TN 10 (12-17)

DI 33025.075 Age 18 Redetermination Cases Under P.L. 104-193

A. Background – Childhood disability eligibility at attainment of age 18

Pursuant to Public Law (P.L.) 104-193, all title XVI childhood disability recipients who attained age 18 on or after August 22, 1996, and were eligible as children in the month before the month in which they attained age 18, must have their eligibility redetermined under the adult standards for initial claims.

Use the adult disability criteria for initial claims to make disability redeterminations, excluding the first step of the sequential evaluation, process, substantial gainful activity (SGA).

NOTE: The medical improvement review standard (MIRS) does not apply in Age 18 redetermination cases.

B. Policy – Appealing the decision in an age 18 redetermination case

Recipients found not disabled in an age 18 redetermination, based on the application of the adult disability criteria, may appeal the determination that they are not disabled. Reconsiderations of the age 18 redetermination cases will be conducted under the regulations that govern the disability hearing process. See 20 CFR §416.1414 through §416.1418.

C. Process for conducting an age 18 redetermination case

Except as set out in this section, age 18 redetermination reconsiderations will be conducted according to DI 33001.000 Disability Hearing Unit Procedures.

For example:

  • If the disability determination services (DDS) could not reach a fully favorable determination, any residual functional capacity assessment forms, including SSA-416 (Medical Evaluation), SSA-4734-BK (Physical Residual Functional Capacity), or SSA-2506-BK (Psychiatric Review Technique), obtained for the case review, will be marked, “Advisory.”

  • The DDS or the disability hearing unit (DHU) will prepare an SSA-887 (Summary of Evidence).

  • The DHU will send the recipient, and his or her representative, if any, notice of the time and place of the disability hearing at least 20 days before the date of the hearing.

  • The recipient and his or her representative, if any, should be encouraged to review the evidence in the case folder on the date of the hearing or at an earlier time.

If, for any reason, additional evidence is obtained after a hearing, and all evidence, taken together, supports an unfavorable decision, the recipient is notified, in writing, and given an opportunity to review and comment on the additional evidence within 10 days of the date the notice is received, unless there is good cause found for granting additional time.

D. Procedure - preparing the disability hearing officer’s report of disability hearing

While conducting the hearing, complete an SSA-1205-BK (Disability Hearing Officer's Report of Disability Hearing) to record the proceeding. Because comparison point decision (CPD) and the MIRS do not apply in age 18 redeterminations, annotate the SSA-1205-BK to show you did not use these concepts. Delete, cross out, or make remarks about any reference to the CPD or the MIRS. Examples of remarks to use in appropriate items include “not applicable” or “The medical improvement standard does not apply.”

E. Procedure - fully favorable age 18 redetermination case

1. Completing the form SSA-1207-BK-OP1

Complete an SSA-1207-BK-OP1 to document a fully favorable determination. Concisely discuss the evidence and provide a rationale that explains the basis of the decision.

2. Completing the form SSA-832

Complete an SSA-832 in every case with a decision. Enter in the remarks section, “This decision is based on the hearing held on (date of hearing).” For special coding instructions, see DI 23570.025 Processing Childhood and Age 18 Disability Redeterminations.

DHO cover notice

Prepare and release the DHO cover notice with the DHO decision.

Refer to DI 33015.025 and DI 33095.100 for a sample Notice of Reconsideration without benefit continuation. Do not use any fill-in that refers to medical improvement. For a fully favorable decision – Notice of Reconsideration with benefit continuation, suggested language follows:

Suggested Language for a Fully Favorable Decision

    

Social Security Administration

Supplemental Security

Notice of Reconsideration

Date:

Name

Address

City, State, and Zip Code

We are writing to let you know that we have made our disability hearing decision on your case.

   

Our Decision

We find that your disability began (insert date of disability here).

We have attached the hearing decision to this letter. Our decision deals only with whether you are disabled. If our decision causes a change in your benefits, you will receive a separate letter.

If you agree with our decision, you do not have to do anything.

  

If you Disagree with The Decision

If you disagree with the decision, you have the right to ask for a hearing. At the hearing, a person who has not seen your case before will review your case again. That person is an Administrative Law Judge (ALJ). In this review, the ALJ will consider any new facts you have.

  • You will have 60 days to ask for a hearing

  • The 60 days start the day after you receive this letter. We assume you will receive this letter within five (5) days after the date that appears above, unless you can show us that you did not receive the letter within five days.

  • You must provide a good reason for a delay if you wait more than 60 days to ask for a hearing.

  • Your request for a hearing must be in writing. We will ask you to sign Form SSA-501, called a ‘Request for a Hearing.’ Contact the nearest Social Security Administration office for a copy of this form and if you need help.

Enclosures:

Hearing Decision

F. Procedure - partially or fully unfavorable age 18 redetermination cases

1. Completing the form SSA-1207–BK-OP1

Complete an SSA-1207-BK-OP1 to document a partially or fully unfavorable determination.

2. Completing the form SSA-832

Complete an SSA-832 in every case with a decision. Enter in the remarks section, “This decision is based on the hearing held on (date of hearing).”

3. DHO cover notice

Prepare and release the DHO cover notice with the DHO decision.

  • Unfavorable decision and benefit continuation not offered -- SSA-L1674

  • Unfavorable decision and benefit continuation is offered – SSA-L1680

See:

  • DI 33015.025 Preparing the Notice of the Disability Hearing Officer's Decision

  • DI 33095.116 SSA-L1680— Disability Hearing Decision Cover Letter — Payment Continuation Elected at Reconsideration and Offered Again at ALJ Hearing Level

Do not use a fill-in that refers to medical improvement. In most cases, the appropriate fill-in will be, “We find that you are no longer eligible for payments.”


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0433025075
DI 33025.075 - Age 18 Redetermination Cases Under P.L. 104-193 - 12/13/2017
Batch run: 12/13/2017
Rev:12/13/2017