TN 1 (12-18)

DI 40505.210 After We Identify Concurrent Cases, We Decide Whether We Need the Title XVI Determination and the Title XVI Continuance Notice

A. Operating policy for concurrent cases

1. Definition of concurrent

An individual who is entitled to Title II disability benefits, and

  1. a. 

    Is eligible for Title XVI payments or Medicaid; or,

  2. b. 

    In post-eligibility situations, is ineligible under Title XVI for non-disability reasons.

2. Title XVI determination and cessation notice needed

Prepare two determinations in a concurrent case whether or not we are making Title XVI payments. If a cessation results, we require two cessation notices.

3. Title XVI continuance notice not always needed

Prepare a continuance notice only if the individual receives Title XVI payments or is eligible for Medicaid under section 1619. For policy and procedure, see DI 40540.001, Section 1619 CDRs.

For Title XVI notice instructions see DI 28095.060, Continuing Disability Review (CDR) Notices for Continuances.

B. Description of a case with Title XVI involvement

A case with Title XVI involvement will generally consist of a Title II case folder with “S” or “SSI Conversion Case” cited in file. Other indications of possible Title XVI involvement:

  • In non-conversion cases, an SSA-831 (Disability Determination and Transmittal), and/or SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal Title XVI), showing Title XVI involvement;

  • Other payment forms or documents indicating Title XVI involvement.

C. Procedure to determine Title XVI involvement with a concurrent case

1. Secure SSI-2 query

If a concurrent case involves Title XVI, obtain SSI-2 query with PSY field when one of the following applies:

  1. a. 

    The file does not contain an SSI query under 30 days old;

  2. b. 

    PSY code on latest query indicates Title XVI eligibility (any code other than N07, N08, N12-N17, N30-N54, T01, or T30-T51); or

  3. c. 

    The latest query shows one of the codes in sentence “b” (i.e., ineligibility) but later evidence indicates Title XVI eligibility.

2. Actions based on Supplemental Security Record (SSR) codes

When sending a concurrent case for a continuing disability review (CDR), tell the Disability Determination Services (DDS) whether we need a Title XVI determination and notice as follows:

  1. a. 

    DS Field Appears - Treat as Title II only, regardless of PSY code. (Social Security Administration (SSA) has made Title XVI initial denial determination.)

  2. b. 

    PSY Codes N07, N08, N12-N17, N27, N30-N54, T01, or T30-T51 - Treat as Title II only.

  3. c. 

    PSY Code C01 (Current Pay) – Prepare concurrent determinations and notices for Title II and Title XVI.

  4. d. 

    PSY Code NO1 - Individual may or may not be receiving Medicaid under section 1619(b). Obtain SSID. Look in CMPH field for column T (Medicaid social services test):

    • If column T shows a, b, or f, the individual is eligible under 1619(b). Prepare Title XVI determination and continuance notices.

    • If column T shows any code other than a, b, or f, the individual is ineligible. Prepare Title XVI determination but do not prepare a continuance notice.

      NOTE: If an individual is in N01 for any reason and the case is concurrent, we should always make decisions on both titles. We cannot adopt cessations and if Title II terminates based on the medical cessation, the Title XVI can go to C01.

  5. e. 

    For PSY Codes E01, N02-N06, N09-N11, N20, or S4-S20, we require Title XVI determination; but we do not require Title XVI continuance notice.

  6. f. 

    For PSY Codes H10-H90 or S21, phone the FO for status (system does not know). If still H10-H90 or S21, Title XVI determination needed; however, Title XVI continuance notice not needed.

  7. g. 

    PSY Code N19 (Voluntary termination): Obtain SSID query. Look in CMPH field for date N19 first appeared in PS segment. Individual went in N19 first day of month and year shown.

    When the individual is in N19 status:

    • 60 or more days treat as Title II only.

    • 60 Days or less, prepare Title XVI cessation determination; however, do not prepare Title XVI continuance notice.

  8. h. 

    For PSY Code M01 (Force Pay; individual may or may not be in pay), obtain SSID. Look in CMPH field (last entry for Payment Status is T31) for date M01 first appeared in PS segment. Look for same month and year in PMTH field, and read over to SMA and FMA segments for that month and year.

    When to prepare Title XVI determination and notice:

    • If there is any money amount shown in either FMA or SMA segment, prepare Title XVI determination and continuance notice.

    • If there is zero money amount shown, prepare Title XVI determination but not continuance notice.

  9. i. 

    For PSY Codes T20 or T22, individual received duplicate Title XVI payments based on same or different Social Security Numbers (SSNs). Check folder to determine what SSNs are involved. If you cannot tell, call the FO and ask. Obtain SSI queries on all SSNs and take action as appropriate.

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DI 40505.210 - After We Identify Concurrent Cases, We Decide Whether We Need the Title XVI Determination and the Title XVI Continuance Notice - 12/18/2018
Batch run: 08/07/2019