SBC applies to medical cessation appeal cases remanded by the AC to an Administrative Law Judge (ALJ) for further action, including court remands not covered by Section 2(d) of P.L. 98-460.

If SBC was elected at a prior ALJ level, reinstate SBC without a new election statement (SSA-795), retroactive to the first month of non-payment resulting from the now vacated prior ALJ decision.

1. a. 

   If SBC was not elected at the prior level, the claimant will have the opportunity to elect or decline SBC pending a new ALJ decision.

2. b. 

   If SBC was elected pending a new ALJ decision, reinstate SBC payment effective the month of the AC remand order.

To reinstate SBC after AC remand:

1. a. 

   Obtain Master Beneficiary Record (MBR) to verify status after contact from the HO.

2. b. 

   Initiate SBC via Critical Payment System (CPS) following SM 00614.000.

3. c. 

   Do not withhold any benefits for possible attorney fees.

4. d. 

   Input special processing code C34.

5. e. 

   Show ALJ level appeal code and the date of remand as the date of the appeal request in remarks.

To develop for suspension, deduction and termination events:

1. a. 

   Contact beneficiary (and auxiliaries) after SBC reinstatement to determine if any payment adjustment is required due to any suspension, deduction or termination event.

2. b. 

   Send advance (due process) notice before making adjustment if an adverse payment adjustment is needed. (See Notices Required Before and After Taking a Title II Adverse Action, GN 03001.015 and Notice Requirements for Title II Due Process Actions, GN 03001.005.)

3. c. 

   Follow DI 12027.050C. and DI 12027.050D. if substantial gainful activity (SGA) development is involved.