The policy instructions in this section are for field office (FO) processing of cases involving ALS, also known as Lou Gehrig's disease. This policy does not apply to claims involving non-ALS anterior horn cell diseases (e.g., Werdnig-Hoffmann disease or spinal muscular atrophy). When responding to inquiries about why the policy does not cover other impairments, explain that currently the law only applies to individuals diagnosed with ALS. Do not attempt to explain why other impairments are not included.

1. No medicare waiting period for ALS

Since July 1, 2001, the 24-month waiting period for Medicare coverage is waived for disabled claimants with ALS. For an individual diagnosed with ALS, the date of Medicare entitlement is the date of entitlement to disability insurance benefits (DIB), disability widow(ers) benefits (DWB), or childhood disability benefits (CDB) based on the diagnosis of ALS.

2. No disability insurance benefits (DIB) waiting period for ALS cases

Since July 23, 2020, the 5-month DIB entitlement waiting periods is waived for disabled claimants with ALS.

For more information on DIB “no waiting period” cases, see DI 10105.075.

1. Terminal illness (TERI)

An allegation or diagnosis of ALS meets the TERI case criteria. Follow TERI procedures in DI 11005.601D when processing the claim.

NOTE: ALS cases are also priority cases under the Quick Disability Determination (QDD) and Compassionate Allowances (CAL) processes. For QDD policy see DI 11005.603 and for CAL policy see DI 11005.604.

2. Electronic Disability Collect System (EDCS)

Add the “ALS” and “TERI” EDCS flags to the claim prior to sending the case the Disability Determination Services (DDS).

For instructions on EDCS flags, see DI 81010.080B. For EDCS exclusions, use the ALS paper flag available in DI 11036.002.

3. Modernized Claims System (MCS)

a. Additional Benefits (ADDB) screen

Enter “1” (YES) to the question “Will Medicare Apply?” on the ADDB screen.

Processing an allowance through MCS Earnings Computation (EC) in an ALS case will establish the hospital insurance (HI) start date equal to the later of the date of entitlement for disability benefit (DOED) or 07/2001. For general information on MCS EC processing, see GN 01010.205.

b. Health Insurance (HIHI) screen

Enter the appropriate supplemental medical insurance (SMI) election information on the Health HIHI screen.

NOTE: MCS EC will automatically generate a SMI refusal paragraph (HIB152 as described in NL 00725.005) advising beneficiaries still in their initial enrollment period (IEP) who refuse SMI on their application that they still have a chance to elect SMI if they respond timely. However, if they do not respond timely and wish to enroll, they will have to wait for a general enrollment period (GEP) or file under the special enrollment period (SEP) provision if applicable.

c. Adjudication through MCS EC

MCS EC will automatically waive the 5-month and 24-month waiting periods for the claim when primary or secondary diagnosis code on the MCS Disability Allowance/Denial (DICL) screen equals 3350.

Typically, the code of 3350 will propagate onto the DICL screen when the DDS makes a favorable disability determination based on a diagnosis of ALS. If the diagnosis code does not propagate, the FO identifies the code in item of 18 of the SSA-831 (Disability Determination and Transmittal) form or electronic equivalent and will manually enter the diagnosis code 3350 on the DICL screen.

NOTE: The FO technician should carefully review the DDS provided diagnosis code in claims with ALS involved prior to adjudication and resolve any discrepancies to ensure waiver of the waiting period is properly applied.

d. Exclusions from District Office Final Authorization (DOFA) or MCS EC adjudication

For non-DOFA cases and other MCS EC exclusions, process the award via automated 101 (A101) or electronic form 101 (EF101). For more information on FO adjudication procedures and processing of determinations, see DI 10005.020B.4.

Cases where beneficiaries allege ALS and are currently serving the 5-month or 24-month waiting period are EDCS exclusions and require processing via the following steps:

1.      Obtain information from the claimant on a curtailed SSA-3368 (Disability Report - Adult), including:

• •

  the ALS alleged onset date,

• •

  the name, address, telephone number, and fax number of each medical source diagnosing ALS, and

• •

  the date the claimant first saw each medical source for ALS.

  2.      Obtain an SSA-827 for each source,

  3.      Place materials in a brown paper folder.

  4.      Attach the ALS case flag to the front on the paper folder.

  5.      Send the paper folder to the DDS.

  6.      Establish a Modernized Development Worksheet (MDW) control pending for the DDS determination. The standard issue should be “ALS.”

NOTE: When curtailing completion of the SSA-3368, do not complete sections five (Education, Training, and Literacy) and six (Work History) of the form. For curtailed SSA-3368 procedures, see DI 11005.020C.