Identification Number:
DI 23570 TN 35
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 235 – Specific Case Instructions
Subchapter 70 – Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS
Transmittal No. 35, 12/15/2021

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, CTE, ERE, FCR, FDE, FDEC, RECONE;
OCO-ODO: CST, DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

DI 23570.010 Disability Determination Services (DDS) Actions to Identify Age-18 Redetermination Cases

This section was revised to provide additional clarity for readers.

DI 23570.010 Disability Determination Services (DDS) Actions to Identify Age-18 Redetermination Cases

A. Identifying cases that require an age-18 redetermination

The DDS should use the following procedures to identify cases that require an age-18 determination.

1. Field office (FO) and automated identifications

Each year, we identify cases of Title XVI recipients receiving disabled child benefits who are attaining age 18. Age-18 redetermination cases are initiated and controlled through the disability control file (DCF). When the case involves a paper folder, the DDS receives these cases from the FO identified as an age-18 redetermination.

2. DDS identification

The DDS uses the following guidelines when identifying and reviewing a case for an age-18 redetermination.

  1. a. 

    Age-18 flag in paper cases

    If the case involves a paper folder due to an electronic disability control system (EDCS) exclusion, review the current folder to see whether the case contains an age-18 disability redetermination flag. For an example of an age-18 redetermination flag, see DI 23570.110. For additional information on electronic age-18 redetermination cases, see DI 81010.232.

  2. b. 

    Review of the claim folder

    During the continuing disability review (CDR) process, the DDS may identify individuals who attained age 18 in the past, on or after August 22, 1996, are subject to an age-18 redetermination.

    An age-18 redetermination is required if, the DDS examiner finds that the Title XVI recipient was:

    • eligible in the month before the month of attainment of age 18; and

    • an age-18 medical redetermination or a determination under the adult initial claims standard was never done.

    Before initiating an age-18 redetermination, the DDS must send notices to the disabled individual and representative payee that an age-18 redetermination will be done rather than a CDR. The DDS must send this notice as soon as possible after the DDS recognizes that a medical redetermination is appropriate. For an example of an age-18 redetermination notice, see DI 23570.100.

  3. c. 

    Prior determination made using the adult criteria

    An age-18 redetermination is not appropriate if the individual has otherwise had a favorable determination under the adult initial claims standard after attainment of age 18.

    Examples of cases that do not require an age-18 redetermination:

    • an age-18 redetermination has already been done;

    • a favorable Title II adult determination (child disability benefits (CDB), disability insurance benefits (DIB) claims), that was processed after the individual attained 18, but if the prior determination was based on collateral estoppel, see DI 27515.001F; or

    • a CDR after age 18 resulted in a continuance based on meeting or equaling an adult listing, or on a residual functional capacity (RFC) assessment plus consideration of vocational factors. However, if the comparison point decision (CPD) was a child determination and the case was continued based on no medical improvement (MI), or no MI related to the ability to work, the determination as not a determination under the adult initial claim standards and the case still requires an age-18 redetermination.

    NOTE: For cases that meet the above criteria, complete the form SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal- Title XVI) as usual with a favorable determination.

  4. d. 

    Screening out a CDR after an age-18 redetermination

If an age-18 redetermination was completed within the last 12 months and soon afterward a new CDR is found pending, the DDS examiner should apply a “no determination” (ND) decision to the CDR case providing that the medical diary has not matured and will not mature in the next 3 months. If the case meets these conditions, the DDS must return the folder to the FO requesting an update to the record to reflect the diary period established by the DDS at the time the age-18 redetermination was processed. For additional information on the screen out process, see DI 28003.005.

B. Notification for an age-18 redetermination

The FO must provide a notice initiating the medical redetermination in cases identified as they attain age 18. The agency requires a special notice for those cases identified by the DDS during a CDR as requiring a medical redetermination or in situations in which a CDR was erroneously developed within 12 months after the age-18 medical redetermination was made (and the medical diary has not matured or will not mature in the next 3 months). The DDS must send the special notice prior to the issuance of a medical determination and must inform both the individual and representative payee that a medical determination will be processed using the initial adult standard. For an example of the medical redetermination notice, see DI 23570.100.

NOTE: The DDS must send a separate notice to the disabled individual and his or her representative payee.


DI 23570 TN 35 - Title XVI Childhood and Age 18 Disability Redetermination Cases (Public Law (P.L.) 104-193 as Modified by P.L. 105-33) - DDS - 12/15/2021