Identification Number:
DI 13050 TN 07
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ORDES
Title:Expedited Reinstatements
Type:POMS Transmittals
Program:Disability
Link To Reference:
 
PROGRAM OPERATIONS MANUAL SYSTEM
Part 04 - Disability Insurance
Chapter 130 - Continuing Disability
Subchapter 50 - Expedited Reinstatements
Transmittal No. 07, 07/2018

Audience

FO/TSC: AWIC, CS, CS TII, CS TXVI, DRT, FR, OA, OS, RR, CSR, TA, CTE, TSC-CSR, WIL
PSC: CA, BA, CS, TSA, TST, DE, DEC, DTE, ICDS, IES, ISRA, PETE, RECONR, SCPS, TST
OCO-ODO: BET, BTE, CR, CTE, CTE TE, CT, CST, DE, DEC, DS, PAS, PETE, PETL, RECONE, RECONR, RECOVR, RCOVTA
OCO-OEIO: BET, BIES, CR, ERE, FCR, FDE, PETL, RECONE, RECONR
ODD-DDS: DHU, REF

Originating Component

ORDES

Effective Date

Upon Receipt

Background

In 2014, The Office of Central Operations (OCO) centralized expedited reinstatement (EXR) processing into its Program Integrity and Targeted Assistance Group (PITAG). OCO is now directing processing of EXR cases to the modules. The Office of Research Demonstration and Employment Support (ORDES) updated the EXR Program Operation Manual System (POMS) instructions to reflect this change.

Summary of Changes

DI 13050.025 Provisional Benefits for Title II Claimant

We made the following changes:

    • Subsection I, updated the follow-up instructions for technicians to email the Processing Center (PC) 7 module; and
    • Subsection J, updated the follow-up instructions for technicians to email the PC 7 module.

DI 13050.060 Field Office (FO) Procedures for Title II Expedited Reinstatement (EXR) Awards

In subsection C, we updated the follow-up instructions for technicians to email PC 7.


DI 13050.025 Provisional Benefits for Title II Claimant

A. Provisional benefit eligibility

1. When a claimant is eligible for provisional benefits

A claimant who meets the non-medical requirements and completes a request for Expedited Reinstatement (EXR) may receive up to 6 months of provisional cash benefits and Medicare while we make a decision on his or her request. Medicare coverage during the provisional benefit period is the same Medicare coverage the claimant had prior to his or her termination.

2. When a claimant is not eligible for provisional benefits

A claimant is not eligible for provisional benefits when any of the following applies:

  • he or she does not meet one of the eligibility requirements for EXR listed in DI 13050.001B.1.;

  • an event has occurred that would preclude entitlement (a childhood disability benefits (CDB) recipient has married); or

  • the disability determination services (DDS) determines the claimant does not meet the disability requirements for EXR.

A claimant can decline provisional cash benefits, but still elect to receive Medicare coverage during the provisional benefit period.

NOTE: Provisional benefits are not payable to auxiliary claimants, other than a previously entitled disabled widow(er) benefit (DWB) or CDB who is eligible and requests EXR. Provisional benefits are not payable to a claimant requesting EXR of CDB benefits on the record of a living number holder who is not currently entitled.

3. Paying provisional benefits on a subsequent EXR request

The Social Security Administration (SSA) does not pay provisional benefits on an EXR request if the claimant previously requested EXR for the same period of eligibility and received provisional benefits based on that request, regardless of how many months he or she received provisional payments on the previous request. However, we can pay provisional payments on a subsequent EXR request if the claimant:

  • was approved for EXR on a previous request;

  • completed the initial reinstatement period (IRP);

  • completed a trial work period (TWP);

  • completed his or her extended period of eligibility (EPE);

  • had his or her benefits later terminated due to substantial gainful activity (SGA), and

  • filed a new request for EXR within 60 months of that termination, or we can find good cause for late filing.

Subsequent request example #1:

Ms. Jones requests EXR on March 4, 2008 and we approve the request on May 4, 2008. She receives 3 months of provisional benefits before she is re-entitled to disability benefits. She completes her IRP, TWP and EPE. After completing the EPE, Ms. Jones’s benefits terminate due to SGA in January 2015. On April 12, 2015, Ms. Jones again files for EXR because she is no longer performing SGA. As Ms. Jones completed the IRP, TWP, and EPE on the new entitlement period, had her benefits terminated for SGA, and then filed a new EXR request within 60 months of that termination, she is eligible to request a subsequent EXR and receive provisional benefits.

Subsequent request example #2:

Mr. Smith requests EXR on March 4, 2008 and we medically deny the request on May 4, 2008. He received 3 months of provisional benefits. Mr. Smith refiles for EXR on May 2010. Because we paid at least one month of provisional benefits on the prior request, we cannot pay provisional benefits on the subsequent request.

B. Provisional benefit amount

1. Benefit computations

Compute the provisional benefit following these steps:

  1. Base the provisional benefit payment amount upon the payable benefit amount at the time the previous entitlement terminated, increased by intervening cost of living adjustments (COLA) and re-computations. This is regardless of any other changes (such as overpayments, offsets):

  2. Base the provisional payment amount upon the prior reduced benefit payable, if the prior payable benefit was reduced due to offset or other reductions;

  3. Apply current tax levies or garnishments to provisional payments in accordance with GN 02410.110 and GN 02410.210;

  4. Apply any Medicare premium arrearages to provisional benefits;

  5. If an overpayment exists on the record, do not recover this against provisional benefits without the claimant’s written consent; and

  6. If we award the EXR request, make adjustments for offsets, such as Workers Compensation/Public Disability Benefits, Government Pension Offset, Windfall Elimination Provision, overpayments, and other payment issues with the first month of reinstated benefits.

2. Dual entitlement benefits

When a claimant requests reinstatement on one record and is currently receiving a Title II benefit on another record, the provisional benefit is payable only if the provisional benefit amount is greater than the current benefit payable on the other record. If the current benefit amount is higher than the provisional benefit amount, no provisional benefits are payable. If a claimant requests EXR for more than one benefit, pay provisional benefits on the record that yields the highest benefit payable amount. If provisional benefits end for a dually entitled beneficiary, payment will resume on the other record as long as they are still eligible for benefits on that record.

NOTE: A claimant must file separate EXR requests for multiple entitlement situations. Evaluate each request against the EXR requirements and process accordingly.

3. Family maximum involved with DWB or CDB request

For DWB and CDB claimants, the payment of provisional benefits may cause the total benefits payable on the record to exceed the family maximum (FMAX). In such cases, pay the provisional benefit amount outside the FMAX and do not adjust the benefit amount for any auxiliary already entitled on the same record during the provisional benefit period.

C. Provisional benefit start month

1. When provisional benefits start

Provisional benefits are payable beginning with the month the claimant completes and submits the signed EXR request per DI 13050.045B.2., assuming benefits have not already been paid for that month. If the claimant performed SGA in the month of filing, provisional benefits are payable with the month after the month of filing. We can only pay provisional benefits during the consecutive 6-month period beginning with the month of the EXR request, or the following month if there is SGA in the month of filing.

NOTE: Do not use the protective filing date for determining when provisional payments should begin. We use the protective filing date to determine the retroactive scope of the EXR.

Start month example 1: A claimant contacts SSA about filing for EXR on April 24, 2015 but does not return the signed request forms until June 03, 2015. He did not perform SGA in June. Provisional benefits will begin June 2015, the month he completed his EXR request.

Start month example 2: A claimant completes and returns a signed request for EXR on June 25, 2017. He performed SGA in the month of June, but stopped performing SGA by the date of his request. Provisional benefits will begin July 2017, the month after he stopped engaging in SGA.

2. Termination of previous benefits

Provisional benefits cannot start until the previous benefits terminate and the master beneficiary record (MBR) Ledger Account File (LAF) Code is T6, T8, U or X7. If we made a determination to terminate the previous benefit but the MBR does not reflect it, the field office (FO) should contact the program service center (PSC) to expedite the termination in order to begin provisional benefits. Use the exclusion case procedures described under DI 13050.025I.3. in this section to expedite the previous benefit termination. We cannot pay provisional benefits for any month in which the claimant has already received the same type of benefit payment on the same entitlement.

EXAMPLE: On April 18, 2014, SSA contacts Mr. Jones to tell him that they will terminate his disability benefits due to performing SGA. The benefit termination month (BTM) is September 2013. Mr. Jones contacts SSA on April 29, 2014 to say that he has not worked for the last 3 months due to his disability and submits his request for EXR. Though we made a final determination to terminate Mr. Jones benefits, the record has not terminated. The FO contacts the PSC to expedite the termination. Benefits terminate ten days later (May 09, 2014). Mr. Jones will receive his first month of provisional benefits for May 2014, since he received a benefit payment for April 2014.

D. Provisional benefit end month

The claimant may not receive more than 6 months of provisional benefits. Payment of provisional benefits ends with the earliest of the month:

  • SSA makes a determination and issues the notice regarding the claimant’s EXR request;

  • the claimant works and performs SGA;

  • before the claimant attains full retirement age, see DI 13050.025H.2. in this section; or

  • before the claimant’s death.

NOTE: These months are the last month the provisional payment is payable. Therefore, if a claimant begins SGA in April 2015, April 2015 is the last possible month of provisional benefits. Provisional benefits do not resume if the claimant stops performing SGA.

E. Suspension and terminating events

Suspend or terminate provisional benefits following normal benefit policies. Such suspension or termination events include:

  • prisoner suspension,

  • alien suspension, and

  • marriage of a CDB

For a discussion of suspension and termination events, see GN 02602.005, RS 00203.030, RS 00203.035, and RS 00207.002. Provisional benefits will not resume when a suspension event continues beyond the provisional benefit period ending month.

F. Medicare entitlement

A claimant previously entitled to disability benefits who requests benefit reinstatement also receives Medicare coverage during the provisional benefit period. It is important to understand the type of Medicare coverage that exists when the claimant enters the provisional benefit period (e.g., Disabled Working Individual [DWI], Extended Medicare, End Stage Renal Disease [ESRD]), as the DDS, medical determination affects the types of coverage differently. For instructions regarding Medicare coverage and termination as they relate to EXR, see HI 00801.164 to HI 00801.167, and DI 13050.070.

G. Appeals process

Actions to pay, adjust or terminate provisional benefits are not initial determinations and are not subject to the administrative and judicial review (appeals) process. However, overpayment decisions relating to provisional benefits are subject to review. For a discussion about appeals, see DI 13050.085.

H. Special situations

1. Claimant is eligible for supplemental security income (SSI) provisional benefits

Regular payment provisions apply. Consider windfall offset. Title II provisional benefits are income for SSI computation purposes. The claimant must file a separate request for reinstatement under Title XVI.

2. Claimant attains full retirement age (FRA) during the provisional benefit period

Provisional benefits terminate when a claimant attains FRA. Provisional benefits do not automatically revert to an aged benefit at FRA. If the claimant wishes to receive aged benefits, he or she must file an application, or already be entitled to a benefit that will automatically convert to an aged benefit at full retirement age (regular widow's benefit or retirement).

3. Claimant has appeal pending on prior claim denial, or on termination of prior entitlement

The appeal of a prior claim denial, or termination, has no effect on the claimant’s eligibility for EXR. The claimant can receive provisional benefits and reinstatement through EXR, if the claimant meets EXR eligibility requirements in the month of the EXR request.

I. Initiating provisional benefits

If the claimant is eligible for EXR based on non-medical eligibility requirements, begin provisional benefits via the Post Entitlement Online System (POS). Do not use the Critical Payment System (CPS) to initiate provisional payments. For non-receipt of EXR provisional payments, see DI 13050.100. If subsequent development determines that the claimant’s EXR request does not meet the non-medical requirements, see instructions in MS T2PE 003.024.

1. Using POS to start provisional benefits

Input the request for provisional benefits on the Provisional Payment (PEPP) screen of the Title II POS. Instructions are in MS T2PE 003.040. Follow these steps to access the PEPP screen:

  1. Select option “2”, Title II/PE, on the SSA MAIN menu and press “Enter”.

  2. On the POS Menu (PEMU) screen, select “1” to establish and complete the required fields, press “Enter”.

  3. On the Post Entitlement Selection List (PESL) screen select “item 1” (Addr/Dir Dep/Tel) and “item 7” (Provisional Payments) for the appropriate BIC and, press “Enter”.

  4. On the Post Entitlement Address (PEAD) screen, enter any needed changes to the claimant’s address, bank data, or telephone number propagated to the PEAD screen from the MBR. If no changes are necessary and all information is correct, press “Enter” to advance to the PEPP screen.

  5. On the PEPP screen, enter the provisional payment start month in MMYY format. Add any necessary remarks, and press “Enter”. The provisional benefit start month is the month we receive the EXR request package. However, if the claimant engaged in SGA in the month of the request, the provisional payment start month is the following month. If the provisional benefit start month is later than the current operating month (COM), make the POS input after the COM changes.

NOTE: If the claimant engaged in SGA in both the month of the EXR request and the following month, deny the request for EXR. For denials, see DI 13050.065

2. Processing exception cases for provisional benefits

Some cases require manual processing in the PSC to start provisional benefits. The following situations will generate an exception alert in the PSC:

  • concurrent Title II/Title XVI cases and a prior month accrual (PMA) check is payable;

  • DWB and CDB cases in which there are other entitled auxiliaries on the same record; and

  • cases where the individual requesting EXR is already entitled to another title II benefit

If the direct input does not process, do not attempt to re-input through POS. Check PCACS for an Action Control Record (ACR) with TOELs DIPROV PAYMENT. It may take up to three business days for the ACR to appear in PCACS. If the ACR does not appear in PCACS after three business days, contact the PSC of jurisdiction.

If the ACR is present in PCACS, tickle the case for 15 business days to allow for PSC processing. If the MBR does not update after 15 business days, contact the PSC of jurisdiction and tickle the case for 15 days for follow up.

To contact the PSC of jurisdiction:

  • For PSC 1 through 6 cases, follow locally established procedures for resolution of high priority cases, or send a modernized development worksheet (MDW) 2560HP request. Enter the remark “Do not place in backlog.” Add a “Special Message” to the MBR indicating the date the provisional benefit request was sent.

  • For PC 7 cases, access the Detailed Office/Organization Resource System (DOORS) using the search SSN function and send a high priority email to the appropriate module with the subject line “Provisional Benefit Request.” Document the contact attempt on the remarks screen (IRMK) of the Disability Control File (DCF). Add a “Special Message” to the MBR indicating the date the provisional benefit request was sent.

If the MBR does not update after the second 15-day tickle or if a dire need/adverse public relation situation exists, FOs should use the Manager-to-Manager process to contact the PSC per GN 01070.228.

3. Processing exclusion cases for provisional benefits

Exclusion cases do not process through a POS input, and require manual action by the PSC. Some examples of exclusion cases are:

  • the provisional benefit is not payable in the first month of the provisional period (payment is suspended) or

  • the EXR request date is more than 60 months after the previous termination (good cause found for late filing)

Do not use CPS to start provisional benefits, as any monies withheld from CPS payments for supplemental medical insurance (SMI) premiums are not credited until the provisional benefit action is processed and may result in an incorrect termination of SMI due to non-payment of premiums. Requests for initiation of provisional benefits are high priority actions.

To contact the PSC of jurisdiction:

  • For PSC 1 through 6 cases, follow locally established procedures for resolution of high priority actions, or send a 2560HP. Enter the remark “Do not place in backlog” Add a “Special Message” to the MBR indicating the date the provisional benefit request was sent.

  • For PC 7 cases, access the Detailed Office/Organization Resource System (DOORS) using the search SSN function and send a high priority email to the appropriate module with the subject line “Provisional Benefit Request.” Document the contact attempt on the remarks screen (IRMK) of the Disability Control File (DCF). Add a “Special Message” to the MBR indicating the date the provisional benefit request was sent.

Tickle for 15 days to follow up. If the MBR does not update after the 15-day follow up tickle expires or if a dire need/adverse public relation situation exists, use the Manager-to-Manager process to contact the PSCs per GN 01070.228.

J. Terminating provisional benefits

When the provisional benefit period ends, provisional benefits and Medicare entitlement based solely on the provisional benefit period terminate, see HI 00801.165. Medicare entitlement based on age, ESRD, or extended Medicare does not terminate at the end of the provisional benefit period. For a detailed discussion about Medicare in relation to EXR determinations, see DI 13050.070.

1. Terminating benefits due to SGA

The performance of SGA during the provisional benefit period terminates provisional benefits. The FO technician must:

  • Develop work activity during the provisional benefit period.

  • Document the work on Forms SSA-820-BK (Work Activity Report Self-Employment) or SSA-821-BK (Work Activity Report - Employee) and record the determination on Form SSA-823 (Report of SGA Determination – For SSA Use Only) and fax into eView or the Claims File User Interface (CFUI).

  • Notify the DDS examiner by telephone of the work and SGA finding.

  • Forward the documentation to the DDS.

  • If the claimant has engaged in SGA, terminate provisional benefits through POS input, see MS T2PE 003.024. The last month of provisional benefits payable is the first month of SGA. Provisional benefits do not resume after termination due to SGA.

  • For cases in PSC 1 through 6 jurisdiction, send an MDW to request action on Medicare termination issues, if necessary.

  • For PC 7 cases, access the Detailed Office/Organization Resource System (DOORS) using the search SSN function and send an email to the appropriate module with the subject line “EXR Provisional Benefit Medicare Termination Request” to request termination of Medicare, if necessary. Add a “Special Message” to the MBR indicating the date the Medicare termination request was sent.

If the claimant performs SGA in the month of the EXR request and the following month, recall the folder from the DDS and process an FO jurisdiction technical denial as outlined in DI 13050.065D. For EXR requests filed prior to April 17, 2017, recall the folder and deny the request if the claimant performed SGA in the month of filing.

2. Terminating provisional benefits due to medical denial determination

Terminate provisional benefits (if currently being paid) when the DDS makes a medical determination to deny expedited reinstatement. The last month provisional benefits are payable is the month the FO mails the EXR denial notice. To determine how a medical determination may affect Medicare coverage, see DI 13050.070. To stop provisional benefits input the medical decision via POS, refer to DI 13050.065B.3.

3. Terminating benefits due to FRA

When a claimant reaches FRA during the provisional benefit period, provisional benefits automatically terminate.

4. Terminating benefits due to end of the six month provisional benefits period

Provisional benefits and Medicare based solely on the provisional benefit period automatically terminate after six months of payments.

5. Terminating benefits when the claimant dies during the provisional period

If the claimant dies during a month that comes after the EXR request but before a medical decision by the DDS, stop the provisional benefits. The month before the month of death is the last month that provisional benefits are payable. The DDS should make a medical decision based on the evidence provided. If we approve the EXR request based on the medical evidence, pay any retroactive benefits as an underpayment per GN 02301.030.

DI 13050.060 Field Office (FO) Procedures for Title II Expedited Reinstatement (EXR) Awards

A. Policy for EXR favorable medical decision

The disability determination services (DDS) makes a determination regarding entitlement, prepares a Form SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II) to document the determination on a Title II request for EXR and sends the folder and SSA-833 allowance to the FO.

NOTE: In dual entitlement situations, if the prior record terminated for substantial gainful activity (SGA) on both records, each entitlement needs a separate DDS medical decision and a separate SSA-833.

1. Month of entitlement (MOE) and retroactivity

If the claimant is disabled and entitled to EXR, we may reinstate benefits retroactively for up to 12 months before the EXR request date, but no earlier than January 1, 2001 provided the claimant meets all factors of entitlement. The MOE is the earliest month that the claimant did not perform SGA and met all of the EXR eligibility requirements. 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. The month of entitlement cannot be before the benefit termination month (BTM) of the previous entitlement. The MOE must be a non-SGA month. If the claimant performed SGA in the month of filing and the following month, the FO must issue a technical denial. Normal suspension and terminating events apply to all reinstated benefits.

MOE example: Mr. Smith was previously entitled to Social Security disability insurance (SSDI) for back problems and his entitlement terminated due to work in January 2015. In June 2017, Mr. Smith has an accident that re-injures his back and he is unable to work. In September 17, he requests EXR. When the FO develops the case to send to the DDS, they document the request date of September 2017 and note the following SGA and non-SGA months in the 12-month retroactive period:

SGA Months: September 2016, October 2016, November 2016, December 2016, January 2017, February 2017, March 2017, and May 2017

Non-SGA Months: April 2017, June 2017, July 2017, August 2017, and September 2017

The DDS decides that Mr. Smith meets the medical requirements of EXR in the month of filing (September 2017). They then look at the first non-SGA month in the retroactive period, which is April 20017. They determine that although Mr. Smith did not perform SGA, he did not meet the Medical Improvement Review Standard (MIRS) criteria in April 2017. They then look at the next non-SGA month (June 2017) and determine that Mr. Smith did meet the MIRS criteria in that month. Therefore, the MOE for EXR is June 2017, which is the first month of the initial reinstatement period (IRP).

2. Auxiliary benefits

Reinstate benefits to auxiliaries previously entitled on the number holder's record, who continue to meet the initial entitlement requirements with the first month of reinstatement for the disabled number holder. Obtain a signed Form SSA-4-BK (Application for Child’s Insurance Benefits) for both previously entitled and new auxiliaries and fax it into eView or the Claims File User Interface (CFUI). Process the claim following the EF-101 procedures. If 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 continuing disability review (CDR) to confirm he or she meets disability requirements before we can reinstate the auxiliary. For more information on the technical requirements for childhood disability benefits (CDB), see DI 11020.015.

NOTE: While we are required to develop auxiliary applications, do not allow pursuit of auxiliary claims to delay processing of the number holder’s award.

B. Title II FO procedures

Follow these procedures:

  1. Determine an EXR approval by reviewing the SSA-833:

    • Item 9A will be selected

    • Item 10 will show “other;”

    • Item 20 will show WRM code 31; and

    • Remarks will show “Expedited Reinstatement MOE MM/YY”.

  2. Transfer the EXR event on the Disability Control File (DCF) from the DDS to the FO.

  3. Complete the Electronic Form 101 (EF-101) following normal amended award procedures, see KC Net EXR EF101 guide. The following screens require entries unique to EXR awards:

    • EFACCT: Code the Critical Case indicator with “Y.” If Workers’ Compensation (WC) or Public Disability Benefits (PDB) is involved, code the WC/PDB Involved indicator with “Y.”

    • EFPIAD: enter Primary Insurance Amounts (PIA) beginning with the EXR MOE. Although EXR re-establishes entitlement to payment, for PIA computation purposes, we proceed as though the original period of disability has not terminated. Therefore, use the disability onset date for the previously terminated period of entitlement, and compute the PIA as if the Extended Period of Eligibility (EPE) termination never occurred. Use all years of earnings not previously included in the Master Beneficiary Record (MBR) PIA history to compute the EXR PIA. For detailed information on the EPE PIA computations, refer to RS 00605.238.

    • EFBENE: review all fields to ensure necessary screens are in the EF101 path (for example, garnishment or tax levy involvement).

    • EFBEN2: Code the “Disability Involved” indicator with “Y.” Even if work is involved, code the “Work Involved” indicator with “N.” Capture work information on the EFDIBWK screen. Bring the EFDIBWK screen into the EF101 path by coding the “SGA or EPE Involved” indicator on the EFBNDIB screen with “Y.” Code the “Appointed Representative Involved,” special notice due to Visual Impairment, and “SSI Windfall Offset” indicators as necessary.

    • EFCOMM: select Common screens which affect entitlement (for example, beneficiary marriage or citizenship)

    • EFBNDIB: the DDO is the last day of the month prior to the EXR MOE (the date of entitlement to disability [DOED]). For example, if the DOED is 04/16, the DDO is 03/31/2016. Code the DAC field with “F.”

    • The DOED cannot be earlier than the previous benefit termination month (BTM). The FO must use the MOE established by the DDS, shown on the SSA-833. The FO cannot change the MOE. If the FO cannot use the MOE established by the DDS (for example, because the claimant performed SGA in that month), send the case back to the DDS to determine a different MOE. If the PSC discovers an incorrect MOE, designated PSC technicians have authorization to correct certain DDS MOE determinations. If there is SGA-level work during the EXR Initial Reinstatement period (IRP) or the new EPE is involved, code the “SGA or EPE Involved” indicator with “Y.”

    • EFDIBWK: code SGA months in the EXR IRP and the new EPE, if applicable. Include this information in remarks on the EFBCRN screen.

    • EFBCLM: the application file date is the EXR protective filing date, if any. The application receipt date is the date we receive the completed EXR package.

    • EFBCRN: use remarks to alert the PSC that this is an EXR case and requires priority handling. Use remarks to alert PSC to any special issues such as SGA months since the EXR MOE, payment of provisional benefits, WC/PDB, etc. If Medicare terminated prior to the EXR award date, add, “Award Medicare based on EXR – See HI 00801.166 – new IEP applicable” to remarks. However, if the claimant’s HI/SMI eligibility has not terminated, no additional remarks are necessary, as HI/SMI will continue based on EXR.

    • EFBNCM: this screen lists a selection of three separate menus. These screens provide access to Common Screens used for suspension, termination and reinstatement events for miscellaneous situations, disability events and foreign events.

    • EFMBEN: Compute the monthly amount payable as if the prior period never terminated due to SGA, increased by intervening COLAs and recomputations. Adjust benefits for any changes in offsets such as, Workers Compensation/Public Disability Benefits and Government Pension Offset, Windfall Elimination Provision, overpayments, and other payment issues with the first month of reinstated benefits.

  4. Adjudicate and transfer the EF-101 per MS T2PE 009.035 and MS T2PE 009.036.

  5. Use the Print function, #8 on the EFMENU screen, to send a copy of the EF-101 to ORS. There is no need to print a paper copy of the EF101.

  6. Store the SSA-833 in eView or CFUI. Check the electronic folder to confirm the forms listed in DI 13050.045B.2 are in file. If they are not in the electronic folder, fax them in.

  7. Transfer the EXR event on the DCF to the PSC per DI 13010.620.

  8. The program service center (PSC) will issue the reinstatement notice.

C. Follow-up procedures – EXR awards (or EXR EF-101s)

If the beneficiary is not receiving provisional benefits, tickle the case for 20 days to verify via the MBR that the PSC has processed the reinstatement. If the beneficiary is receiving provisional benefits, tickle the case for 30 days. If the reinstatement is not processed, follow these steps:

  1. Query PCACS to verify location/jurisdiction of the EF-101 action.

  2. Access the Detailed Office/Organization Resource System (DOORS) using the search SSN function and send an email to the appropriate module with the subject line “EXR Award Effectuation Request.” Add a “Special Message” to the MBR indicating the date the effectuation request was sent.

  3. Tickle the case for 10 days. If the MBR does not correctly reflect the reinstatement after the follow-up tickle expires and the beneficiary is not receiving provisional benefits, consider critical case processing according to DI 13050.100. If a dire need or an adverse public relation situation exists, FOs should use the Manager-to-Manager process to contact the PSCs per GN 01070.228.

  4. After the PSC processes the EXR award, send the paper folder to the following address:

    National Records Center

    6002 E GeoSpace Dr.

    601 S 291 Hwy.

    Independence, MO 64056

    Attach the correct coversheet for non-actionable Title II folders and mark the folder “All FO/PC Actions complete.”

D. Policy for payment of representative’s fees

Claimants have the right to representation while applying for EXR and any related appeals. We do not include provisional benefits in authorizing a fee under the fee agreement process. Do not use provisional benefits to calculate the amount of past due benefits to withhold for direct payment of a representative’s fee under the fee agreement or fee petition process, or to pay a fee authorized by a court. For more information on representatives fees, see subchapter GN 03913.000.



DI 13050 TN 07 - Expedited Reinstatements - 07/09/2018