Use the information in the SSI folder to determine the appropriate method of payment
following the guidelines in GN 00502.075C.1.b.
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, P.L.
104-193, includes a provision which requires a payee to present evidence at the time
of the CDR that shows the child is, and has been, receiving treatment to the extent
considered medically necessary and available for his or her disabling condition. This
requirement does not apply if the Social Security Administration (SSA) determines
that such evidence would be inappropriate or unnecessary considering the nature of
the child's impairment(s). Evidence of compliance with the treatment requirement may
include, but is not limited to, doctor's receipts; name and telephone number of the
treatment source for FO verification, appointment slips, or cancelled checks. In situations
where the payee refuses to cooperate or submits unacceptable evidence of treatment,
consider a change of payee, if you cannot establish good cause for failure to cooperate.
Some examples of “good cause” for failure to obtain treatment for the child include:
physical limitations of the beneficiary which preclude the payee from obtaining necessary
payee has not been properly informed of the availability of treatment for the beneficiary;
payee's lack of transportation hinders him or her in getting the beneficiary to a
treatment facility; and
the payee's employment conflicts with the hours designated for required treatment.
Even if you may have found “good cause”, the payee remains responsible for seeking
treatment for the child. Make every effort to assist the payee in conforming to the
treatment requirement. If the payee still does not obtain appropriate treatment for
the beneficiary, consider a payee change since the payee's suitability is in question.