TN 2 (04-13)
DI 55025.010 Processing the Medical Continuing Disability Review (CDR) for Beneficiaries with Tickets
A. Procedure for when the beneficiary indicates receiving vocational rehabilitation (VR) or employment support services
If the beneficiary alleges receiving vocational rehabilitation services, field offices (FOs) and processing centers (PCs) take the following actions when processing medical CDRs:
If the beneficiary states on a Disability Report Update (Form SSA 454-OCR-SM, Continuing Disability Review Report) or on another source that he or she is participating in a VR program or employment support, and the Ticket status is other than:
ASSIGNED IN USE,
NOT ASSIGNED IN USE EXTENDED, or
IN USE SVR,
do not continue the medical CDR until the Office of Employment Support Programs (OESP) investigates the Ticket In-Use eligibility status.
NOTE: For ticket information, access Ticket Use History screen (TKUH) query screen on Disability Control File (DCF).
Please contact OESP via email at: ^VR helpdesk within SSA intranet or VR.Helpdesk@ssa.gov via the internet and provide the following information in the email:
Subject Line: Initiation of Medical CDR Pending – Request to Resolve Alleged Ticket In-Use Status
Please include the following information in your email:
IMPORTANT: Unless you provide OESP with a different email address, they will reply to the email address on the message. If you want OESP to send the response to a different email address, please provide that email address in your email request. If you would prefer a telephone call, please provide the telephone number.
If you do not receive an acknowledgement after seven calendar days, followup on your request to OESP. OESP will verify the ticket assignability and ticket status, and contact your office with a final response within 60 calendar days. (For instructions on establishing a diary, see GN 02606.150.)
If OESP does not respond after 60 days, you should obtain a new Ticket Use History screen for the ticket status. If the ticket status is still other than “ASSIGNED IN USE, NOT ASSIGNED IN USE-EXTENDED or IN USE SVR,” you should process the CDR.
B. Procedure for processing CDRs when the beneficiary has a ticket
Use the following chart to determine when to process medical CDRs for beneficiaries with tickets. Obtain this information from the “Ticket Use History” (TKUH) query in the DCF. To close out the CDR, when appropriate, use standard procedures in DI 13005.020I.
CDR initiated before ticket status was In-Use.
CDR continues, unless the beneficiary alleges ticket use begin date is incorrect. For In-Use begin date investigation, follow instructions in DI 55025.010A (in this section).
Beneficiary alleges ticket In-Use.
FOs or PCs check the DCF to see if CDR closed because of ticket. If contrary to allegation, the ticket is Not-In-Use and the CDR is open, follow DI 55025.010A (in this section).
OESP confirms beneficiary’s allegation of ticket use prior to CDR initiation date.
OESP notifies the Program Manager to change ticket status to “In-Use” and the system closes out CDR.
OESP denies beneficiary’s allegation of ticket use.
Process the CDR if the DCF still shows ticket “Not-In-Use”
CDR not closed and ticket not In-Use.
FO/PC sends notice of CDR. (For copy of notice, see NL 00705.350.)
CDR closed out.
FO/PC sends the CDR deferral notice. (For copy of notice, see NL 00705.355.)
NOTE: If neither the beneficiary nor provider notifies us that the beneficiary was receiving VR or employment support services and a medical CDR determination terminates benefits, the cessation will stand even if we retroactively assigned the ticket prior to the date of the determination.
C. Procedure when SSA initiates a medical CDR on the ticket holder
If we initiate a medical CDR while the ticket is not in use:
Continue processing the CDR.
Send the beneficiary a notice to inform him or her that we initiated the CDR.
Input the CDR initiation date (notice date) into the DCF following the instructions in MSOM CDR 001.007.
Use event type 8, “Direct Release Notice Information.”
Make sure that the CDR initiation date is correct and matches the notice date.
If we initiated the medical CDR while the ticket was in use, stop processing the CDR.
NOTE: If we initiated the medical CDR as a result of work activity and not a direct release CDR, follow DI 13010.012.
DI 55025.001 Determining Ticket Status