If the child’s parent or guardian does not provide evidence showing good cause for
FTFPT, follow established procedures specific to child cases before denying the claim
or ceasing benefits. If the parent, guardian, or child asserts that the child would
have followed prescribed treatment but for the actions of the child’s representative
payee, return the claim to the field office (FO) as a “no determination” and ask the
FO to pursue a new payee for the child. For more information about “no determination”
claims, see DI 81020.127 (electronic processing) or DI 32005.020 (paper case only).
The FO will defer adjudication on the claim. After establishing a new representative
payee, the FO will provide six additional months to allow the child time to follow
the prescribed treatment. After 6 months, the FO will return the claim to DDS for
For more information about determining if a payee sought medically necessary and available
treatment, see DI 28005.031.
Refer child claims to the appropriate Vocational Rehabilitation (VR) agency or to
the appropriate State agency administering the State program under Title V of the
Act when medical evidence from a CE, MC, PC, or ME (but not from one of the child’s
own medical sources) indicates a specific treatment if followed would result in the
child no longer having marked or extreme limitations.
IMPORTANT: In States participating in the Ticket to Work program, you are prohibited from referring
any adult to a VR agency. See DI 26520.010 and DI 55001.500.