The Disability Cessations and the Manual Adjustments, Credit and Awards Processes
(MADCAP) programs are used to process disability cessation actions for disabled beneficiaries
who have HI/SMI involvement. HI/SMI involvement means that the disabled beneficiary
has reached the 22nd month of entitlement to a disability-based benefit and HI/SMI
enrollment information has been annotated to the MBR.
The Disability Cessations program is restricted to use only by the Office of Disability
Operations and the Disability Determination Services for disability cessation actions
for disabled wage earners. This is an automated process which will terminate benefits
and record the termination on the MBR. It will also automatically determine, for those
beneficiaries with HI/SMI involvement, the correct HI/SMI termination date and record
such dates on the MBR as well. The Disability Cessations program produces three different
documents; i.e., the Form SSA-3926-C2, a 5 ×8 future month diary alert, and a 5 ×8
exception alert. All three will display the date of termination of HI and/or SMI (DOTH
and DOTS). They will also display the current premium due amount (CPDA) on record
at the time the termination action is taken. The Office of Disability Operations will
use this information in their notice to the beneficiary that benefits were or will
be stopped. Their notice will be the only notice of the termination of health insurance
entitlement and of any premium arrearage or overage existing at the time of the termination.
(See HI 00820.110 for an explanation of when the SALT and TATTER programs will terminate HI/SMI.)
There is no automated facility for terminating disabled adult child (DAC's) or disabled
widow beneficiaries (DWBs) when disability ceases. Disability cessation termination actions
for these beneficiaries must be processed through the MADCAP program. When there is
HI/SMI involvement, RID 6 must be coded as follows.
When the date of termination to health insurance (as determined by the chart above)
is equal to the last month of benefit entitlement, RID 6 of the MADCAP summary form must contain
the BIC, the appropriate entry in the HI termination date (HTD) field, and an HI option
code (HOC) of “C.” Additionally, if the beneficiary is entitled to SMI, the appropriate entry must be
coded in the date of termination to SMI (DTS) field and an SMI option code (SOC) of
“C” entered.
When the date of termination to health insurance (as determined by the chart above)
is later than the last month of entitlement to benefits (i.e., a future month at least 2 months
beyond the current operating month), RID 6 of the SSA-2795-U3 must contain only the BIC, a “D” in the reason for future termination (RFT) field, and the appropriate date in the
DTS field. Do not code the SOC, HOC or HTD fields.
The coding of the RFT of “D,” indicating HI/SMI termination due to disability cessation, will cause the following
data to be recorded on the MBR by means of internal systems processing:
-
1.
the date entered in the DTS field of the SSA-2795-U3 will be posted in the future
withdrawal or termination date (FWTD) of the MBR; and
-
2.
the entitlement LAF of the record will be changed to “U”, indicating that health insurance coverage is continuing beyond the last month of
benefit entitlement; and
-
3.
the benefit termination of LAF “T-8” will be posted in the work identification code (WIC) position of the history field;
and
-
4.
when the date shown in the FWTD field is reached, this date will be posted in the
DOTH and DOTS fields and the LAF of record will be changed from “U” to “X-7,” indicating that health insurance has been terminated. This is done in a subsequent
action in which the Regular Transcript and Attainment Pass (RETAP) program selects
the accounts in the month immediately preceding the month displayed in the FWTD field
and passes the records to the Transfer and Termination (TATTER) program for processing.
That is, the TATTER program is the facility through which the “future” HI/SMI terminations are effectuated.
ODO will receive no folder documentation subsequent to the termination and credit
action; the Form SSA-2795-U3 is the record of such action. However, program service
centers 1 through 6 will receive 5 ×8 informational forms indicating whether the HI/SMI
termination was processed.
The TATTER program will produce an informational containing an MBR printout for HI/SMI
terminations which are non-processable. However, this situation should be encountered
infrequently as the RETAP selection and TATTER program actions are based solely on
the information present on the MBR. Therefore, all factors for total processing should
be in concert.
When a nonprocessable condition is encountered, however, the informational will be
produced and carry the following entries: “Disability Cess,” A/N and BIC, the words “Nonprocessable HI/SMI Term,” plus the month and year the termination should have been effective. These informationals
will be directed to the Health Insurance and Inquiries Examiner for processing through
MADCAP.