TN 60 (08-96)
DI 32586.050 Payment Period and Onset - Title XVI -- Stieberger
A. Policy -- general
The FO is responsible for computing the PAYMENT PERIOD on a case-by-case basis (see DI 12586.050).
The Stieberger PAYMENT PERIOD and the potential onset date that will be shown on the SSA-831 are not necessarily related. Rather, the onset will usually be determined by the PAYMENT PERIOD. Unless DDS determines that a different onset must be established (see F., below), the onset in a Stieberger case will be established to permit payment in the first month of the PAYMENT PERIOD.
B. Policy -- payment period
The Stieberger PAYMENT PERIOD in Title XVI cases is generally the full 48-month period immediately preceding 12/91 (i.e., 12/87 through 11/ 91). However, if eligibility and disability continue, benefits may be paid beyond 11/91. Certain exclusions listed below will affect the title XVI PAYMENT PERIOD.
C. Process -- computing T-XVI payment periods
Use the following procedures when computing the title XVI PAYMENT PERIOD:
Count back 48 months prior to 12/91. When counting back, do not include:
months of title XVI eligibility including nonpayment months that occur during a period of title XVI eligibility;
months of potential eligibility to title XVI payments based on a pending claim;
months covered by a non-New York medical denial or cessation decision;
months the class member would not be eligible for a title XVI payment due to institutionalization (SI 00520.001);
months the class member would not be eligible for a title XVI payment because he/she was out of the U.S. (SI 00501.400).
IMPORTANT: In no case may payment be made for any period prior to the first day of potential eligibility on the earliest title XVI claim in the Stieberger period.
The only title XVI claim, filed 7/22/83, was denied by the NY DDS at reconsideration on 3/10/84.
The PAYMENT PERIOD is 12/87 through 11/91 (see B., above).
The same facts as in a., except the class member was institutionalized, resulting in title XVI ineligibility throughout the months of 10/88-6/89.
The PAYMENT PERIOD cannot include the period of institutionalization (10 /88-6/89).
The PAYMENT PERIOD is 7/89-11/91 (and possibly continuing -- see B., above), and 3/87-9/88.
The earliest Stieberger claim was filed on 6/12/87, and was denied at the ALJ level on 2/16/89. The class member became eligible for AI benefits on 3/31/90.
The PAYMENT PERIOD cannot include months of eligibility to title XVI, so begin counting back with 2/90. Forty-eight full months would be 3/86; BUT, in no case may payment be made for any period prior to the first possible day of eligibility on the earliest Stieberger claim. Since the date of filing of the earliest claim is 6/12/87, the first possible date of eligibility is 6/12/87.
The PAYMENT PERIOD is 6/12/87 through 2/90.
D. Policy -- documentation
The FO will compute the PAYMENT PERIOD potential onset prior to sending the case to the DDS. The information will be shown on the DEVELOPMENT/PAYMENT PERIOD Worksheet (See DI 32586.095, Exhibit 3). The Stieberger ONSET will be shown in the Remarks block of the SSA-831-U3. The Worksheet will be prong filed on the right side of the DIB folder, just beneath the SSA-831.
E. Policy -- onset
The onset date is established to permit payment to start with the first day of the first month of the PAYMENT PERIOD. Unless the DDS must adjust the onset based on its development (see F. below), the Stieberger ONSET in Title XVI cases is the first day of the first month of the PAYMENT PERIOD.
F. Procedure -- DDS adjusts onset
If the claimant is found disabled in part but not all of the DEVELOPMENT PERIOD and Sec. 10 (e)(5) development has been undertaken, usually the actual onset will be established (exception: cessations, CDBs and DWBs). If Sec. 10 (e)(5) development has been ruled out, whether or not an actual or artificial onset will be established will usually depend on whether the claimant was found disabled in the first month of the DEVELOPMENT PERIOD. If the claimant was disabled in the first month of the DEVELOPMENT PERIOD, an artificial onset will be set, unless it is obvious from the evidence (e.g., traumatic onset) that disability actually began at some later point during the first month. If the claimant was not disabled in the first month of the DEVELOPMENT PERIOD, an actual onset will be established.
Closed periods will be established as appropriate.
In actual onset cases, the DDS will line out the PAYMENT PERIOD section of the Stieberger Worksheet and the actual onset will be shown on the SSA-831.
G. Policy -- non-New York denials
Neither the Stieberger DEVELOPMENT PERIOD nor PAYMENT PERIOD may include a period covered by a medical denial (or cessation) made while the class member was a non-New York State resident (See DI 32586.035 B). Both disability and entitlement end with the AOD in the non-New York denial (or DOF, if the non-New York denial is title XVI). If the class member is once again disabled, a new period of disability is established after the period covered by the non-New York denial ends.
The DEVELOPMENT PERIOD/PAYMENT PERIOD Worksheet will indicate what months are part of a period covered by a non-New York state denial. It may be necessary to prepare two SSA-831-U3s, one for the closed period preceding the non-New York denial and one for the period after the close of the period adjudicated under the non-New York denial.
NOTE: Contact the Disability Programs Branch in the New York RO for assistance in such cases.