TN 14 (08-92)

DI 40510.165 Conducting a CDR for Premium-HI Cases

A. Policy

A CDR conducted for entitlement to Premium-HI must not consider the performance of SGA in evaluating continuing disability. A finding that the individual is not disabled for Premium-HI must be based on medical improvement.

ODIO/PSCs initiate the CDR and process all disability continuances to completion. Cases involving medical improvement or other medical issues for which a cessation is probable are referred to the DDS for processing.

The interim award notice must inform the applicant for Premium-HI that continuing entitlement to benefits is subject to a medical review, and serves as the prereview notice normally sent to a disability beneficiary when a CDR is initiated.

B. Procedure

When conducting a CDR for an initial Premium-HI enrollment period, follow the instructions below:

1. Notice

Do not send a prereview notice. The interim award notice will inform the applicant for Premium-HI that continuing entitlement to benefits is subject to a medical review.

2. Determination

Follow the CDR evaluation process including the MIRS as covered in
DI 28005.000. Do not consider SGA when evaluating Premium-HI cases.

a. Currently disabled

If the individual can be found currently disabled for Premium-HI:

  • Complete an SSA-831-U3 as required by DI 40510.165. Be sure that the identifying Medicare remark is displayed in item 34, and that an entry of “S” appears in item 29.

  • Establish a future medical review diary per DI 40510.160.

  • Route the folder to the typist for preparation and release of the final award notice, Exhibit 4, DI 40510.185.

b. CDR raises an issue of MI/different allegation

  • Forward the case to the DDS under cover of an SSA-847-U3 for a decision if the CDR raises an issue of MI, or the original impairment is no longer disabling and individual has alleged a different impairment than the one on which the most recent favorable determination was based.

  • Check block l.b. and block 3 “Other” and annotate the form “Section 6012 - Premium Medicare Case.”

  • Advise the DDS to follow the continuing impairment severity adjudication procedure set out in DI 28055.025. Emphasize that SGA should not be considered in evaluating these cases.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0440510165
DI 40510.165 - Conducting a CDR for Premium-HI Cases - 03/29/2013
Batch run: 03/29/2013
Rev:03/29/2013