TN 31 (01-00)

DI 23570.015 Case Received From FO and Cases Pending in DDS - General Process

A. Policy - Timeliness of Disability Redetermination Actions

The law requires that SSA perform a disability redetermination for affected childhood disability beneficiaries within 18 months of enactment or as soon as practicable thereafter and individuals attaining age 18 within one year of attainment of age 18 or in lieu of a subsequent CDR. FOs and DDSs must make every effort to initiate and complete the actions timely. However, FOs and DDSs will diligently pursue development and disability redetermination decisions on any case whenever it is identified as being subject to a disability redetermination.

B. Procedure - General

The FO will conduct the disability interview in the same manner as for an initial claim, except that they will not take a new application and will not develop medical information back to the original onset date. They will obtain completed disability reports and functional reports appropriate to initial disability determinations.

Disability will be evaluated using the initial disability standard for children and the initial adult standards for age 18 cases. The SGA step of the sequential evaluation process and the MIRS do not apply to these disability redeterminations.

Although the cases will be evaluated using the rules for initial claims (except for the SGA step), they will be processed much like CDRs. The decisions will be documented and input in the same manner as a CDR via Form SSA-832-C3/U3.

C. Procedure - Receipt of Cases

Generally, the DDS will receive the age 18 cases from the FO with the Disability Redetermination Flag (see DI 23570.110) stapled to the top of the file identifying the case as an age 18 disability redetermination case to be adjudicated under P.L. 104-193. However, some age 18 cases and most, if not all, newly identified childhood disability redetermination cases, may be received as CDRs and then identified by the DDS as requiring a disability redetermination instead of a CDR.

If the prior file is not available, the FO will place the new disability material in a brown folder and staple the flag to the top of the folder. (Since this is to be a new medical determination using the initial standards, and the evidence will be developed as though it is a new claim and a determination made without regard to the previous determination, the prior file is not as critical as in CDRs). While the DDS may make a determination on a disability redetermination that is initiated by the FO without the folder, the DDS may not decide that a childhood case initiated as a CDR should have a disability redetermination without a review of the prior folder.

A decision that an age 18 disability redetermination is appropriate in lieu of a CDR can be made based on systems coding if that coding shows that a CDR or disability redetermination was not done after age 18 or, if a CDR was done after age 18, it is clear from the system that the prior continuance was not based on consideration of the adult standard applicable to initial claims. (See DI 23570.010B.1.b.)

Receipt the case as a CDR using the following codes:

CDT:

02 — Childhood Disability Redetermination Case

NOTE: Once the original childhood redetermination workload is completed, it will be unusual to receive a case from the FO identified as a childhood disability redetermination.

04 — Age 18 Disability Redetermination Case

SLC: 8

D. Procedure - Pending CDRS

If a CDR is pending on a child under age 18, first check to see if the CDR meets the childhood disability redetermination requirements. If so, process the case as a disability redetermination. Notify the individual of the standards that will be employed using the special notice provided for that purpose.

If a CDR is pending on any individual who attained age 18 on or after August 22, 1996, who was eligible as a child in the month before the month of attainment of age 18 and who has not had a determination under the initial adult standard after attaining age 18 (see DI 23570.010B.1.b.), a disability redetermination is appropriate. Provide notification of the redetermination using the special notice provided for that purpose. (See DI 23570.100 for example.)

If a CDR is pending on a child, and the child is now or will attain age 18 within 2 months, process the case as an age 18 redetermination. However, no determination can be made on the case until the child attains age 18. DDS must verify eligibility and provide a notice of