If the cessation was based on medical reasons, i.e., current severity, medical improvement or an exception to medical improvement OTHER than SGA:

1. a. 

   Prepare an SSA-831-U3 per DI 40510.175 and forward the folder to the appropriate technician to complete an SSA-2795-U2 to post a denial to the RDD field of the MBR.

2. b. 

   Forward the folder to the typist for preparation and release of a disallowance notice to the individual per Exhibit 1, DI 40510.185.

3. c. 

   Instruct the typist to retain a copy of the notice in the claim folder for documentation.

If the cessation is based on SGA, proceed to C. below.

1. a. 

   If an individual enrolls during the IEP, find them disabled for Premium-HI if the following conditions are met:

   • •

     Favorable medical determination completed within past 2 years (for EPE /extended Medicare or medical CDR) AND

   • •

     No past due scheduled CDR diary.

   • •

     Individual alleges same impairment(s) that were present and documented at time of favorable medical determination.

2. b. 

   Prepare an SSA-831-U3 (DI 40510.175) and route the folder to the appropriate technician for enrollment action prior to notice preparation.

3. c. 

   Request the typist to send the individual a permanent award notice per Exhibit 2 in DI 40510.185.

4. d. 

   If there is a past due medical improvement expected (MIE) CDR diary, instruct the typist to send an interim award notice per Exhibit 3 in DI 40510.185, and forward case to the DDS under cover of an SSA-847-U3 for immediate CDR per DI 43535.025. Check blocks l.b and block 3 “Other”, and annotate the form “Section 6012 - Premium Medicare case.”

5. e. 

   If there is a past due medical improvement possible (MIP) or medical improvement not expected (MINE) diary or  more than 2 years since the last favorable medical determination was done, conduct new MFR per DI 40510.155.

If an individual enrolls during the GEP, follow DI 40510.150C.1. above.

If an individual enrolls during SEP, follow DI 40510.150C.1. above.