Identification Number:
EM-17011
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/
OCO-CSTs/ODAR/DDS
Originating Office:ORDP ORDES
Title:A New Rule Allows Previously Entitled Beneficiaries to Apply for Expedited Reinstatement (EXR) in the Same Month They Stop Performing Substantial Gainful Activity (SGA)
Type:EM - Emergency Messages
Program:Title II (RSI); Title XVI (SSI); Disability
Link To Reference:See References at the end of this EM.
 
Retention Date: March 29, 2018

A. Purpose

This emergency message (EM) informs field office (FO), disability determination services (DDS) and payment center (PC) technicians about a new rule regarding EXR.
    The new rule is effective April 17, 2017. Until we revise the instructions in the Program Operations Manual System to reflect changes made by the final rule, apply the instructions in this EM to process requests for EXR.

B. Background

    The new rule allows previously entitled beneficiaries to apply for EXR in the same month they stop performing SGA, and provides that provisional benefits to begin the month after the request for EXR if the beneficiary stops performing SGA in the month of the EXR request. The changes simplify our policies and make them easier for the public to understand.

    The procedures in this EM describe the new rule and pertain to requests filed on or after April 17, 2017.

    Prior to April 17, 2017, technicians must deny requests for EXR if the applicant performed SGA in the month of the EXR request.

C. Policy for EXR eligibility

      Applicants are “not able” to perform SGA if, in the month of their EXR request, they do not work or their work is not SGA.

      Applicants “become unable” to perform SGA if, in the month of their EXR request, their work is SGA, but they stop performing SGA by the day they file their request. To meet the requirement of having become unable to perform SGA, they must also not perform SGA in the month following the EXR request.
    To be eligible for EXR, an applicant must:
      · Be “not able” or “become unable” to work at the SGA level due to his or her medical condition;
      · Be “not able” or have “become unable” to perform SGA in the month of the EXR request;,
      · Have stopped performing SGA within 60 months of his or her prior termination;,
      · Have a current medical impairment(s) that is the same as or related to the original impairment(s);, and
      · Be under a disability based on application of the medical improvement review standards (MIRS).

    D. Policy for provisional benefits

        1. Title XVI provisional benefits

          Provisional benefits start with the month after the month the applicant completes the request for EXR. Protective filing does not apply to provisional benefits. Provisional benefits begin the month after the month the applicant submits the required documentation and signed EXR request.
        2. Title II provisional benefits

          If there is no SGA in the month of the EXR request, we pay provisional benefits beginning with the month the beneficiary completes and submits the signed EXR request, assuming we have not already paid benefits for that month. Do not use the protective filing date (if one exists) to begin provisional benefits. If there is SGA in the month of the EXR request, then pay provisional benefits beginning with the month after the request for reinstatement.

    E. Field office (FO) procedures to initiate provisional benefits
        1. Title XVI provisional benefits

          For instructions on initiating TXVI provisional benefits, see DI 13050.030I.
        2. Title II provisional benefits

          For instructions on initiating TII provisional benefits, see DI 13050.025I.
          If there is SGA in the month of the EXR request, the provisional benefit start month is the following month. If the provisional benefit start month is later than the current operating month (COM), make the post entitlement online system (POS) input after the COM changes.
    F. Procedure for documenting SGA
        1. Title XVI SGA documentation

          The FO must document all SGA and non-SGA months beginning with the month of filing on the SSA-820-BK (Work Activity Report – Self Employment) or SSA-821-BK (Work Activity Report - Employee) and record the SGA determination on the SSA-823 (Report of SGA Determination - For SSA Use Only). If there is SGA in the month of filing, the FO documents the SSA-823 with the remarks, “SGA ended in the month of filing.”

        2. Title II SGA documentation

          The FO must identify all months of SGA and non-SGA in the 12-month period prior to EXR request on the SSA-820-BK or SSA-821-BK, and record the SGA determination on the SSA-823. If there is SGA in all months of the 12-month retro period and in the month of filing, the first possible month of entitlement (MOE) is the month following the month of filing. The FO documents the SSA-823 with the remarks, “SGA in month of filing. First possible MOE is MM/YY.”
    G. DDS instructions for MOE determination
        1. Title XVI month of eligibility

          Eligibility for reinstated benefits begins with the month following the month of the EXR request. There is no retroactive eligibility to Title XVI payments under EXR. For additional information, see DI 28057.015.

        2. Title II month of entitlement

          The DDS reviews the SSA-454-BK (Continuing Disability Review Report) and SSA-823 to determine the appropriate EXR MOE. If there is SGA in all months of the 12-month retro period and in the month of filing, the first possible MOE is the month following the month of filing. For additional information, see DI 28057.015.
    H. Other EXR procedural changes
        1. FO procedures for storing EXR documents

          Before sending the case to DDS, fax:

            · the appropriate forms listed in DI 13050.045B.2 or DI 13050.050B.2 and

            · and any supporting documents into eView using the “MDF E” barcode;

            · annotate the “Note” field with “EXR Documentation,” or into the Claims File Records Management System (CFRMS) using the “other” document type;

            · annotate the remarks field with “EXR Documentation.”

    When the DDS returns the case to the FO:
            · fax the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II) into eView or CFRMS.

            · Check the electronic folder to confirm that the appropriate forms and supporting documents are in the electronic folder.

            · Fax all missing documents.


          Title II payment center (PC) procedures to contact the FO

          If the PC requires additional information from the FO to process provisional benefits or EXR allowances, contact the FO using the Detailed Office/Organization Resource System (DOORS) to obtain the servicing FO’s email address and request the information from the FO. To follow up on requests to resolve any discrepancies, use the high priority procedures in GN 01070.400 through GN 01070.440.

        2. Title II FO procedures to contact the PC after EXR award transfer

          After you transfer the EF-101, tickle the case (20 days if the beneficiary is not receiving provisional benefits or 30 if the beneficiary is receiving provisional benefits) to verify that the PC updated the Master Beneficiary Record (MBR).

          If diary matures and the reinstatement is not processed, query PCACS to verify the location or jurisdiction of the EF-101 action.

          For PSC 1