR). Show your office number as the “Office Responsible.” The DCF will automatically assign the date of input.
Conduct the interview according to DI 11005.001. Do not take a new application.
Sections 1619(a) and (b) of the Act apply to these cases (see SI 02302.000). The initial claims procedure concerning SGA denials does not apply.
Complete the appropriate initial disability interview forms including Form SSA-3367-F4 (Disability Report Field Office), Form SSA-3368-BK (Disability Report), and appropriate disability and functional reports (see DI 11005.018), as well as Form SSA-827 (Authorization for Source to Release Information to the Social Security Administration). Specifically, obtain the names and addresses of medical sources and functional information for the year preceding the date of the interview.
Ask the individual if he/she is receiving VR, employment, training, educational, or other support services from any source. See DI 14515.003 if the individual is receiving such services.
Flag the folder with the Disability Redetermination Flag (See DI 11070.110 Exhibit 1). Check the age 18 line. In concurrent entitlement situations annotate the flag with “concurrent claim” and attach the title II folder.
Update the CDR FO Input screen (IFOA) of the DCF to show the transfer of the file to the DDS. (See MSOM Chapter 185.) Also, enter any pertinent remarks under the “remarks” section of the DCF.
Forward the folder to the DDS.
D. Procedures - DDS Receipt: Age 18 Disability Redetermination Cases
The DDS will receive the case from the FO with the Disability Redetermination Flag stapled to the top of the file identifying it as an age 18 disability redetermination case. Upon receipt of the case, the DDS will code the case as a CDR using a CDT code of “04” and an SLC code of “8.” (These codes identify the case as an age 18 disability redetermination and permit in-line tracking and control of cases.)