DI 13050.040 Reinstatement Determinations - Title XVI
A. Policy - individual does not meet eligibility requirements for expedited reinstatement
Deny a request for expedited reinstatement (EXR) when you determine the reinstatement requirements described in DI 13050.001C. are not met. Send notice of the denial determination to the individual. The last provisional benefit payable is for the month the denial notice is sent, if not stopped earlier for another reason.
The request for reinstatement can be used as protective filing for a new application if the individual chooses to file. (See DI 13050.015C.2.)
B. Policy - unfavorable medical decision
If SSA determines that the individual is not eligible for reinstatement based on application of the same as or related or medical improvement review standard (MIRS), send notice to the individual explaining the reason the reinstatement request is denied. The last provisional payment payable is the month the denial notice is sent, if not stopped earlier for another reason.
The disability determination (denial of EXR) may be appealed but the provisional payment determination may not be appealed (See DI 13050.085B.). Payment continuation provisions do not apply to the EXR process.
C. Policy - favorable medical decision
1. Initiate reinstated payments
When an individual (and spouse, if applicable) is found to be under a disability based on MIRS, and meets all other eligibility requirements for EXR:
initiate reinstated payments. Payment begins the month after the month the individual requested reinstatement, but no earlier than 02/01/01;
use normal payment eligibility and computation methods to determine what, if any, payments are due for reinstated months of eligibility; and
reduce reinstated payments due by the amount of the provisional payments already paid.
2. 24-month initial reinstatement period
The 24-month initial reinstatement period (IRP) begins with the month of reinstatement to SSI and continues until the recipient has been paid a SSI payment in 24 months.
Months of eligibility under section 1619 count as a payment month toward completing the IRP.
If an entire SSI payment is withheld to recover an overpayment, the month counts as a payment month toward completing the IRP.
Months a payment is not payable (non-payment due to resources, income, etc.) do not count toward the IRP.
3. After IRP is completed
After the IRP is completed, the individual is eligible to a new 60-month period in which he or she can request expedited reinstatement if SSI eligibility subsequently terminates due to earned income (or a combination of earned and unearned income).
D. Procedure - documenting the 24-month initial reinstatement period
When an individual requests EXR after a prior EXR reinstatement has been processed, document the current EXR file that the individual has completed the IRP applicable to that reinstatement.
2. Documenting the file
Prepare a SSA-5002, Report of Contact, or annotate the applicable queries in file, to document the IRP has been completed. The documentation must show:
NOTE: The latest SSR will normally only contain the payment data related to the recipient for the period after the reinstatement decision was processed. A prior record may contain some payment data for the provisional payment period. All records that are related to the EXR request must be reviewed to determine the IRP.