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 for date MO1 first appeared in PS segment. Look for same month and year in PMTH field, and read over to SMA and FMA segments for that month and year.

    • If money amount shown in either FMA or SMA segment: title XVI determination and continuance notice required.

    • If no money amount (0.00) shown - title XVI determination required, but title XVI continuance notice not required.

  2. PSY Codes T20 or T22 - Individual received duplicate title XVI payments based on same or different SSNs. Check folder to determine what SSNs are involved. If you cannot tell, call the FO and ask. Obtain SSI queries on all SSNs and take action as appropriate.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0440505210
DI 40505.210 - Identifying Concurrent Cases - Deciding Need for Title XVI Determination and Title XVI Continuance Notice - 03/29/2013
Batch run: 03/29/2013
Rev:03/29/2013