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:
eligible for title XVI payments/medicaid; or,
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.
1. Secure SSI-2 query
If title XVI may be involved, obtain SSI-2 query with PSY field when:
There is no SSI query under 30 days old in file, or
PSY code on latest query indicates title XVI eligibility (any code other than N07, N08, N12-N17, N30-N54, T01, or T30-T51), or
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:
DS Field Appears - Treat as title II only, regardless of PSY code. (Title XVI initial denial determination has been made.)
PSY Codes N07, N08, N12-N17, N27, N30-N54, T01,or T30-T51 - Treat as title II only.
PSY Code C01 (Current Pay) - Concurrent. Determinations and notices required for both titles.
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.
PSY Codes E01, N02-N06, N09-N11, N20, or S4-S20 - title XVI determination required; but title XVI continuance notice not required.
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.
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.
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.
PSY Code M01 (Force Pay; recipient may or may not be in pay) - Obtain SSID. Look in CMPH field f