Identification Number:
DI 32010 TN 4
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Continuing Disability Review Case Routing
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 320 – Disposition and Routing
Subchapter 10 – Continuing Disability Review Case Routing
Transmittal No. 4, 10/06/2021

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal and there are no policy or procedure changes.

Summary of Changes

DI 32010.005 Continuing Disability Review (CDR) 'Quality Assurance (QA) Review'

Subsection B - Spelled out DQB.

DI 32010.010 Continuing Disability Review (CDR) 'No Determination' Cases

  • Changed paragraph formats to subsection heading formats.

  • Capitalize the word State in the first row of the table.

DI 32010.015 Initial Continuing Disability Review (CDR) 'Continuance Determination Cases with No Additional Action Required'

  • Changed paragraph formats to subsection heading formats.

  • Corrected section title "Continuing Disability Review of Initial (CDR) 'Continuance Determination Cases with No Additional Action Required' to read as follows:

    Initial Continuing Disability Review (CDR) 'Continuance Determination Cases with No Additional Action Required'

DI 32010.020 Continuing Disability Review (CDR) 'Continuance Determination Cases with Additional Action Required'

  • Corrected section title: Added the word "Determination" between "Continuance" and "Cases."

  • Changed paragraph format to subsection heading format.

DI 32010.025 Continuing Disability Review (CDR) 'Cessation Determination' Cases

  • Changed paragraph formats to subsection heading formats.

  • Removed Disability Determination Services since it was spelled.

DI 32010.045 Continuing Disability Review (CDR) Cases with 'Section 301 or Potential Section 301 Involvement'

  • Changed paragraph formats to subsection heading formats.

  • Add an ' at the end of the word case in the first sentence.

  • Removed comma after DDS in first bullet point.

DI 32010.055 Continuing Disability Review (CDR) 'Medicare Qualified Government Employee (MQGE)' Cases

  • Changed paragraph formats to subsection heading formats.

  • Replaced "Continuing Disability Review" with acronym CDR.

DI 32010.075 Continuing Disability Review (CDR) 'Section 301 Reconsideration of Initial Cessation Determination' Cases

  • Changed paragraph formats to subsection heading formats.

  • Removed a colon from the third and fifth row in the table.

DI 32010.085 Continuing Disability Review (CDR) 'Adverse Reopening' Cases

Subsection A.1. - Added an "s" at the end of Disability Determination Services.

DI 32010.005 Continuing Disability Review (CDR) 'Quality Assurance (QA) Review' Cases

A. Procedures for routing an electronic CDR (eCDR) case

  • Create an undated notice or explanation of the determination in the Certified Electronic Folder (CEF).

  • Forward the eCDR to the appropriate QA review component. See DI 81020.205 - Receipting an Electronic Continuing Disability Review (eCDR).

B. Procedures for handling prior comparison point decision (CPD) paper folders

  • Paper folders are excluded from Disability Quality Branch (DQB) reviews. Scan all relevant medical or other pertinent documents pertaining to the prior CPD paper folder into the CEF.

    Create an undated explanation of the determination

  • Forward the eCDR and CEF to the QA reviewing component. See DI 81020.010 Paper Folder Indicators (PFI) and DI 81020.255 Processing a Reconsideration Appeal of an Electronic Continuing Disability Review (eCDR) Cessation.

DI 32010.010 Continuing Disability Review (CDR) 'No Determination' Cases

A. Procedure for routing 'no determination' case folders

  • Place a remark in the 'Alerts' and 'Messages' section of the Certified Electronic Folder (CEF) in eView using the chart below.

  • For paper cases, add the remarks to form SSA-408 (Route Slip). See DI 81020.127 Processing “No Determination” (ND) Claims for more examples of, 'No Determination/Decision' cases.

  • Send the electronic CDR (eCDR) and the CPD to the same location.

B. Routing 'no determination' eCDR cases

The following chart displays the destination and necessary remarks for the Disability Determination Services (DDS) routing of 'no determination' eCDR cases:

Situation

Destination

Remarks

Individual no longer lives in the State

Send to the DDS of the individual's current State of residence (see DI 81020.250B for eCDR routing instructions). Indicate Type of Case:

(Title II, Title XVI or concurrent) 'CDR Required.'

Title II: Whereabouts Unknown

Send to the originating Field Office (FO) of individual's last known address (see DI 14510.003B).

'Title II - Whereabouts Unknown. Possible cessation determination needed.'

Title XVI: Whereabouts Unknown

Send to the originating or FO of the individual's last known address (see DI 14510.003B).

'Title XVI - Whereabouts Unknown. Possible cessation determination needed.'

Title XVI: Re-entitlement Case: - Payments not Reinstated. No CDR Issue

Send to the originating (sending) FO.

'Title XVI - No CDR Necessary. Not in Payment Status. No Payment Reinstatement Necessary.'

Folder misrouted to the DDS

Forward to appropriate FO or DDS based on the individual's state of residence. If appropriate office cannot be determined, return to originating FO.

'No Determination. Folder misrouted.'

No CDR Issue

Send to the originating FO. 'Indicate Type of Case: 'Title II, Title XVI or concurrent - No CDR Issue.'

DI 32010.015 Initial Continuing Disability Review (CDR) 'Continuance Determination Cases with No Additional Action Required'

A. Initial Title II only CDR cases - no additional action required

Route all Title II only CDR cases that have no additional actions required to the Social Security Administration (SSA) National Records Center (NRC) Folder Storage (Office code N88) at:

SSA National Records Center
601 S 291 Highway
6002 East Geospace
Independence, MO 64056

B. Initial Title XVI only CDR cases- no additional action required

Route all initial Title XVI only CDR cases that have no additional actions required to the NRC Folder Storage (Office code L0(zero)E) at:

SSA National Records Center
601 S 291 Highway
6016 East Geospace
Independence, MO 64056

C. Concurrent cases - no additional action required

Route both cases to the NRC (Office code N88) at the address shown above code. In paper cases, if a Form SSA-4387 (SSI Folder Return) flag is on top of the folder, DO NOT REMOVE. If another flag or form must be placed on top of the folder (for example, an SSA-408 (Route Slip), attach the additional flag or form on top of the SSA-4387.

DI 32010.020 Continuing Disability Review (CDR) 'Continuance Determination Cases with Additional Action Required'

Procedures for routing continuance cases that require additional action

There are times when additional action is necessary on a case after the Disability Determination Services (DDS) makes an initial CDR determination. For example, the most common reasons for a CDR continuance case to require additional actions include:

  • Payee issues

  • Work Activity Involved (Title II cases)

  • Payments in suspense

  • Change of disability status from 'Blind' to 'Disabled'

  • Change of disability status from 'Disabled' to 'Blind'

  • Field Office (FO) requests folder return

For cases requiring additional action(s), return the entire case to the originating FO. Add a remark in eView for electronic cases or an SSA-408 (Route Slip) for paper folders. Notate what additional action(s) is necessary or provide a reason for the return.

DI 32010.025 Continuing Disability Review (CDR) 'Cessation Determination' Cases

A. Procedure for handling folder return

Return all initial CDR case folders that have a cessation determination to the originating field office (FO). The FO will hold the case for the appeal period.

B. Routing CDR cessation determinations

The Disability Determination Services (DDS) may receive cases where eligibility has previously terminated for a non-disability reason, for example, a termination could occur following a suspension period of 12 consecutive calendar months. Further, State conversion reentitlement cases are processed by the DDS.

  • If the cessation determination is a paper CDR folder, include a remark on an SSA-408 (Route Slip), indicating the type of case and a remark stating what cessation or termination action was taken or may be necessary.

  • If the cessation determination is an electronic folder or needs to be converted to an electronic folder, please see DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases.

The following chart displays examples of the destination and necessary remarks for (DDS) routing of cessation determination CDR cases:

Situation

Destination

Remarks

Title XVI Cessation only - Benefits Continue

Send to the originating FO.

'Title XVI Cessation Only - Benefits Continue'

State benefit conversion only - Benefits Continue

Send to the DDS of state where benefit conversion occurs.

'Title XVI Federal Cessation Only - State Plan Determination Required' (See DI 23525.001 Title XVI Conversion Reentitlement Cases)

State benefit conversion only - Recipient is a Resident of Conversion State Send to the originating FO.

'Title XVI Cessation Only' - State Benefits Continue.' See DI 52135.001 - Introduction to State Specific Public Disability Benefits (PDB)

NOTE: Do not remove Form SSA-4387 (Supplemental Security Income Folder Return Flag) from the paper folder. If another flag or form must be placed on top of the folder (for example, the SSA-408 Route Slip), attach the additional flag or form on top of the SSA-4387.

DI 32010.045 Continuing Disability Review (CDR) Cases with 'Section 301 or Potential Section 301 Involvement'

A. Procedure for handling folder routing

When an individual is participating in a Vocational Rehabilitation (VR) or similar program, eView will display a 'Potential Section 301 Case.' A 'Potential Section 301 Case' flag generates an alert to the field office (FO) via the Electronic Disability Collect System (EDCS) Actions Page: 'CDR Cessation Added - Potential 301 Benefit Continuation.'

  • If the case is a certified electronic folder (CEF) routed from the FO to the Disability Determination Services (DDS), add a 'Potential Section 301 Case' flag in the EDCS to identify that the beneficiary is participating in a VR or similar program. See DI 81020.085 Certified Electronic Folder Flags (CEF), and DI 14510.010 Procedures for Cases Involving Participation in Vocational Rehabilitation (VR) or Similar Program.

  • For paper cases, the DDS alerts the FO of the cessation with the remark on an SSA-408 (Route Slip), attached to the outside of the folder annotated with a 'Potential Section 301 Benefits flag - handle per DI 14510.003C.'

B. Routing CDR cases with potential Section 301 involvement

Return all Section 301 (individual enrolled in a Vocational Rehabilitation or similar program) and potential Section 301 cases to the originating field office. See DI 14510.010 for detailed continuation and cessation instructions.

DI 32010.055 Continuing Disability Review (CDR) 'Medicare Qualified Government Employee (MQGE)' Cases

A. Procedure for transfers of MQGE cases

Individuals who qualify as MQGE are subject to the same conditions and reviews that apply to regular Title II disabled individuals (e.g., extended period of eligibility (EPE), medical and trial work period (TWP).

  • If the folder is electronic, insert: 'Attn: Disability Examiner. See Form SSA-833 in file' on the Alerts and Messages screen.

  • If folder is paper, attach an SSA-408 (Route slip) annotated with 'Attn: Disability Examiner. See Form SSA-833 in file.'

  • Include messages to explain what action is necessary, if any, for both the paper and electronic folder.

B. Routing CDR MQGE cases

Refer to the chart below for instructions regarding routing of CDR MQGE cases.

Situation

Destination

Remarks

Continuance Cases:

Title II Only or Concurrent Cases (Title II and Title XVI claims - two folders)

Send to the originating Field Office (FO)

'MQGE Continuance - establish a Medical Review diary. See form SSA-833 in File.'

Cessation Cases:

Title II Only or Concurrent Cases (Title II and Title XVI)

Send to the originating FO

'Title II MQGE Cessation, or Title II/Title XVI Concurrent MQGE Cessation - Termination Action Required.'

DI 32010.075 Continuing Disability Review (CDR) 'Section 301 Reconsideration of Initial Cessation Determination' Cases

Procedure for handling folder transfer

When an initial cessation determination involves reverting a 'Section 301 Reconsideration of Initial Cessation Determination for a Medical CDR or Age 18 Redetermination' to 'continuance,' annotate the following remarks on the Master Beneficiary Record (MBR) special message field, the Supplemental Security Record (SSR) Remarks, or both: 'Potential 301 case sent to DDS on mm/dd/yr.'

1. Electronic CDR (eCDR)

Add a 'Potential Section 301 Case' flag in the Electronic Disability Collect System (EDCS) to identify that the beneficiary is participating in a Vocational Rehabilitation (VR) or a similar program.

NOTE: Children under the age of 18 who are participating in the programs described in DI 14505.010B.2. through DI 14505.010B.6. are eligible for Section 301 benefits. If a beneficiary indicates they are participating in an appropriate program including Promoting Readiness of Minors in SSI (PROMISE), add the Section 301 flag to the case.

2. Paper folder

Attach route slip SSA-408 to the outside of the folder, add the remark 'Potential Section 301 Case,' and transfer the folder to the DDS.

Refer to the chart below for instructions regarding routing Section 301 CDR reconsideration cases.

Situation

Destination

Remarks

Reversal to Continuance - Title II Only

Return to originating Field Office (FO)

(Place Modular Disability

Folder (MDF) in an envelope per DI 14510.003D.1.)

'Section 301 Title II Continuance' Case

Reversal to Continuance - Title XVI only

Return to originating FO

(Place MDF in an envelope per DI 14510.003D.2.)

'Section 301 Title XVI Reconsideration - Reversal to Continuance Case - payment effectuation required'

Reversal to Continuance - Concurrent Title II/Title XVI (eCDR and paper folder)

Return to originating FO.

Upon FO completion of Title XVI payment effectuation, route Title II to Disability Determination Services for Title II effectuation. (Place MDF in an envelope per DI 14510.003D.1.)

'Section 301 Title II/Title XVI Reconsideration of Reversal to Continuance Case. Upon FO completion of Title XVI payment effectuation, route Title II to Disability Determination Services for Title II effectuation

Add, 'Attn: Disability Examiner'

Reversal to Continuance - Concurrent Title II/Title XVI (eCDR or paper folder)

Return to originating FO.

(Place MDF in an envelope per DI 14510.003D.1.)

'Section 301 Case Title II/Title XVI Reconsideration of Reversal to Continuance. Upon FO completion of Title XVI payment effectuation, route Title II to Disability Determination Services for Title II effectuation

Add, 'Attn: Disability Examiner'

Affirmation of Cessation Indicated

Send to the Disability Hearings Unit (DHU). See DI 81020.255B.

(Place MDF in an envelope per DI 14510.003D.1.)

'Section 301 Case: Affirmation of Cessation Indicated.' Per DI 14510.010, 'Potential 301 benefits– handle per DI 14510.003C.'

Add 'Attn: Disability Hearing Officer.'

NOTE: All DHU closures will be returned to the originating FO (see DI 81020.255C).

DI 32010.085 Continuing Disability Review (CDR) 'Adverse Reopening' Cases

Always send the paper comparison point decision (CPD) folder to the same location where the certified electronic folder (CEF) is transferred. Include messages to explain what action is necessary, if any, for both the paper and electronic folder.

A. Policy

The component responsible for the adverse reopening is determined by the level of the prior CDR determination.

1. Initial CDR determinations

The Disability Determination Services (DDS) is responsible for preparing an adverse reopening of the initial CDR determinations.

2. Reconsideration CDR determinations

The disability hearings unit (DHU) is responsible for adverse reopening of reconsideration determinations.

B. Procedure

1. Destination of certified electronic (CEF) folder

Route folder to the field office (FO) for appeals period.

2. Destination of paper folder

Create an SSA-408 (Route Slip) entry, indicating the type of case - 'CDR Adverse Reopening Indicated.' Route to the appropriate component.

C. Reference

For a list of who may reopen a case, see DI 27501.005 Reopening and Revising a Determination or Decision.


DI 32010 TN 4 - Continuing Disability Review Case Routing - 10/06/2021