TN 60 (01-00)
DI 11070.040 Case Returned From the DDS
A. Policy - General
While the DDS will redetermine the childhood and age 18 attainment cases using the initial standards for children and adults respectively, the forms and processing system for documenting and inputting the determinations will be the same as that used for processing CDRs.
B. Policy - Fully Favorable Determinations
Fully favorable determinations are processed in the same manner as CDR continuances. The DDS will only return folders to the FO if there are unresolved non-disability issues. Otherwise the DDS will forward the case to the National Records Center (SSANRC) following usual procedures.
C. Policy - Unfavorable Determinations/Cessation Dates
1. Childhood Cases (Under Age 18)
Disability will cease as of the date of the disability redetermination decision. Under a provision of P.L. 104-193 for childhood redetermination cases, eligibility ended the later of the close of the last day of June 1997 (this was an issue only if the cessation month was prior to April 1, 1997) or the close of the last day of the second month after the cessation month. For cessation dates prior to April 1, 1997, an individual received benefits through June 1997. (The individual received the June check but not the July check.) For cessation dates of April 1, 1997, or later, the individual will be eligible, as usual, for benefits for the month of the redetermination and two months afterward.
NOTE: During the period between the month of cessation and the last month of payment, the individual must otherwise be eligible for benefits. Non-disability actions (e.g., income and resource changes, etc.) are still appropriate. However, once the cessation has been established, CDRs or other disability redeterminations are not appropriate.
2. Age 18 Cases
The law does not provide any special rules for the termination of benefits to individuals affected by the age 18 disability redeterminations. The normal cessation and termination rules apply. Disability ceases as of the date of the disability redetermination decision. Eligibility ends the last day of the second month following the month of cessation. As usual, benefits are paid for two months following the month of cessation. See “NOTE” in DI 11070.040C.1.
D. Procedure - Unfavorable Determinations
1. Childhood Cases
FOs can expect to receive unfavorable decisions on the initial childhood disability redeterminations well into 1999. Beyond that point the FO may occassionally receive unfavorable childhood disability redeterminations on cases that were initiated as CDRs. While there is no difference in the processing for these cases, FOs should be aware of the changed nature of the medical determination and be able to explain the decision to the beneficiary.
Cessation date is April 1, 1997, or later — Process and provide notice as in a CDR cessation. Hold the input until the current computation month (CCM) is the same as the termination month.
EXAMPLE: Cessation = May 7, 1997; Input to terminate benefits should be made after the recurring cutoff in May. The system will then be in the July operating month. Termination will be effective July 31, 1997.
NOTE: It is no longer necessary to suppress the notice of planned action. The system will not generate a notice of planned action when taking N07 or N08 actions.
2. Age 18 Cases
When the file is returned from the DDS (or ODO), follow normal processing procedures for processing cessations in CDR cases. The procedure will be the same as shown for childhood cases with cessation dates of April 1, 1997, and later. See DI 11070.040D.1.
3. Modified Determinations
A special screening process was in place for the initial childhood redetermination workload. “Modified Determinations” were prepared for cases screened out as not requiring a disability redetermination. Form SSA-832-C3/U3 (Cessation or Continuance of Disability or Blindness Determination and Transmittal-Title XVI) for these cases will carry a remark “Modified Determination” and will show a diary date of 01/01/99 or 12/ 31/99 with a diary code of “A” . It is not intended that these diary dates show on the system. Do not attempt to reconcile the diary date on the system for these cases.
The FO may receive some of these cases as the initial implementation workload is cleared by the DDS.
A “modified determination” is never appropriate for any case that was initiated as a CDR, or as an age 18 disability redetermination. Upon receipt of a case with an improper “modified determination” write “Improper Action” across the front of Form SSA-832-C3/U3 and return the case to the DDS for a full redetermination or CDR.
4. Concurrent Cases
If the issue has not already been addressed by the DDS/Disability Hearing Officer(DHO)/Administrative Law Judge (ALJ), the FO will initiate a CDR or consider an adverse reopening of the Title II determination whenever there is an unfavorable action on a disability redetermination. Normally, the DDS/DHO /ALJ will have addressed this issue. The FO will not delay implementation of the Title XVI determination pending action on the Title II claim. Because the standard for continuing disability is different than the standard applied with respect to a redetermination, it is not unlikely that disability will cease on the Title XVI case while disability is continued under Title II.
Once eligibility is continued based on an age 18 disability redetermination, the case will be treated, for all purposes, as an adult (DI) claim.
A cessation will act as a permanent bar to the cross title adoption of any favorable determination that pre-dates the cessation action.
REMINDER: The field office may never adopt a pre-age 18 Title XVI disability determination to a Title II claim.
E. Policy - Appeals
An individual who is dissatisfied with the disability redetermination under the childhood or age 18 provisions of the law will have all normal appeals provided for disability cessations in CDR cases, including the DHO hearing. The individual will be eligible for statutory benefit continuation through the ALJ appeals level.
When forwarding a reconsideration case to the DDS for action use the Disability Redetermination Flag provided at DI 11070.110, Exhibit 2.
When forwarding an ODAR hearing request, use the Disability Redetermination Flag provided in DI 11070.110, Exhibit 3.
F. Policy - Benefit Continuation
Always offer benefit continuation and obtain a signed Form SSA-795 (Statement of Claimant or Other Person) regarding the election if the individual files during the 10-day period.
Always discuss good cause if the individual files after the 10-day period, even if the individual does not inquire about benefit continuation. (See DI 12027.010.)
Never attempt to dissuade an individual from filing an appeal or electing benefit continuation.