TN 1 (09-09)

DI 27540.030 Title XVI-Only – Goldberg/Kelly Payment Continuation Applies

A. Policy

Goldberg/Kelly automatic payment continuation governs the following types of reopenings and revisions:

  • failure to follow prescribed treatment; and

  • fraud or similar fault.

A predetermination notice is not required when Goldberg/Kelly automatic payment continuation applies.

For information on the cases where the Disability Determination Services (DDS) sends a predetermination due process notice, see Policy – Due Process for Adverse Reopenings, DI 27525.001C.

See Also:

  • DI 28080.025 – Providing Due Process Notification for Title XVI-Only Cases

  • DI 13015.015 – Benefit Continuation in Failure to Cooperate/Whereabouts Unknown Cases.

  • DI 28075.005 – Failure to Cooperate (FTC) and Whereabouts Unknown (WU) Cases

NOTE: Goldberg/Kelly procedures do not apply to Title XVI whereabouts unknown cases because WU (S06) is considered an administrative suspension and does not result in a loss of eligibility.

B. Procedure for selecting notices

Prepare the notice on blank SSA-L8052-U2 letterhead using the model language indicated. Do not include the italicized language from the model notices in the actual notice that is being released because it is informational to the DDS personnel and not meant for the beneficiary.

Use the notice indicated for the following situations:

1. Reopening and revision is less than fully favorable

  • Allowance to Closed Period – Title XVI – Reopening Notice 5 (NL 00705.221)

  • Denial to Partially Favorable Onset (Not AOD) – Title XVI – Reopening Notice 7 (NL 00705.231)

  • Denial to Closed Period – Title XVI – Reopening Notice 9 (NL 00705.241)

  • Fully or Partially Favorable Onset to a Later Onset – Title XVI – Reopening Notice 11 (NL 00705.251)

2. Reopening and revision is unfavorable

Allowance to Denial – Title XVI – Reopening Notice 2 (NL 00705.206)

3. Basis change only

Blind to Disabled – Title XVI – Reopening Notice 14 (NL 00705.266)

4. No change in basis or end result – claimant aware

  • No Change in Basis or End Result – Claimant Aware – Reopening Notice 12 (NL 00705.256); or

  • Denial of Request to Reopen and Revise – Reopening Notice 12 (NL 00705.256)

5. No change in basis or end result – claimant unaware

No DDS notice is required.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427540030
DI 27540.030 - Title XVI-Only - Goldberg/Kelly Payment Continuation Applies - 03/19/2010
Batch run: 03/19/2010
Rev:03/19/2010