Identification Number:
EM-20040
Intended Audience:RCs/ARCs/ADs/FOs/TSCs/OCO-CSTs/OHO/OARO
Originating Office:ORDP ODP
Title:Statutory Benefit Continuation (SBC) Requests during the COVID-19 National Public Health Emergency- Title II and Title XVI
Type:EM - Emergency Messages
Program:Disability
Link To Reference:See References at the end of this EM
 
Retention Date: 03/09/2021


    A. Purpose

      This EM provides the field office (FO) and the teleservice center (TSC) with supplemental guidance for handling late election of statutory benefit continuation (SBC) requests. These temporary instructions also explain the additional circumstances in which good cause may exist when we receive an SBC request late due to unusual or unavoidable circumstances caused or affected by the COVID-19 pandemic national public health emergency.


    B. Background

      As of March 17, 2020, the Social Security Administration (SSA) stopped processing title II and title XVI continuing disability review (CDR) cessation determinations to limit adverse actions to disability beneficiaries or recipients during the COVID-19 national public health emergency. Due to the many limitations and closures resulting from the COVID-19 national public health emergency and as we resume processing CDR cessations, there may be unusual or unavoidable circumstances in which individuals may find it difficult to submit a written statement for electing SBC timely.

      When a beneficiary or recipient appeals a disability medical cessation determination at the reconsideration or hearing levels, he or she has 15 days (10 days plus 5 mailing days) from the notice date to elect SBC for himself or herself and (for title II benefits) other auxiliaries on the record. Upon a timely request for SBC, benefits continue while we make the appeal determination or decision.

      When a beneficiary or recipient (or their representative payee or appointed representative) files a reconsideration or hearing appeal request within the 60-day appeal period but we receive the SBC election after the 15-day period, the FO can approve a late request for payment continuation when it finds there was good cause for submitting the late request. For a reconsideration appeal requested after the 60-day appeal period, the FO makes a good cause determination for both the appeal and SBC election (if requested).

      For hearing requests filed after the 60-day appeal period, the administrative law judge (ALJ) makes the good cause finding for both the appeal and SBC request. When a FO receives an untimely SBC election for a hearing request filed after the appeal period, the FO will forward the late request to the appropriate hearing office’s desktop fax number. During the current COVID-19 national public health emergency, we have applied good cause provisions with maximum flexibility. Therefore, apply the guidance in this EM to determine whether good cause exists when an individual requests SBC untimely due to the COVID-19 national public health emergency.


    C. Good Cause for Late Election of SBC During the COVID-19 National Public Health Emergency

      Our current policy provides sufficient flexibility to allow the FO to make a good cause finding for late SBC elections during the COVID-19 national public health emergency.

      Apply existing policy under the good cause provisions to make a good cause finding based on the circumstance for the late SBC election. When the circumstances meet our current policy, the FO should find good cause for the late filing of the SBC election and process the beneficiary or recipient’s payment continuation request.

      Use the following provisions to determine if good cause exists. Listed under each provision are examples of when good cause can apply for COVID-19 related circumstances. Although these examples are the more common circumstances, this is not an exhaustive list.


        1. Circumstances impeded the claimant’s or representative payee’s efforts to pursue his or her claim or appeal another issue:

          a. Claimant or representative payee attempts to visit the FO to elect SBC but the office is closed to the public due to unforeseen circumstances (e.g., COVID-19 national public health emergency).

          b. Interruptions to mail delivery or inability to access mailbox (e.g., post office or private mailbox service).

          c. Interruption in transportation services or limited access to transportation.

          d. Claimant or representative payee moved from the address of record and did not receive the determination notice or did not receive the notice in sufficient time.

          e. Claimant or representative payee could not complete request in time because of child or family care changes due to stay at home orders or school at home requirements.

          f. Claimant or representative payee contacted SSA timely (within 15 days) by telephone either through the 800# or directly to the FO indicating the intent to pursue payment continuation but could not get the appropriate election submitted timely in writing due to personal circumstances (as described in section C.2 below).


        2. The claimant’s physical, mental, educational, or linguistic limitations (including any lack of facility with the English language) prevented him or her from timely filing an appeal or SBC request:

          a. Claimant, representative payee, or claimant’s primary caretaker is seriously ill or hospitalized, preventing him or her from contacting us.

          b. Death or serious illness in the claimant or representative payee’s immediate family, including being seriously ill due to COVID-19.

          c. Non-English speaking claimant received an English language notice, did not understand the instructions in the notice to call for assistance, and due to stay-at- home orders could not obtain assistance from a friend or relative.


        3. SSA or the Centers for Medicare and Medicaid Services (CMS) actions were confusing or misleading.

          a. Claimant or the representative payee received a subsequent notice indicating there was an error in the initial cessation notice or the subsequent notice led the claimant to believe the cessation notice was an error and could be disregarded.

          b. Claimant or representative payee contacted us by telephone and we gave incorrect or incomplete information.


        4. The claimant or representative payee did not understand the requirements of the Social Security Act (Act), resulting from amendments to the Act, other legislation, or court decisions.

    D. Procedures

      A claimant, representative payee, or appointed representative may contact SSA (within 15 days of the date on the notice) by telephone either through the 800# or directly to the FO indicating the beneficiary or recipient’s intent to pursue benefit continuation.


        1. National 800 Number Network (N8NN)

          When a beneficiary or recipient (including a representative payee, or appointed representative) contacts the TSC to request payment continuation and appeal of the disability cessation determination, follow current procedures in TC 03001.020 to establish a lead referral (step 2). Select “Requests Payment Continuation” and any other options that apply. Send the necessary appeal and benefit continuation forms to the beneficiary or recipient.


        2. FO

          When a beneficiary or recipient (including a representative payee or appointed representative) contacts the FO directly within 15 days of the date on the notice indicating his or her interest to pursue payment continuation and an appeal, follow current procedures in DI 12027.010B.

          FOs should find good cause when the reason for the late SBC request is due to a personal circumstance caused or impacted by the COVID-19 national public health emergency. Refer to section C above for examples.

    Direct all program–related and technical questions to your RO support staff. RO support staff may refer questions or problems to their Central Office contacts.

    References:

    DI 12027.008 Evaluating the Time Limits for Statutory Benefit Continuation (SBC)

    DI 12027.010 Processing Statutory Benefit Continuation (SBC)

    GN 03101.020 Good Cause for Extending the Time Limit to File an Appeal

    TC 03001.020 Handling Appeal Requests

    TC 17001.100 Reconsideration on a Continuing Disability Review (CDR)


EM-20040 - Statutory Benefit Continuation (SBC) Requests during the COVID-19 National Public Health Emergency- Title II and Title XVI - 9/10/2020