The Office of Disability Programs identified a large group of UMC cases. With the exception of the Office of International Operations, all administrative actions taken on this group of identified UMC determinations (made before January 01, 2006), will be tracked using the Uneffectuated Medical Cessations Clearance Control (UMCCC) on the New York Regional website (http://nynet.ny.ssa.gov/UMC/ ). The FO taking action on the new CDR is responsible for entering all information into the tracking system.

Do not clear cases from the UMCCC website until all actions are completed and recorded to SSA mainframe systems (i.e., the new CDR determination is received from the DDS and successfully effectuated). If an appeal is filed on the new CDR determination, do not clear the UMCCC until the appeal decision is rendered and effectuated. Do not attempt to add or track any other UMC cases subsequently discovered on the UMCCC website. However, if a UMC case is subsequently discovered, follow established policy and procedures for initiating a new medical CDR.

If, at the time of the medical cessation determination, the individual was either concurrently (Title II and Title XVI) or dually (more than one Title II claim) entitled, but the termination action was effectuated on only one title, the termination action on the effectuated title is considered final (after the appropriate appeals period). For the title on which the medical cessation determination was not effectuated, the appropriate action to be taken depends on the date of the original DDS medical cessation determination.

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  If the DDS medical cessation determination was made on or after January 01, 2006, process the uneffectuated title under the OMC procedures (i.e., take necessary action to terminate benefits retroactively on the uneffectuated title, based on the original cessation determination, as per DI 13010.197E.). Do not send OMC cases to the DDS for a new medical CDR determination.

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  If the DDS medical cessation determination was made before January 01, 2006, process the uneffectuated title under the UMC procedures (i.e., afford a new CDR determination for the uneffectuated title only).

If appropriate, take a new claim on the title that was ceased. Obtain an SSA-3368, and an SSA-454 to capture any information not on the SSA-3368, and send the new claim to the DDS along with the CDR. If the new claim is allowed, the retroactivity will be based solely on the new application (i.e., 6 or 12 months retroactivity, as appropriate, for a Title II application; no retroactivity for a Title XVI application). Do not use either the prior application date or the continued entitlement on the title that was not ceased, as a protective filing for the new application on the properly ceased title. Retroactive benefits are not payable back to the medical cessation date.

Certain situations may arise where the UMC case was not a concurrent/dual entitlement case at the time of the original medical cessation. However, an action subsequent to the original medical cessation (such as the filing of a new claim) involved the other title. Treat these cases as concurrent/dual entitlement filings for UMC purposes. Because of the unique scenarios that may be encountered, established policies and procedures may need to be modified.

DDS makes a medical cessation determination in 04/2000 on a Title XVI only case, but the cessation is never processed. The NH files for Title II DIB in 11/2002 and the Title XVI allowance is adopted; the medical re-exam diary is set at 11/2005. The entitlement on the Title XVI record terminates in 2004 due to income and resources.

In this example, DDS made the Title XVI medical cessation determination in 2000. Therefore, the case falls under the UMC procedures (i.e., set aside the original medical cessation and afford a new CDR). However, because the Title XVI entitlement is already terminated (for non-medical reasons), it would serve no purpose to do a new Title XVI CDR, because, with certain exceptions, a medical cessation is not retroactive. Therefore, do not send the Title XVI UMC case to the DDS for a CDR.

The other issue to be considered is the Title II adoption of the Title XVI allowance, which was done in error because the Title XVI claim should have been ceased in 2000. Because of the special circumstances involved in this case, a new CDR will be initiated on the Title II claim to establish a medical basis for future CDRs. The Comparison Point Decision folder will be the original Title XVI allowance from which the Title II allowance was erroneously adopted.

DDS makes a medical cessation determination in 01/2002 on a concurrent Title II/Title XVI claim. The Title XVI claim is terminated, but the cessation is never processed on the Title II claim. In 05/2003, a Ticket to Work is mailed; it is assigned in use on 06/28/06. SSA discovers the UMC situation in 11/2007.

Because DDS made a medical cessation determination in 2002, this case falls under the UMC procedures (i.e., set aside the original medical cessation and afford a new CDR). However, because a Ticket is in use when SSA discovers the UMC issue, a new CDR will not be initiated until the Ticket use terminates.

For unusual situations requiring additional guidance, FO personnel should contact their regional coordinators. Regional coordinators needing assistance may contact the Office of Public Services and Operations Support (OPSOS).

If a Ticket to Work is assigned and in use when SSA discovers and processes the UMC issue, a new medical CDR will not be initiated until the Ticket is no longer in use. Document the UMC issue on the DCF and MBR remarks with instructions to pursue the medical CDR if/when the Ticket use terminates. Update the UMCCC website appropriately (i.e., No Termination Required with an explanation of the ticket involvement in remarks).

If the person is already terminated (for a reason other than the medical cessation determination) when the UMC issue is discovered, do not initiate a new CDR. Annotate the MBR/SSR and DCF remarks to show the UMC involvement, indicating benefits should not be reinstated without a new medical determination. Update the UMCCC website appropriately (i.e., No Termination Required with an explanation of the prior termination in remarks).

If a new CDR is initiated on a UMC case, but the beneficiary fails to comply with our request for needed information or evidence to complete the CDR, make a failure to cooperate (FTC) determination (after making every effort to obtain the information or evidence per DI 13015.005A.1.). Record the FTC determination on the DCF per DI 13015.005A.2.d. Update the UMCCC website appropriately (i.e., No Termination Required with an explanation of the FTC issue in remarks).

If a new CDR is initiated on a UMC case, but a whereabouts unknown (WU) issue arises, handle as per DI 13015.005B.

If a FTC or WU situation arises in the DDS, the DDS will process as per DI 28075.005 and DI 28075.007.

If a new CDR is required on a UMC case but the beneficiarys/recipients benefits are in suspense status due to incarceration, take the following appropriate action based on the title involved.

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  On Title XVI cases, if it is expected that the recipient will be suspended for imprisonment for at least 12 months, then a CDR is not required. Annotate the UMC issue in the CG field on the SSR and the DCF remarks, indicating a CDR is required if the recipient is released from prison before benefits are terminated. Clear the UMC case on the UMCCC website by indicating No Termination Required and documenting the reason in the remarks.

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  On Title II cases, a CDR is required (DI 28065.001C). If the beneficiary is unable to cooperate due to prison policies, annotate the UMC issue on the MBR and DCF, indicating benefits should not be reinstated until a CDR is initiated. Clear the UMC case on the UMCCC website by indicating No Termination Required and documenting the reason in the remarks.

If a work CDR is also necessary, it should be completed before sending the case to the DDS. If the completed work CDR results in an SGA cessation and benefits are suspended in the EPE, the medical CDR should still be completed. However, if the work CDR results in an SGA cessation and benefits are terminated, do not send the case for a new medical CDR unless an impairment severity review is needed for Medicare coverage and the individual is not protected from the review under Section 111 (DI 13010.012). Clear the UMCCC website by annotating, No Termination Required and explain in the remarks why a termination is not needed (i.e., prior work CDR termination). Also, explain in the DCF the actions that were taken.

Section 301 of the Social Security Disability Amendments of 1980 (P.L. 96-265), provides for continuation of disability benefits to certain individuals whose disability medically ceases while the individual is engaged in a program of vocational rehabilitation or similar program (see DI 14500-14515). Therefore, if benefits continue after a DDS cessation determination made prior to January 01, 2006, because of a favorable Section 301 allowance determination, the case is not a UMC case and the special UMC procedures do not apply.

The new CDRs for these UMC cases will not be initiated on the Disability Control File (DCF) as is normally done for an Automated Direct Release (ADR) run. The prior CDR for many of these cases may still be open on the DCF (i.e., the cessation determination was never posted); the DCF does not allow a second medical CDR to be initiated while the first medical CDR is still open. In other situations, the prior CDR was processed prior to the conversion to the DCF (11/02) and is not reflected on the DCF. Because these UMC cases cannot be released via the ADR process, the folders for these cases will not be automatically sent to the FO. The FO must manually request the folders. (See DI 13015.055, DI 13015.060, DI 13015.070, DI 13015.080, and DI 13015.090.) After obtaining the folder, manually establish the new CDR on the DCF as follows:

When the CDR package is complete and ready for transfer to the DDS, place the flag shown in Exhibit 1 on top of the folder and send the case to DDS for adjudication. DO NOT clear the UMCCC at this point; the UMCCC should not be cleared until after the new DDS CDR determination is made and effectuated.