TN 9 (05-22)

DI 28040.105 Initial Notification of the Continuing Disability Review (CDR) in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

A. Notification in MINE and MINE-equivalent cases

The field office (FO) sends MINE, or MINE-equivalent, cases to the disability determination services (DDS) without a completed SSA-454-BK (Continuing Disability Review Report), or any other contact with the beneficiary or recipient, payee, or representative. The DDS is responsible for the first contact with the beneficiary or recipient, payee, or representative. The DDS must notify the beneficiary or recipient of the CDR by telephone and by written notification.

The disability examiner (DE) must be aware that many of these beneficiaries or recipients may have been receiving disability benefits for years and may never have had their cases reviewed. One of the primary objectives of the MINE and MINE-equivalent process is to deal sensitively with individuals that have severe impairments.

Prior to initiating the CDR process, the DE must obtain and review the current Master Beneficiary Record (MBR) and Supplemental Security Income Display (SSID) queries.

B. Telephone contact on MINE and MINE-equivalent cases

1. Overview of the telephone interview

The purpose of the MINE CDR telephone interview is to:

  • verify the beneficiary or recipient is alive and not working;

  • explain the purpose and nature of the review and answer any questions in a manner that is sensitive to the beneficiary or recipient's concerns and needs;

  • secure a statement that the impairment remains severe; and

  • verify that none of the exceptions to the medical improvement review standard (MIRS) exist. For more information on MIRS exceptions see DI 28020.001.

    
    
    
    

Telephone contact is intended to expedite the process for cases with a MINE diary. The DE should make three contact attempts on successive dates, at different hours of the day. Make every effort to speak directly to the beneficiary or recipient, payee, or representative. If an interpreter is needed, follow instructions in DI 23040.001.

Review the folder, queries, and other available resources to locate a current telephone number if needed. The servicing FO may be a resource to locate beneficiaries or recipients whose telephone numbers are not readily available, particularly in Title XVI cases.

Be prepared to conduct the full interview during this initial phone contact if the beneficiary or recipient, payee, or representative is prepared to provide the necessary CDR information and prefers to do so at that time.

NOTE: In Title XVI child cases, if there are any problems obtaining required information from the child’s payee or representative, make special efforts to identify and contact an additional adult or agency responsible for the child’s care. The general approach to failure to cooperate issues in DI 25205.020 applies to CDRs as well as to initial claims situations.

The DE must document the name of any beneficiary or recipient contacted, the information received, and attempts at contact using an SSA-5002 (Report of Contact), claims communication, case note, or other SSA approved method. Sites using the electronic Claims Analysis Tool (eCAT) should refer to theeCAT User Guide and the Disability Case Processing System (DCPS) guide for electronic CDR (eCDR) documentation guidance.

 

2. Contacting the beneficiary or recipient, payee or representative

a. Making telephone contact

On making telephone contact, the DE must:

  • Exercise a high level of sensitivity because of the severe nature of the impairment(s) in MINE and MINE-equivalent cases. The beneficiary or recipient has impairments that are not expected to improve. They have been receiving Title II and/or Title XVI payments for at least 5 years, and this may be the first contact made regarding his or her disability.

  • Identify himself or herself as an employee of an agency of the individual's State, calling on behalf of the Social Security Administration (SSA).

  • Explain that the law requires SSA to periodically review all disability cases. However, the review will mainly verify with the beneficiary or recipient, and his or her medical sources, that the impairment continues to exist and has not improved.

  • Use the SSA-454-BK as a guide and the developmental guidelines in DI 28040.130 to determine what questions should be fully developed. Tailor the questions based on the nature of the impairment and the age of the beneficiary or recipient. For example, do not request answers to the work-related questions on the SSA-454-BK if the individual is a Title XVI child under age 15, unless there are indications the child may be working.

  • Answer all questions on the SSA-454 or annotate as “NA” (Not Applicable).

  • Obtain answers to any other questions pertinent to completing the CDR determination.

  • Inform the representative payee or representative that we will send a confirmation notice to the beneficiary or recipient.

b. Obtaining a signature on the SSA-827 (Authorization to Disclose Information to the Social Security Administration)

Tell the beneficiary or recipient, payee, or representative that we required a signed and dated SSA-827 to allow doctors, hospitals, clinics, and other sources to provide information about the disabled person’s condition. Explain that we cannot complete his or her review until we have this signed form. Obtain a signature on the SSA-827 using the attestation method(s) in DI 22501.007 if possible.

c. The beneficiary or recipient, payee, or representative prefers to provide needed information in writing rather than by telephone

If the beneficiary or recipient, payee, or representative prefers to provide needed information in writing rather than by telephone, the DDS must mail the confirmation of the review notice, SSA-454, and SSA-827s, and a return envelope to the beneficiary or recipient. Instruct the beneficiary or recipient to return these completed forms to the DDS. Explain to the beneficiary or recipient that he or she may call the DE with questions about the forms or the CDR process.

If the DDS does not receive the forms within 14 calendar days from the date of the confirmation of review notice, follow up with the beneficiary or recipient via telephone. If applicable, follow the procedures outlined in DI 28040.110.

3. Case must be referred back to field office (FO)

If the case will be referred back to the FO for any reason (for example, personal contact, or work is alleged), inform the beneficiary or recipient that a SSA field office representative will be contacting him or her for further information. Ensure you do not alarm the beneficiary or recipient.

4. Speaking with someone other than the beneficiary or recipient, payee, or representative

If an answering machine, voice mail system, or someone other than the beneficiary or recipient, payee, or representative answers the call, leave a message for the individual to call the DE. Do not provide an explanation of the specific request for evidence or action to anyone other than the beneficiary or recipient, payee, or representative.

5. Unable to speak with anyone and cannot complete the initial phone contact

If the DE is unable to speak with anyone, proceed with the appropriate confirmation of review notice and further actions as shown in DI 28040.110.

C. Written notice of the CDR

1. Confirmation of review notice

The DDS must send a review notice informing the beneficiary, recipient, representative payee or representative of the start of the CDR process. Select the appropriate confirmation of review notice based on the situations listed in the table in DI 28040.105C.2. in this section. All notices may be used for Title II, Title XVI, or concurrent (Title II and Title XVI) cases. After you have selected the appropriate notice, use the correct heading and type of case(s) for the notice. Include the DDS’s and the DE’s contact information in the notice.

Set a diary on the case for 14 calendar days from the date of the confirmation of review notice.

2. What confirmatory review notice to send

Initial Phone Contact

Confirmatory Review Notice Sample Text

Phone contact successful and SSA-454-BK completed via phone

DI 28040.300B.1. Exhibit - 1

Phone contact successful, but individual prefers to complete SSA-454-BK by mail

DI 28040.300B.2. Exhibit - 2

Initial phone contact unsuccessful

DI 28040.300B.3. Exhibit - 3

D. Attempts to contact are unsuccessful or unproductive

In cases where both telephone and written contact are unsuccessful, refer to the procedures in DI 28040.110, Attempts to Contact are Unsuccessful or Unproductive in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases.

E. References

  • DI 11005.056 Signature Requirements for Form SSA-827

  • DI 13005.040 Completion of Form SSA-454-BK (Continuing Disability Review Report) in Adult and Title XVI Child Continuing Disability Review CDR Cases

  • DI 23040.001 DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals Requiring Language Assistance

  • DI 23045.001 Translation of Foreign-Language Documents

  • DI 28030.010 Understanding and Using Supplemental Security Income Display (SSID, SSI2 or SSI3) Query Replies to Determine Title II Entitlement and Title XVI Eligibility

  • DI 28040.110 Attempts to Contact are Unsuccessful or Unproductive in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases

  • DI 81020.100 Electronic Assistance Requests (AR)

  • GN 03360.005 Releasing Information by Telephone


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428040105
DI 28040.105 - Initial Notification of the Continuing Disability Review (CDR) in Medical Improvement Not Expected (MINE) or MINE-Equivalent Cases - 05/04/2022
Batch run: 05/04/2022
Rev:05/04/2022