TN 14 (02-10)

DI 40515.010 Due Process Requirements - Title XVI

CITATIONS: Social Security Act, Section 1631 (a) (7) ; Regulations 20 CFR 416.995 , 416.996 , and 416.1336

A. Policy on Title XVI due process requirements

1. Due process and notice of planned action

  1. Due process requires that you send the beneficiary a notice of planned action before benefits are adversely affected.

  2. Benefits are continued if:

    • An appeal is requested within 10 days of receipt of the notice of planned action; and

    • The beneficiary does not waive, in writing his or her right to continuation of benefits. See SI 02301.300 for additional guidance in Title XVI due process cases.

EXCEPTION: Due process notification is not required when the beneficiary's death has been confirmed.

2. Statutory benefit continuation option applies

The decision notice provides due process when the statutory benefit continuation option applies. The policy for Title XVI cases is the same as that for Title II cases. See DI 40515.005B.2.

3. Title II/Title XVI concurrent cases

  • Medical

    Process the Title II case under Title II procedures, and the Title XVI case under Title XVI procedures. The decision notice provides due process for Title II and Title XVI when the statutory benefit continuation option applies.

  • Work and earnings

    The Title II case receives Title II due process per DI 13010.185F, and the Title XVI case receives Goldberg/Kelly (G/K) due process per SI 02301.300. This applies whether you process the adverse actions at different times or at the same time.

B. References

  • SI 02301.300, Due Process Protections - General

  • SI 02301.301, Overview of Goldberg/Kelly (GK) Processing.

  • SI 02301.305, Online Goldberg Kelly (GK) Notices

  • SI 02301.307, Manual Goldberg Kelly (GK) Notice Procedures

  • SI 02301.310, Appeal and the Right to Goldberg Kelly (GK) Payment Continuation

  • SI 02301.315, Erroneous Payments and GK Payment Continuation

  • DI 40515.100, Title II and Title XVI Statutory Benefit Continuation During Medical Cessation Appeal.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0440515010
DI 40515.010 - Due Process Requirements - Title XVI - 08/14/2012
Batch run: 08/14/2012
Rev:08/14/2012