TN 3 (04-12)

DI 28080.030 Due Process Requirements for Concurrent Title II/Title XVI Continuing Disability Review Cases

A. Concurrent title II/title XVI

The title XVI due process requirements described in DI 28080.025 apply to both the title XVI and title II portions of the concurrent claim.

The title II determination notice provides due process for both title II and title XVI when statutory benefit continuation (SBC) applies in a cessation determination.

NOTE: In initial medical cessations, the reconsideration disability hearing is the first level of appeal.

B. Common issue determinations

When processing cessation determinations for a common issue concurrent title II/title XVI case, the due process requirements for title XVI also apply to the title II. A reconsideration disability hearing is the initial appeal step for both determinations. If the recipient’s request for appeal and SBC is within 10 days of receipt of the due process notice, we continue payments until the Disability Determination Services (DDS) hearing officer issues an appeals decision. Alternatively, the recipient may waive SBC.

NOTE: In “common issue” claims, it is not necessary for the onset or ending dates in the two determinations to coincide. See DI 12045.005, Claims Under Different Titles – Common Issue – General.

C. Individual receiving title II benefits is ineligible for title XVI payments for a non-disability reason

The title XVI due process provisions apply to concurrent title II/title XVI cases involving situations where we suspended the title XVI payments for a non-disability reason, but title II benefits continue to be paid.

  • The current status of the title XVI payments at the time of the DDS query response determines concurrency for due process purposes. The SSI record (SSR) shows suspended title XVI claims by nonpayment status codes.

  • For concurrent title II/title XVI cessations, the DDS should obtain an SSI2 standard response query immediately prior to preparing the cessation notice. This second query is necessary since it is possible that the title XVI payment status changed since the DDS obtained the query upon case receipt. For display of the SSI2 query format and an explanation of the various codes, see SM 01601.190.

  • Determine whether the beneficiary or recipient receives title II or title XVI due process by examining both the Payment Status Code (PSY) field and the Denial Status (DS) field.

D. Title II

The title II due process provisions in DI 28080.010 apply to the title II claim when processing a title XVI continuance concurrently with a title II cessation; e.g., when a State plan criteria is the basis for the title XVI determination of continuance.

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