BASIC (12-08)

DI 40505.315 Handling CDRs where the Cessation Determination was Not Effectuated

A. Operating policy

1. General

There is no time limit on correcting an error in processing a determination. See Relationship Between Initial Determination and Administrative Finality GN 04001.030B.4.

As a general rule, if an individual was notified of a continuing disability review (CDR) cessation and has not appealed, process the cessation. However, for procedures concerning Uneffectuated Medical Cessation (UMC) and Overdue Medical Cessation (OMC) cases, see Special Instructions for Processing UMC and OMC Cases DI 13015.265 for FO and DI 28075.200 for DDS.

UMC cases are DDS medical cessation determinations made before January 01, 2006, that due to administrative error, were not effectuated at the time they were rendered.

OMC cases are DDS medical cessation determinations made on or after January 01, 2006, that were not effectuated for more than 2 months after the month of termination or date of the cessation notice, whichever is later.

2. Exception if the medical improvement review standard was not applied

The medical improvement review standard (MIRS) must have been applied before a medical cessation may be processed.

3. Notice of action

A notice must be sent to explain the action. However, in processing Overdue Medical Cessation cases, additional due process is not necessary before stopping the checks because the individual already received a cessation notice.

B. Procedure

1. Overdue Medical Cessation (OMC) cases

Forward all OMC cases to the FO and request the FO to

  • send notice per Special Situations – Policy – Payment Termination not Effectuated DI 13010.197E; and

  • process the case per Special Instructions for Processing UMC and OMC Cases DI 13015.265B.

Process OMC appeals by following cessation procedures. If the individual wants to appeal, the FO considers whether good cause exists for late filing and for benefit continuation, if requested.

2. Uneffectuated Medical Cessation (UMC) cases

If a UMC case is discovered in the PC, forward it to the FO under cover of the flag shown in Exhibit 1 and request the FO to process per Special Instructions for Processing UMC and OMC Cases DI 13015.265C.

Do not terminate benefits on any UMC case for which the DDS medical cessation determination was made prior to January 1, 2006.

The FO initiates a new CDR on all UMC cases. Do not attempt to identify cases where benefits have already been terminated. However, if any type of protest (for example, a request for waiver of the overpayment or Congressional contact) is received on a UMC case that was previously terminated, forward the case to the FO for processing per Special Instructions for Processing UMC and OMC Cases DI 13015.265.

If you receive a UMC case and if

  • the folder is in the PC, return it to the FO under cover of the flag shown in Exhibit 1 and request the FO to process per Special Instructions for Processing UMC and OMC Cases DI 13015.265.

  • the folder is not in the PC, send an MDW to the FO indicating the termination action was not processed and requesting the FO to process per Special Instructions for Processing UMC and OMC Cases, DI 13015.265.

NOTE: These special UMC procedures do not apply once the DDS makes a new CDR determination. For example, if the new CDR determination (made after January 01, 2006) again results in a cessation determination, terminate benefits based on the new CDR cessation date and process any subsequent appeal. In addition, these instructions do not apply to Overdue Medical Cessation (OMC) cases for which the DDS cessation determination was made on or after January 01, 2006 (see Special Instructions for Processing UMC and OMC Cases, DI 13015.265B).

G-DI_40505.315-1

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