Identification Number:
SI 02309 TN 14
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Critical Birthday and Insured Status Diaries
Type:POMS Transmittals
Program:Supplemental Nutrition Assistance Program,All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part SI – Supplemental Security Income
Chapter 023 – Posteligibility Events
Subchapter 09 – Critical Birthday and Insured Status Diaries
Transmittal No. 14, 04/14/2020

Audience

OCO-OEIO: CR, FCR, FDE, RECONE;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

The KC diary alert requires Claims Specialists (CS) to conduct gerontology interviews with Supplemental Security Income (SSI) recipients who will attain age 90 in the fiscal year or who are already over age 90. To ensure program integrity, we must refer case to the Office of the Inspector General when suspect fraud at any time with these recipients. We updated our instructions because of the release of Allegation Referral Intake System (ARIS).

Summary of Changes

SI 02309.006 Gerontology Limited Issue KC Diary

Section A - removed outdated text

Section B - retitled as "Policy for developing the KC Diary" and removed outdated text

Section C - retitled as "Preparing for an RZ or LI gerontology interview

 

SI 02309.006 Gerontology Limited Issue KC Diary

A. Introduction

The KC diary requires Claims Specialists (CS) to conduct gerontology interviews with Supplemental Security Income (SSI) recipients who will attain age 90 in the fiscal year or who are already over age 90. This section provides instructions for handling those interviews and documenting the Development Gerontology (DGEN) screen.

The criteria for the KC diary are:

  • SSI only recipients;

  • Recipients in current pay status (C01) only; and

  • No Supplemental Security Record (SSR) activity for 3 or more years.

The KC diary is available on StaRZ & Stripes - The Next Generation

(SSTNG), MI Central Workload Listings, and CHINET’s SSI Diary

Workload Control Application.

B. Policy for developing the KC Diary

1. Determine if the recipient is alive

Interviewing the recipient and the representative payee, if applicable, allows us to verify the recipient is still alive.

2. Ensure program integrity

Verify the SSI recipient's identity. To ensure program integrity, immediately refer a case to the Office of the Inspector General (OIG) if you suspect fraud at any time. Refer the case via the Allegation Referral Intake System (ARIS). When completing the allegation, be sure to annotate the case as "Gerontology LI".

3. Determine recipient capability

Presume a legally competent adult recipient is capable of managing or directing someone else to manage his or her SSI payments. If during the interview, it becomes apparent that the recipient is not handling his or her payments or is incapable of continuing to do so, develop for a representative payee. For more information on representative payees, see GN 00502.001.

4. Ensure payment accuracy

Review all eligibility factors and resolve all payment discrepancies.

The KC diary indicates that CSs must initiate a scheduled redetermination (RZ) or limited issue (LI) interview with the SSI recipient (or representative payee). For general information on RZs, see SI 02305.001. For LI information and processing instructions, see SI 02305.015.

C. Preparing for an RZ or LI gerontology interview

Telephone contact is the preferred method for conducting a gerontology interview.

A management official decides whether a home visit interview is necessary on a case-by-case basis. The following examples may require us to conduct a home visit interview.

  • The recipient or representative payee, if applicable, requests a home visit interview;

  • The recipient or representative payee, if applicable, may have conditions that impair effective telephone communication; or

  • You are unable to verify the recipient or representative payee’s identity during the telephone interview.

Before sending the recipient an appointment letter, review the recipient’s Social Security records (e.g., SSR and Number holder Identification (NUMI) record). Identify any discrepancies (e.g., date of birth, payment history) so that you can resolve the discrepancies with the recipient during the interview.

1. Send the interview notice

Send an interview notice to the recipient and his or her representative payee, if applicable. The interview notice(s), along with the Spanish translations are available in the StaRZ & StriPEs—The Next Generation (SSTNG).

After you determine how you will conduct the interview, send one of the following notices:

a. Telephone interview

Use Form SSA-L502 (Telephone Interview Letter) to schedule a telephone interview with the recipient and representative payee, if applicable. For a sample SSA-L502, see NL 00701.136.

b. Home visit interview

Use Form SSA-L501 (Home Visit Letter) to schedule a face-to-face interview with the recipient and representative payee, if applicable at his or her residence. For a sample SSA-L501, see NL 00701.135.

If the appointment letter returns as undeliverable, follow the instructions in GN 02605.060.

2. Able to reach recipient or representative payee by phone

If the recipient or representative payee answers the phone, inform him or her you are calling to conduct the interview. If asked to reschedule the interview, do so and inform the recipient or representative payee that you will send a letter notifying him or her of the new date and time. Remind him or her of the importance of being available at the time of the rescheduled interview. If the recipient requests third-party assistance, advise that the third-party representative must be present during the rescheduled interview. For more information on third-party assistance, see SI 02309.006E.

3. Unable to reach recipient or representative payee by phone

If you reach a voicemail, leave a detailed message that includes your name, the office you are calling from, your office phone number and reason for your call. Do not release any personally identifiable information (PII). Send a new appointment notice to the recipient or representative payee. If you cannot leave a voicemail, document the attempted phone contact(s) (e.g., number of attempts, dates and times attempted) on a MSSICS Development Worksheet (DW01) screen or Report of Contact (DROC) screen. Lock the DROC screen upon completion. For non-MSSICS cases, use Form SSA-5002 (Report of Contact) and store the form electronically. Initiate a home visit interview.

4. Must reschedule the interview

Allow only two rescheduled appointments.

If it is necessary to reschedule the interview:

  • Call the recipient or the representative payee, if applicable, to reschedule based on the date and time that he or she requests;

  • Mail a new interview appointment letter to the recipient and the representative payee, if applicable. The letter must provide the new date and time of the appointment. If the new appointment is less than 1 week from the original appointment, an appointment letter is optional, but confirms that all parties will be available at the appointment time. Include the following language in the appointment letter when scheduling the final (third) appointment: “We have tried to schedule an appointment with you twice. Each time we rescheduled, you were unavailable. It is very important that you keep this appointment. If you do not keep this appointment, we may suspend your SSI payments until we speak with you.” and

  • Add a remark to the DW01 or DROC screen to document the reason for rescheduling. Lock the DROC screen upon completion. For non-MSSICS cases, add remarks to an SSA-5002 (Report of Contact) and fax remarks into the non-disability repository for evidentiary document (NDRED).

5. Unable to locate recipient

A suspension of SSI eligibility for “whereabouts unknown” is proper when we cannot locate a recipient, and determine his or her current eligibility and correct payment amount. Exhaust all efforts to locate and contact the recipient. Contact any interested person or source that you believe may have contact with the recipient, such as a financial institution, benefit source, medical treatment source, or social service agency. If you are unable to locate the recipient, suspend his or her payments using S06 (Whereabouts Unknown). For more information on S06 suspension, see SI 02301.240.

6. Recipient or representative payee fails to keep appointments

After you exhaust all efforts and the recipient or representative payee, if applicable fails to keep the appointment and his or her mail has not been returned undeliverable, suspend the recipient’s payments using N20. For more information, see SI 02305.021 and SI 02301.235.

7. Recipient may be deceased

If you suspect the recipient is deceased, use the appropriate suspense code per SI 02309.006C.5. or SI 02309.006C.6. Immediately refer the case to the OIG for its fraud investigation via the ARIS . When completing the allegation, be sure to annotate the case as a "Gerontology LI".

Include the outcome of your development with the United States Postal Service and financial institution. Additionally, provide as much information as possible such as your contacts with any social service agency, homeless shelter, benefit source, or medical treatment source.

Annotate the DGEN screen showing that you referred the case to the OIG. For more information on the ARIS application, see the ARIS User Guide within the application.

D. Conducting the gerontology interview

When conducting a gerontology interview:

  1. 1. 

    Verify the identity of the recipient and representative payee, if applicable, before the interview begins using the procedures to establish identity as noted in GN 00203.020.

    NOTE: If you cannot establish identity during the initial appointment, a home visit interview may be necessary. Consult with management and mail Form SSA-L501 (Home Visit Letter) to schedule the second appointment.

    IMPORTANT: If the recipient has a representative payee, you must speak with and identify the recipient to ensure he or she is alive.

  2. 2. 

    Develop any additional post-eligibility issues. These issues include:

    Issue

    Reference

    Recipient’s capability to manage SSI payments

    GN 00502.020

    Change in payee

    GN 00504.100 and GN 00504.105

    Living arrangements

    SI 00835.001

    Income and resource development

    SI 00810.001 and SI 01110.003;

    Date of birth corrections

    RM 10210.295

  3. 3. 

    Using MSSICS, open a Redetermination or Limited Issue event to create the DGEN screen during the interview. Completing this screen ensures you document all applicable information to clear the diary.

    NOTE: You may record additional remarks on the DW01 screen or DROC. Lock the DROC screen upon careful review and completion to ensure its availability for historical purposes.

  4. 4. 

    For MSSICS cases, complete the DGEN screen and build the SSR. NOTE: If all development is complete, then the system will allow you to close the limited issue. If any part of the development is incomplete or the development screens do not show “development complete”, then the system will not allow you to close the limited issue.

    For non-MSSICS cases, develop all posteligibility issues, delete the diary via direct SSR update (the UDIA screen) and complete the 1719b to clear the LI. Document the interview on an SSA-5002 and fax into NDRED. For additional information about development documentation, see MSOM MSSICS 022.012 or MSOM MSSICS 022.029.

E. Third-party interview assistance

During the interview, the recipient may request assistance from a third-party. The purpose of a third-party helper is to assist the recipient with conducting his or her business with us. A third-party helper may be a relative, friend, or other individual who does not have access rights to the recipient’s information. When the third-party helper assists with the interview, complete the following steps:

  1. 1. 

    After identifying the recipient, obtain the recipient’s permission to speak with the third-party helper.

  2. 2. 

    Document the third-party helper’s name, telephone, and relationship to the recipient on the DW01 screen.

    NOTE: If it appears that the recipient needs a representative payee, refer to GN 00502.020.

  3. 3. 

    Continue the interview process per SI 02309.006D in this section.

F. Recipient is outside of the country

You may discover that a recipient is out of the country. Immediately obtain the complete foreign address and telephone number. If the reporter alleges he or she does not know how to contact the recipient, initiate unable to locate procedures found in SI 02301.240. It may also be an indication of death. For death cases, see SI 02309.006G.

If the recipient is residing outside of the country and the foreign address is available, follow procedures found in SI 02301.225.

G. Gerontology death cases

Follow these instructions upon receiving a report of the recipient’s death:

  1. 1. 

    Obtain proof of death following regular policy guidelines. (For preferred evidence of death, see GN 00304.005.)

  2. 2. 

    Post the proof of death to the Evidence Screen (EVID) in the Shared Processes menu. For more information on the EVID screen, see MS 01701.003.

    REMINDER: If the date of death is posted on the SSR without proper documentation on the EVID screen, you cannot use it as verified evidence of the recipient’s death. You may use death data on the Numident as proof of the recipient’s death if certain requirements are met. (For use of Numident death data, see GN 00304.100B.3.)

  3. 3. 

    Terminate payments based on the verified date of death. Terminate SSI payments following instructions at SM 01301.375 through SM 01301.380.

  4. 4. 

    If the report of death is not timely and we paid at least 2 months of SSI payments after the date of death, submit a referral to the Office of Inspector General (OIG) via the ARIS application. (For more information on the ARIS application, see the ARIS User Guide within the application.

  5. 5. 

    Post the following remark on the SSR:

    “Gerontology Limited Issue- KC Diary (Month and Year)-recipient is deceased.” Include your FO code, initials or unit.

 


SI 02309 TN 14 - Critical Birthday and Insured Status Diaries - 4/14/2020