DI 40505.210 Identifying Concurrent Cases - Deciding Need for Title XVI Determination and Title XVI Continuance Notice

A. Operating policy

1. Concurrent defined

Individual entitled to title II disability benefits, and:

  1. eligible for title XVI payments/medicaid; or,

  2. in posteligibility situations, is ineligible under title XVI for non-disability reasons.

2. Title XVI determination and cessation notice needed

Two determinations are needed in a concurrent case whether or not title XVI payments are being made. If cessation results, two cessation notices are required.

3. Title XVI continuance notice not always needed

A continuance notice is needed only if individual is receiving title XVI payment or is eligible for Medicaid under section 1619 (DI 40540.001).

NOTE: See DI 28095.060 for title XVI notice instructions.

B. Description of a case with Title XVI involvement

Will generally consist of a title II claim folder with “S” or “SSI Conversion Case” on the outside of the jacket under the SSN. Other indications of possible title XVI involvement:

  • In conversion cases, a computer-generated SSI conversion document (SSA-8080-TR);

  • In non-conversion cases, an SSA-831-U5 and/or SSA-833-U5 showing title XVI involvement;

  • A conversion of benefit rate Form SSA-596 with “yes” entered in the SSI INV block; or,

  • Other payment forms or documents indicating title XVI involvement.

C. References

  • Payment Status (PSY) codes - SM 01305.001.

  • Other Supplemental Security Income Record (SSR) codes - SM 01601.400G.

D. Procedure

1. Secure SSI-2 query

If title XVI may be involved, obtain SSI-2 query with PSY field when:

  1. There is no SSI query under 30 days old in file, or

  2. PSY code on latest query indicates title XVI eligibility (any code other than N07, N08, N12-N17, N30-N54, T01, or T30-T51), or

  3. The latest query shows one of the above codes but later evidence indicates title XVI eligibility.

2. Actions based on SSR codes

When sending a concurrent case for CDR, tell the DDS on the routing form whether title XVI determination and/or notice are needed as follows:

  1. DS Field Appears - Treat as title II only, regardless of PSY code. (Title XVI initial denial determination has been made.)

  2. PSY Codes N07, N08, N12-N17, N27, N30-N54, T01,or T30-T51 - Treat as title II only.

  3. PSY Code C01 (Current Pay) - Concurrent. Determinations and notices required for both titles.

  4. PSY Code NO1 - Individual may or may not be receiving Medicaid under section 1619(b). Obtain SSID. Look in CMPH field for column T (Medicaid social services test):

    • a, b, or f shown in column T - eligible under 1619(b). Title XVI determination and continuance notice required .

    • Any code other than a, b, or f in column T - individual ineligible. Title XVI determination required, but continuance notice not required.

  5. PSY Codes E01, N02-N06, N09-N11, N20, or S4-S20 - title XVI determination required; but title XVI continuance notice not required.

  6. PSY Codes H10-H90 or S21 - Phone FO for status (system does not know). If still H10-H90 or S21: title XVI determination needed ; title XVI continuance notice not needed.

  7. PSY Code N19 (Voluntary termination) - Obtain SSID query. Look in CMPH field for date N19 first appeared in PS segment. Individual went in N19 first day of month and year shown.

    Example:

Graphic Unavailable: ID G-DI_40505.210D.2.g

This individual went into N19 status 6/1/87.

  • Individual in N19 60 or more days - treat as title II only.

  • Individual in N19 less than 60 days - title XVI determination required, but title XVI continuance notice not required.

  1. PSY Code M01 (Force Pay; recipient may or may not be in pay) - Obtain SSID. Look in CMPH field f