Effective Dates: 11/01/2024 - Present Previous | Next

TN 16 (11-24)

DI 14510.035 Appeals Process for Cases Involving Section 301 Determinations

A. Procedure for appeal of medical cessation

1. Reconsideration request

If the Disability Determination Services (DDS) issues a medical cessation determination, the beneficiary may request a reconsideration of the decision.

a. Appeal filed within 10 days with payment continuation

If the beneficiary files an appeal within 10 days, with a payment continuation request:

  • •

    Suspend Section 301 development;

  • •

    Process the payment continuation;

  • •

    Complete the request for reconsideration and route the claim to Disability Determination Services (DDS);

  • •

    Annotate the master beneficiary record (MBR) special message field or the supplemental security record (SSR) remarks field with “Potential 301 case pending medical cessation recon MM/DD/YY.”

NOTE: If the DDS subsequently confirms the cessation, the FO receives a 301RECON tickle on the DCF CDRW screen (WAC CDR Tickles list). Receipt the tickle and resume Section 301 development per DI 14510.003C.

b. Payment continuation not applicable

When a payment continuation request is not applicable:

  • •

    Process the reconsideration and route the claim to DDS;

  • •

    Complete Section 301 development and fax the SSA-4290-F5 (Development of Participation In Vocational Rehabilitation or Similar Program) and supporting documents into eView;

  • •

    Transmit to the Office of Disability Operations (ODO) by uploading the Potential 301 Flag along with the SSA-4290 and related documents to ODO's Paperless Processing Center (PPC) system using the Evidence Portal's (EP) 4290 Barcode. Select the "Yes" on the Document Information screen, to make the transmission actionable when PC involvement is required;

  • •

    Annotate the MBR special message field or SSR remarks field with “Potential Section 301 determination sent to ODO MM/DD/YY.”

2. Hearing request before an administrative law judge (ALJ)

After the DDS makes a reconsideration determination , the beneficiary may request a hearing before an ALJ.

a. Hearing request filed within 10 days with payment continuation

If the FO receives a hearing request filed within 10 days with a payment continuation request:

  • •

    Suspend Section 301 development;

  • •

    Process the payment continuation;

  • •

    Process the hearing request;

  • •

    Annotate the MBR special message field or the SSR remarks field with, “Potential 301 case pending medical cessation hearing MM/DD/YY.”

NOTE: If the ALJ finds that the beneficiary's disability medically ceased , the FO receives a 301ALJ tickle on the DCF CDRW screen (WAC CDR Tickles list). Receipt the tickle and resume Section 301 development per DI 14510.003.

b. Payment continuation not applicable

When a payment continuation request is not applicable:

  • •

    Process the hearing request;

  • •

    Complete the Section 301 development and fax the SSA-4290-F5 and supporting documents into eView;

  • •

    Annotate the MBR special message field or SSR remarks field with, “Appeal pending at the Office of Hearings Operations (OHO), SBC declined, and potential Section 301 determination sent to ODO on MM/DD/YY.”

  • •

    Transmit to ODO by uploading the Potential 301 Flag along with the SSA-4290 and related documents to ODO's PPC using the EP's 4290 Barcode. Select the "Yes" on the Document Information screen, to make the transmission actionable when PC involvement is required.

B. Procedure for appeal of ODO determination on Section 301 payments

A determination that an individual is not eligible for Section 301 payments is an initial determination that has appeals rights.

1. Supporting documentation

When an individual appeals a determination regarding eligibility for continuing payments, take a statement as to why they disagree with the determination. Obtain documentation that supports their allegations about participating in a qualifying program. Document the information on an SSA-5002 (Report of Contact).

EXAMPLE: If the beneficiary states that they are participating in a program of VR services and takes part in the activities and services outlined in their employment plan, but received a notice denying Section 301 payments, obtain copies of any materials to support the statement. Use an SSA-4290-F5 to obtain evidence from the provider of services.

NOTE: Statutory benefit continuation rights do not apply to appeals of termination of Section 301 payments.

2. Reconsideration of ODO determination

If the FO receives a request for reconsideration of the ODO determination on continued payment:

  • •

    Obtain an SSA-561-U2 (Request for Reconsideration) and supporting documentation.

  • •

    Fax the SSA-4290-F5, SSA-561-U2, and related documentation into eView.

  • •

    Upload the Potential 301 Flag using the EP's 4290 Barcode. Select the "Yes" on the Document Information screen, to make the transmission actionable when PC involvement is required.

If the case is at DDS pending reconsideration of the medical cessation determination when you receive the request for reconsideration of the ODO determination, hold the material until DDS makes a reconsidered medical determination. Annotate the Special Message field of the MBR or Remarks field of the SSR with, “Potential Section 301 case awaiting medical appeal decision.”

If we affirm the cessation, forward the request for reconsideration to ODO. Upload the Potential Section 301 Case Flag along with the SSA-4290 and related documents to the PPC using the EP's 4290 Barcode. Select the "Yes" on the Document Information screen, to make the transmission actionable when PC involvement is required.

If we reverse the cessation, you do not need an ODO determination.

3. Hearing before ALJ

If the FO receives a request for a hearing on the issue of Section 301 payments:

  • •

    Obtain an HA-501-U5 (Request for Hearing by Administrative Law Judge) and supporting documentation.

  • •

    Send the case to the hearing office.

If an appeal of the medical cessation determination is pending when you receive the appeal of the ODO determination:

  • •

    Fax the material into eView and hold until the ALJ makes a decision.

  • •

    Annotate the Special Message field of the MBR or Remarks field of the SSR with, “Potential Section 301 case waiting medical appeal decision.”

If the ALJ finds that the beneficiary's disability medically ceased, forward the hearing request following usual procedures.

If the ALJ finds that the beneficiary's disability did not medically cease , you do not need a hearing on the issue of Section 301 payments.

4. Appeals Council (AC) review

If the beneficiary is dissatisfied with the hearing decision on the Section 301 issue, they may request AC review of the ALJ decision. Obtain form HA-520-UF (Request for Review of Hearing Decision/Order) and any supporting documentation.

If a medical cessation appeal is pending when you receive a request for AC review, hold the material until the AC completes its action. Annotate the special message field of the MBR or remarks field of the SSR with “Potential Section 301 case awaiting appeal.”

If the AC finds that the beneficiary's disability medically ceased, forward the request for AC review following usual procedure, as explained in DI 12020.001.

If the AC finds that the beneficiary's disability did not medically cease, you do not need an AC review on the issue of Section 301 payments.

C. Procedure for appeal of termination of Section 301 payments

ODO terminates Section 301 payments effective with the month after the month in which one of the following first occurs:

  • •

    The beneficiary completes a program of VR services, employment services, or other support services;

  • •

    The beneficiary stops participating in the program for any reason;

  • •

    ODO determines that the beneficiary’s continued participation in the program will no longer increase the likelihood that they will not return to the disability or blindness benefit rolls.

The appeals process is the same as described in DI 14510.035B.

NOTE: Statutory benefit continuation rights do not apply to appeals of terminations of Section 301 payments.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0414510035
DI 14510.035 - Appeals Process for Cases Involving Section 301 Determinations - 11/01/2024
Batch run: 11/01/2024
Rev:11/01/2024