TN 4 (06-05)
SI 04070.060 SSI Posteligibility Actions
A. Policy – Redeterminations
1. Scheduled Redeterminations
SSA formally redetermines eligibility and payment amount on a periodic basis. (See SI 02305.000 – Redeterminations of Eligibility and/or Payment Amount)
2. Unscheduled Redeterminations
SSA may formally redetermine eligibility and/or payment amount when:
3. Redetermination Involves a Change in Eligibility or Payment
Redeterminations which involve a change in eligibility or payment can be:
a. Initial Determinations
A redetermination that results in a determination which prospectively changes either a factor of eligibility or payment amount is an “initial determination” (see SI 04010.010 – What Is and Is Not an Initial SSI Determination). Such determinations can later be reopened and revised under the 1-year, 2-year rules or indefinite (unlimited) rule for fraud or similar fault as appropriate.
The time period for reopening is measured from the date of the notice of the initial determination. (It is the initial determination resulting from the redetermination process, not the redetermination (process) itself that can be reopened.)
b. Revised Determinations
If the change made by a redetermination has retroactive effect, it is a revised determination. Revised determinations can be reopened and revised. It is important to note that the 1- or 2-year period for reopening a revised determination is measured from the date of the notice of the initial determination or date of the deemed determination that it revises, not from the date of the notice of the revised determination.
EXAMPLE – Reopening a Revised Determination
A notice of an initial determination is dated June 7, 2002. The determination is revised on December 14, 2002. The notice of the revision is also December 14. The revised determination itself may be revised for good cause at any time until June 7, 2004 since the administrative finality period is measured from the date of the notice of initial determination.
c. Determinations That Are Both Initial and Revised
Determinations resulting from a redetermination can be both “initial” and “revised” determinations at the same time. To the extent that they are prospective, they are “initial” determinations, and to the extent that they have retroactive effect, they are “revised” determinations.
To the extent that such determinations are initial determinations, they can be reopened up to 2 years from the date of the notice of the determination. To the extent that they are revised determinations, they can be reopened up to 2 years from the date of the notice of the initial determination they are revising.
4. Redeterminations Involving No Change
If the redetermination results in no change in eligibility or payment amount, it is not a determination for purposes of administrative finality and is therefore not subject to reopening and revision. The deemed determinations for the months in the retroactive period which the redetermination process covers can be subsequently reopened and revised within the applicable time limits as if the redetermination had not occurred.
B. Reference -Interface
See SI 02310.005 – Interface Operations and Related Issues