Social Security

Summary of Changes:

· Revise list of excepted CDR case types in Section C
· Provide DDS processing instructions in Section D
· Include FO processing instructions in Section E
· Update notice instructions in Section F

B. Background

With the enactment of our full-year appropriation for this fiscal year, we lowered our Full Medical CDR target from 575,000 to 375,000. This reduction will allow DDSs to focus on processing Initial Disability Claims and Reconsideration cases.

The Full Medical CDR target for FY 2024 has been reached. Components should take no further action on Full Medical CDRs unless they are an excepted CDR case type identified in Section C.

C. Excepted CDR Case Types

Continue to initiate, send, receipt, assign, develop and complete all cases in the following categories:

a. Low Birth Weight (LBW) baby CDRs,
b. Expedited Reinstatements (EXRs),
c. Appeals of CDR cessations, including:
o Pre-Hearing (PH),
o Disability Hearing (DH),
o OHO cases,
d. Fraud or Similar Fault (FSF) cases,
e. Congressional Inquiry cases, (apply “Congressional Inquiry” flag)
f. OQR returns for CDRs,
g. Multiple pending cases (MPCs) for the same claimant (also referred to as ‘associated claims’):
o Allowances/Continuances
h. CDRs to assess blindness when an individual returns to work (DI 26001.015B.1.b),
i. CDRs to correct an erroneous allowance,
j. CDRs for auxiliaries when an EXR is allowed (DI 13050.060A.2),
k. CDRs to determine a reduced Medicare waiting period due to ALS (apply “ALS Case – Expedited Action Needed” flag) (DI 11036.001), and
l. CDRs to assess uneffectuated cessations.

1. Age 18 Redeterminations:

No additional action should be taken on stand-alone Age 18 Redetermination cases (e.g., Age 18 Redetermination only with no associated claim) until further notice.

2. CDRs with Associated Initial Claims (e.g., Age 18 Redetermination with CDB claim, Initial or Reconsideration Claim with CDR):

Please continue to receipt, assign, and work existing CDRs from non-excepted workloads if they have an associated Initial claim.

· If the determination on Initial Claim results in an allowance:
o Develop and complete both the determination on the Initial claim and the CDR for all allowances.
· If the determination on Initial Claim results in a denial:
o Do not close either the Initial Claim or the CDR and hold both in the DDS until you receive additional instructions.
3. Collateral Estoppel:

Subsequent Initial cases for claimants receiving benefits under a different title or benefit type where the medical evidence raises a CDR issue (DI 27515.050B) must be held until further notice.

4. Hearing Office Requests for CDRs:

Continue to process OHO requests for MER and CE development CDR cases pending at the hearing level.

1. Continue to develop and send the following cases to DDS:
· Expedited Reinstatements (EXR),

· Pre-Hearing (PH),

· Disability Hearing (DH),

· Fraud or Similar Fault (FSF),

o Add the Possible Fraud and Similar Fault flag,
· Low Birth Weight (LBW) babies,

· CDR required when an auxiliary received a benefit based on the auxiliary’s disability – the auxiliary must meet the initial entitlement requirements and continue to meet the disability requirements before reinstatement. You must send the case to the DDS for a CDR to confirm they meet disability requirements before we can reinstate the auxiliary (DI 13050.060).

o Add the Special Handling flag in EDCS and in remarks add: Excepted CDR per EM-24021 REV EXR AUX case.
· CDR required when a currently entitled beneficiary is serving the 24-month waiting period for Medicare, but now alleges Amyotrophic Lateral Sclerosis (ALS) (DI 11036.001).
o Add the ALS and Special Handling flag in EDCS and in remarks add: Excepted CDR per EM-24021 REV ALS Case.
· CDR required to establish statutory blindness not previously established for a work review (DI 13010.135).
o Add the Special Handling flag in EDCS and in remarks add: Excepted CDR per EM-24021 REV Stat Blind Case.
· Special Release 2 Cases, uneffectuated CDRs.
o Add the Special T2 Disability Workload Case and the Special Handling flags in EDCS and in remarks add: Excepted CDR per EM-24021 REV Special Release 2.
· Send to DDS initial CDB or DIB claims associated with an Age 18 medical redetermination (CDR). Do NOT send Age 18 cases that are not affiliated with an initial claim.

· Congressional Inquiry cases,

o Add the Congressional Inquiry flag.

Other than the examples listed above, do not send additional CDR cases to the DDS, this includes Title XVI Age 18 Medical CDRs that are not affiliated with an initial claim. The FO should continue to hold all other CDR case types.

· Do not initiate or follow-up on any other CDRS, except as described above in this section.

o Review and receipt forms for previously initiated cases. Upon receipt of the CDR packet, enter the receipt date on the CDR Development Worksheet (CDRW) screen on Disability Control File (DCF).
· Do not follow up on CDRs that have not yet been returned.
· If an FO receives an i454, DO NOT import the i454 into EDCS. The i454 should remain pending on the FO WAC/WMI listing until further notice. Upon the receipt of the i454, enter the receipt date on the CDRW screen on the DCF. Hold all cases until further notice.
· Reinstate T2 cases placed in failure to cooperate (FTC) after the individual returns their forms. Send a request to the PC of jurisdiction via Evidence Portal with any returned forms to reinstate benefits or draft an MDW requesting PC initiate reinstatement. Do not transfer the case to the DDS (DI 13015.007 A.1.a)
· Reinstate SSI CDRs placed in PSY N20 due to failure to cooperate when the individual returns their forms. However, do not send the case to the DDS. Instead, control the CDR for easy identification once this moratorium is lifted for FY25.
· SSA-455 – send to the PC per existing policy.

G. Additional Information

Direct all program-related and technical questions to your Regional Office (RO) support staff using vHelp or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.