When conducting a Title XVI child CDR in which the child has a representative payee (payee), we must determine whether the child is and has been receiving treatment to the extent considered medically necessary and available for the condition(s) that was the basis for providing benefits at the comparison point decision (CPD), unless requiring such evidence would be inappropriate or unnecessary considering the nature of the child's impairment(s). See DI
28010.010B and DI
28010.105 for the policy on the CPD and which impairments to consider. We will refer to this requirement as the "show treatment" requirement throughout this section.
The requirement to determine if the child has been receiving treatment that is medically necessary and available only applies to child CDR cases where disability continues. This requirement does to cessations. Although we do not consider this in cessations, if evidence suggests a different payee may be necessary, the adjudicator should follow the same procedures in DI 28005.031B.4.b. for payee development.
In some instances, the payee may not be the legal guardian. The legal guardian may care for the child, but there may be a different payee. For the purposes of assessing the medically necessary and available treatment provision, we will determine if additional action is necessary to consider another payee. For the definition of a payee, see GN 00502.001B.
If the payee refuses without good cause to comply with this requirement, we may pay the benefits to another payee or to the child directly if we decide it is in the child's best interests. See DI
28005.031A5 for additional discussion of good cause.
The payee has a statutory obligation to present this evidence. Consistent with 20 CFR 416.994a(i), the payee must present evidence to demonstrate the child has been receiving the medically necessary and available treatment.
If the payee refuses without good cause to comply with this requirement, we may determine whether a change is necessary to pay benefits to another payee or whether it would be in the best interest of the child to receive benefits directly. If it is in the child's best interest, we may pay benefits to a child who is age 15 or older, or to a child under age 15 who is legally emancipated. See DI 28005.031B4 for additional discussion of good cause.