BASIC (02-18)

DI 60075.030 Field Office (FO), Processing Center (PC), and National 800 Number Network (N8NN) Responsibilities under the Promoting Opportunity Demonstration (POD)

A. POD participant questions legitimacy of project

Letters from Abt Associates (Abt) tell POD participants to contact either the POD Call Center or their POD work incentive counselor (WIC) to report work activity. If a POD participant contacts an FO, PC, or the N8NN with questions about the POD project, refer the POD participant to one of the following:

NOTE: FO, PC, and N8NN staff can identify POD treatment-group participants based on DP coding on the Disability Control File (DCF) demo screen - Select #16 Demonstration Project on the DCF MCDR - and Master Beneficiary Record (MBR) coding as described in DI 60075.015.

B. POD participant reports work activity to FO, PC, or N8NN

POD participants may be concurrently entitled to Title II and Title XVI benefits and will be required to report their earnings to Abt for Title II and their FO for Title XVI purposes. If a POD participant attempts to report Title II work to the FO, PC or N8NN, please follow the instructions below:

1. Work reports

If a Social Security Disability Insurance (SSDI) beneficiary reports work activity, the FO, PC, or N8NN should follow the normal processing instructions for establishing a work report in eWork. When establishing the work report, eWork populates a red alert message identifying the beneficiary as a POD participant and a contact number for Abt Associates. POD participants are to report work activity directly to their POD counselor or Abt. eWork will not accept a work report input during the POD participation period.

2. Recording submitted proof of earnings

Do not accept any proof of earnings or IRWE from a POD participant for Title II purposes. Return all documentation of earnings or IRWE to the beneficiary with instructions to contact the POD Call Center or POD counselor. The POD Call Center number is 1-888-771-9188.

NOTE: If the beneficiary is entitled to SSI, make a copy of the documentation and accept the report for SSI purposes. POD participants may have dual reporting responsibilities for Title II and Title XVI. Return original documentation to the beneficiary and advise them to report Title II earnings and IRWE to their POD counselor.

C. Work Continuing Disability Reviews (CDRs)

POD participants are exempt from work CDRs while participating in the POD. Instead, SSA evaluates earnings outside of eWork and applies offset using the POD Automated System (PAS). eWork generates the following warning message when trying to initiate a work CDR for a POD participant:

POD Participant. The beneficiary is currently in the POD program. Access to eWork – Initiate/Update Work Review is restricted. Refer beneficiary to the POD Call Center 888-771-9188.”

D. Reopening or reconsideration of a determination prior to the POD start date

FOs and PCs can reopen or reconsider a determination in eWork made prior to the start date of POD participation (found on the DCF). The reopening or reconsideration is for a closed period and will only evaluate earnings up to the end date of the last review period. Earnings from the month after the prior review period end date to the date of current effectuation are not evaluated.

eWork may allow a technician to input earnings during the POD participation period when performing a reconsideration or reopening, however the earnings are not used in the determination. The “Earnings and Events” screen in eWork will show all earnings input, but will not record a TWP/EPE or IRP code as a Decision Event Code for earnings posted during the POD participation period.

NOTE: Once a beneficiary completes POD participation, all reopening or reconsiderations of pre-POD determinations are restricted.

E. Ticket to Work program cases

A beneficiary participating in the Ticket to Work (TTW) program is eligible for the POD. The POD will apply an alternate rule for issuing payments to a qualified service provider assigned a ticket by a POD participant in treatment groups 1 and 2. Under the POD, SSA will pay the providers as set out below, depending on the payment system involved.

Since there are no work CDRs in the POD, SSA will use an average of either quarterly or yearly earnings to determine SGA.

1. Outcome-milestone payment system

For the outcome-milestone payment system, SSA will pay all available milestone payments as they are due. The outcome period will start the month following the month SSA pays the last milestone payment.

2. Outcome payment system

For the outcome payment system, SSA will pay outcome payments beginning the month following the 9th month of SGA. (The 9 months of SGA stand in for the Trial Work Period (TWP), which is required under the current rules to trigger an outcome payment but which does not exist in the POD.

NOTE: Outcome payments under both payment systems will count towards the maximum 36-month limit under regular TTW rules.

3. Verify Earnings (VY) issues

If the FO receives a systems-generated TICKET VY issue for a POD participant, review the DEMO screen in the DCF for the DP demo indicator and close the issue by keying the current date in the CLOSED field. In the remarks section, mark the reason for close out as “POD case”. Tickles may reappear if alleged wages continue to post to the DCF and no verified wages are posted for the POD cases. The FO should continue to close the T2VY issues and only verify and post T16 wages to the SSID.

The TTW program staff in the Office of Research, Demonstration, and Employment Support (ORDES) at Headquarters in Baltimore, MD, will manually process Employment Network (EN) payments for these T2VY issues. For more information on VY issues for TTW cases and the Continuing Disability Review Worksheet (CDRW) screen, see DI 55030.010 and DI 13010.605.

F. Expedited reinstatement (EXR) and initial disability applications

POD participants assigned to treatment group 2 can have their entitlement to SSDI terminate if they experience a period of 12 consecutive months in full offset (that is, their benefit is reduced to zero). In these situations, they will remain a participant in the POD, but will not be eligible for the $1 for $2 offset until they become re-entitled to disability benefits through a new claim or EXR. If the beneficiary decides to pursue a new claim or EXR, Abt will refer the beneficiary to the N8NN to make an appointment with their local FO to file the appropriate paperwork.

If POD participants become re-entitled to SSDI, they resume eligibility for the $1 for $2 offset beginning with the new month of entitlement (MOE), as long as they still have months remaining in their POD participation period.

A beneficiary re-entitled through a new claim is subject to TWP regulations beginning the month after the POD participation period ends.

A beneficiary re-entitled through an EXR claim will begin the Initial Reinstatement Period (IRP) the month after the POD participation period ends.

NOTE: EXR or initial disability applications must meet regular SSDI rules for approval. We do not offset provisional benefits for EXR claims.

G. Medical CDRs and work development

A beneficiary participating in the POD is still subject to medical CDRs.

1. POD workgroup unit discovers need for a medical CDR

When a medical review is due, the PITAG/I&E unit transfers the case to the FO to develop the case and send it to the DDS for a medical decision.

2. FO or PC discovers need for a medical CDR

If the FO or PC discovers a need for a medical review for a POD participant with earnings on the record, do not attempt to initiate a work review. The POD evaluates earnings outside of eWork. It may appear that earnings are undeveloped per the DCF and eWork, but the POD Automated System (PAS) is evaluating and offsetting earnings. Proceed with medical CDR development as though all earnings are developed per regular SSDI rules.

In a Form SSA-5002 (Report of Contact), state that the beneficiary is participating in the POD (MMDDYY – MMDDYY) and is not subject to work CDRs during participation.

NOTE: Annotate in the Electronic Data Collect System (EDCS) that the beneficiary is a POD participant and that the POD evaluates earnings on a monthly basis, outside of the eWork system.

3. Work development during the POD offset period

The POD evaluates earnings during the participation period on a monthly basis using the PAS. The FOs and PCs do not have to develop work when processing medical CDRs. However, they must notify DDS that work development is complete.

4. Medical cessation

If the DDS finds medical improvement, review the MBR for a HISTDEMO group and a Demonstration Project Indicator (DPI) code of DP.

a. MBR has HISTDEMO group and a DPI code of DP

If the MBR has this coding, send an email to the appropriate POD PC email account according to jurisdiction, see DI 60075.050A, with the subject “POD Case – Medical Cessation”. Indicate in the email that the POD participant has medically ceased and the PC must update the MBR.

The PITAG (PC1-6) or I&E unit (PC7) will code the medical CDR determination on the MBR. The FO should not attempt to input the medical cessation information via the post entitlement online system (POS). Doing so will cause the input to except and delay the posting of the medical information to the MBR.

b. MBR does not have a HISTDEMO group or a DPI code of DP

If the MBR does not have a HISTDEMO group, the system will automatically process the termination as long as the proper medical cessation coding appears on the MBR DIB line.

NOTE: Follow normal procedures for processing a medical CDR and appeals for all POD cases including those where Section 301 payment continuation applies. The local FO should take control of this case and process it normally.

5. POD participant – offset user

If a beneficiary contacts SSA about changing an address, phone number, direct deposit, or representative payee, check the MBR for the HISTDEMO group. A POD offset case has a DPI code of DP on the MBR.

NOTE: Changes to the SSID will follow normal processing procedures.

a. MBR does not have DPI code of DP

If there is no HISTDEMO line or the HISTDEMO line has a DPI code other than DP, follow normal procedures for processing changes to the MBR.

b. MBR has DPI code of DP

If the HISTDEMO line has a DPI code of DP:

  • Follow normal procedures for processing changes to the MBR if the action date is after the POD stop date and the date of the action is after the stop date; and

  • If the action date is on or before the POD stop date, and the date of the action falls between the start and stop dates on the HISTDEMO line, follow normal procedures for processing changes to the MBR. The HISTDEMO field will prevent the action from processing through POS. The POS exception will create an Action Control Record (ACR) in Paperless for the PC of jurisdiction. The PITAG/I&E unit will verify the information and process any changes.

6. PC attempts to input a PE action

If a non-POD unit in the PC attempts to input a PE action through a MADCAP or MACADE transaction within the start and stop dates of the demonstration project, an alert specifies the need to access an additional screen to override the current demonstration information on the MBR. This is a preventative measure to avoid incorrect inputs by the PCs. PC staff should refer necessary actions within the demonstration period to the PITAG (PC1-6) or I&E unit (PC7) within the PC of jurisdiction.

H. Special processing scenarios

These instructions will assist you when you encounter situations where special processing applies:

Scenario

Alert

Action

Attempting to create a Work Report in eWork when the beneficiary is still participating in the POD

POD ParticipantThe Beneficiary is currently in the POD program. Access to eWork – Work Report Summary is restricted. Refer beneficiary to the POD Call Center (888) 771-9188.

If the person is also on SSI see DI 60075.030B.

Do not accept the work report from the POD beneficiary. Instead, return all documentation to the beneficiary. Instruct the beneficiary to report all work to the POD counselor or the POD Call Center.

Attempting to create a Work Review in eWork during the POD participation period Start and Stop date.

POD Participant – The beneficiary is currently in the POD program. Access to eWork – Initiate/Update Work Review is restricted. Refer beneficiary to the POD Call Center 888-771-9188.

PC User:

If you are attempting to set this case up in eWork because of the continuing disability review enforcement operation (CDREO), annotate the Action Control Record (ACR) “NAN-POD participant.” Send the ACR to FIN FIN.   

Clear the Enforcement via the CDR PC Input (IPCA) screen on the DCF using 8=SSR/MBR CONDITIONS-STOP CDR. Annotate to the DCF remarks that the CDR was stopped due to POD participation.

FO User:

Clear the Enforcement via the CDR FO Input (IFOA) screen using 5=SSR/MBR/STOP CDR. Annotate to the DCF remarks that the CDR was stopped due to POD participation.

Attempting to initiate an IC evaluation in eWork during the POD participation period.

POD Participant – The beneficiary is currently in the POD program. Access to eWork – Initiate/Update IC Evaluation is restricted. Refer beneficiary to the POD Call Center 888-771-9188.

The IC function of eWork is not a work around for the restricted Initiate/Update Work Review screen. All work CDRs during POD are restricted.

Instruct the beneficiary to contact the POD Call Center to report earnings.

A FO or PC user attempts to save new information for a protected POD month in an eWork Short Path, or attempts to reopen a month in the protected period from a prior review on the Earnings Details Screens during a post-POD work CDR.

Work Review Summary Screen will display:

***Prior POD Beneficiary***

The information you changed is in the Short Path period. The EPE events (e.g. EPE Begin Month, Cessation, Reinstatements, and Suspensions) during the Short Path period are based on the months previously entered. This period contains months within a protected POD demonstration period and cannot be reopened.

Do not attempt to input earnings related information after the month of the last work CDR decision in eWork and prior to and during the POD period. Only input earnings after the STOP date of POD participation.

I. Fraud issues and the POD

Normal processing procedures apply for all fraud cases. A POD participant will remain in the POD during the investigation and processing of fraud allegations. However, if the decision involves removing earnings that affected the offset decision, we will modify our decisions accordingly. For more information on handling fraud, see DI 11006.025.

J. Post-POD work CDRs

POD participants can withdraw from the demonstration at any point within their participation period. When POD participation ends, the beneficiary reverts to regular SSDI rules for work the following month. We may need to process a work CDR following POD participation in order to evaluate SGA level earnings. If processing a post-POD work CDR, follow these steps:

  1. Initiate Work CDR: eWork will identify the beneficiary as a Prior POD Beneficiary;

  2. Develop earnings for the post-POD review period only: eWork will set a review start date for the first month after POD participation ends. Do not develop or input wages in the POD participation period; and

  3. Do not attempt to reopen any prior decisions: eWork will restrict the reopening of any decision prior to POD.

NOTE: Excuse all earnings from the last recorded decision in eWork through the end of POD participation from regular rules SSDI evaluation. It is important to evaluate earnings within the new review period only in eWork.


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http://policy.ssa.gov/poms.nsf/lnx/0460075030
DI 60075.030 - Field Office (FO), Processing Center (PC), and National 800 Number Network (N8NN) Responsibilities under the Promoting Opportunity Demonstration (POD) - 02/01/2018
Batch run: 02/01/2018
Rev:02/01/2018