TN 7 (10-15)
DI 28075.010 Non-rollback Conversion Cases
A. Policy for non-rollback conversion cases
Section 1614 of the Social Security Act provides that an individual shall be considered to be disabled or blind for Title XVI purposes if he or she:
Is blind or permanently and totally disabled as defined under a State plan in effect for 10/1972,
Received aid under such a State plan due to disability and blindness for 12/1973, and
For disability cases, also received aid for at least 1 month prior to 07/1973.
Section 1614 also provides that individuals who meet these criteria will continue to be disabled or blind for Title XVI purposes so long as they are continuously disabled or blind as defined under a State plan.
ALERT: If disability or blindness ceased under the State plan, the date of disability cessation is the current date of determination under both the Federal and State plan definitions.
1. General information on non-rollback conversion cases
A non-rollback conversion individual who has been ineligible because of an event unrelated to disability or blindness may re-establish Title XVI eligibility. The re-established eligibility is based on meeting the State plan criteria so long as he or she has been continuously disabled or blind as defined by the State plan since 12/1973.
2. State welfare agency (SWA) records
Follow these procedures:
SWA procedures for housing and maintaining records and their duplicating capacities vary to such an extent that arrangements must be made with each SWA to obtain the folders or certified photocopies of the necessary records.
The Disability Processing Branch (DPB) negotiates these arrangements subject to the capabilities and needs of the parties concerned.
SSA does not require the individual's consent to secure the records.
SWA publishes a manual of instructions to provide direction, coordination, and control of its program.
Generally, manuals contain guidelines that interpret provisions in a State plan to define disability and blindness. When these guidelines do not conflict with the approved State plan, we may treat them as part of the State plan definition.
B. Procedure for developing non-conversion cases
1. Identification of non-rollback conversion cases
To identify non-rollback conversion cases:
2. SWA records
Take the following actions:
Obtain all SWA records that relate to the conversion individual’s disability for blindness in accordance with agreements made or securing the records. These records include medical records and social summaries relating to medical issues and vocational factors such as the individual’s age, education, work experience, and any vocational training.
Obtain any prior SWA determinations and redeterminations of disability or blindness along with other records the SWA may house which may aid in the determination.
NOTE: The Disability Processing Branch (DPB) is aware of the general character of the SWA files in the region and will assist the Disability Determination Services (DDS) to identify and obtain those records from the SWA.
File the obtained records in the current case folder.
If we cannot obtain records, document the current file to show the reason.
3. Individual does not reside in conversion State
If the individual does not reside in a conversion State, the field office (FO) will forward the folder directly to the DDS with jurisdiction at the time the continuing disability issue is raised.
The DDS will obtain SWA records in the State of conversion only if the individual does not meet the Federal criteria and it is necessary to transfer the case back to the DDS in the State of conversion for a continuing disability evaluation under the State plan. For instructions regarding the procedures for transferring a case to the State of conversion, see DI 28075.010D.1. in this section.
C. Procedure for evaluation
1. Determination instructions
Follow these instructions:
Apply Federal criteria, including the Medical Improvement Review Standard (MIRS). See DI 28005.001 through DI 28005.030.
If the adjudicator finds a cessation under the Federal criteria, apply State criteria and include another consideration of MIRS.
For a discussion of the Comparison Point Decision (CPD), see DI 28010.105B.4.
When it is difficult or impossible to locate the evidence considered in making the most recent prior decision under the State plan, follow DI 28035.025.
For breaks in Title XVI eligibility, follow DI 28075.020.
2. State plan material
When we must make a determination as to whether disability or blindness under a State plan continues to exist, follow DI 21501.001 through DI 21501.270.
Consider the entire State plan definition in making the determination.
Especially consider those written State plan definitions of disability and blindness that are clearly more liberal. The more liberal definitions are italicized.
3. Supplemental SWA instructions
Follow these instructions:
Obtain written supplemental manual instructions to provide clarification of State plan requirements.
Consider these instructions as part of the State plan definition.
Forward a copy of instructions to the DPB.
If used for the adjudication of a conversion case, identify and describe the relevant supplemental manual instructions.
Explain the effect of these instructions on the determination.
Refer any questions to the DPB.
D. Procedure for processing cases
1. Individual resides in conversion State
If the individual resides in a conversion State:
Prepare a determination of continuance or cessation, based on Federal and State criteria, as applicable.
Prepare a Form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) per DI 28084.001 through DI 28084.065.
2. Individual moved from conversion State
If the individual moved from a conversion State:
a. Resident State DDS action
Follow these instructions:
Develop case and complete the continuing disability evaluation under the Federal definition of disability or blindness.
If disability or blindness continues under the Federal definition, or if cessation is based on FTC, do not evaluate under the State Plan.
If disability or blindness ceased under the Federal definition, evaluate under the State plan.
If a continuance is established, prepare a determination.
When we cease disability or blindness under the Federal definition, forward the file, including Title II material in concurrent Title II or Title XVI cases, to the DDS in the State of conversion for a complete evaluation under the State plan.
NOTE: The DDS in the State of conversion may have materials that may clarify or interpret that specific State plan.
Prepare a Form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) for all Title XVI determinations and follow instructions in DI 28084.001 through DI 28084.065.
In cessation cases, enter in the “Remarks" section of the Form SSA-832 “State conversion – Determination under (show appropriate State) plan required.”
For paper cases, sign and place an unstripped (i.e., copies are not separated) Form SSA-832 along with any other material, on top of all material on the inside right side of the folder.
Route folder via SSA-408 (Route slip) to the conversion State.
NOTE: If any of these cases are electronic, see DI 81020.125 for electronic procedures.
b. Conversion State DDS action
Follow these instructions:
Develop and complete the continuing disability evaluation under the State definition of disability or blindness.
Prepare a Form SSA-832 adopting the findings and conclusions under the Federal definition in the determination prepared by the resident DDS State.
For paper cases, strip (i.e., copies are separated) and distribute copies of the Form SSA-832 as usual.
Do not strip or distribute copies of the Form SSA-832 prepared by the State of current residence.
Enter in the “Remarks” section of the Form SSA-832 prepared by the State of current residence "See revised determination of (date of determination under the State plan) which adopts this determination."
DI 21501.001 through DI 21501.270, State Welfare Plans