DI 13050.050: Expedited Reinstatement (EXR) Title XVI Interview
Effective Dates: 10/23/2014 - Present TN 2 (02-06) DI 13050.050 Expedited Reinstatement Interview - Title XVI A. Procedure — screening for eligibility Follow these screening steps to determine if an individual is eligible for EXR. 1. Review the SSR Review the SSR to determine if the individual was previously eligible for a disability payment under title XVI, whether the eligibility has terminated and the reason for termination. To determine if the individual's previous eligibility was terminated due to earned income or a combination of earned and unearned income, query the following elements of the SSR:
- * CMPH segment - the last entry in the Payment Status (PS) field is T31;
- * CMPH segment - there is an entry of N01 in the PS field in the month before the T31 month; and
- * ENIH segment - there is earned income in the month before the T31 month.
2. Review other corroborating information Review the following additional sources of information to verify that termination was due to earned income or a combination of earned and unearned income: * the individual may have a notice that explains the basis for termination or the notice may be available on an online system * other records may exist (such as a MDW or a local file) * the NDDS may contain a record of a medical determination. 3. Determine EXR request period Determine if the EXR request date is within 60 months of the previous termination (T31) month. If not, * See DI 13050.010 for further information about the EXR request period and consideration of good cause for late filing. * Consider the protective filing guidelines in DI 13050.015. 4. Establish protective writing If the interview cannot be taken immediately, schedule a post-entitlement (PE) appointment in the calendar of the individual's servicing field office (FO). Type “EXPEDITED REINSTATEMENT” in the remarks section of the PE appointment lead. Advise the individual filing for EXR that the actual filing date determines the month that provisional payments start. B. Procedure - expedited reinstatement interview – Title XVI 1. Explain EXR provisions When the screening procedures outlined in DI 13050.045A have been completed, explain the EXR eligibility requirements to the individual and determine if he/she is eligible for EXR (see DI 13050.001C.1.). If eligible, explain the provisions of EXR as compared to those of filing a new application. The individual must decide whether he or she wishes to pursue EXR or an initial claim. See DI 13050.020 for a more in depth discussion of some issues to consider. If the individual elects to file a new claim instead of EXR, state the reason for not filing EXR in the Remarks section of the initial application form. If you are unable to determine eligibility for EXR based on available evidence, proceed as if the individual is eligible and request the file needed to provide this information. When received, review the folder to verify the individual's eligibility for reinstatement and proceed accordingly. 2. Obtain EXR request package Obtain a completed and signed EXR package from the individual. The EXR package will include at least the following forms: * SSA-372, Request for Reinstatement for title XVI Individual (or Disabled Spouse with Work Activity), (see DI 13050.105). Staple this to the front of a SSA-8000-BK. Write “Supplement to the Request for Expedited Reinstatement” at the top of an SSA-8000; NOTE: Complete the supplemental SSA-8000 in the same manner as for a PERC. Develop all factors of eligibility immediately. * SSA-454, Report of Continuing Disability. Enter the month and year of the EXR request in the “Remarks” section (if protective filing exists, use the protective filing date). * SSA-827, Authorization for Source to Release Information to the Social Security Administration. * SSA-820/821 Work Activity Report and SSA-823, Report of SGA Determination. Document SGA/nonSGA months beginning with the month of filing (if protective filing exists, use the protective filing date) on the SSA-820 or 821 and record the SGA determination on the SSA-823. NOTE: If the interview is by telephone, explain to the individual that you are sending to him/her the EXR forms for signature and the 60-day EXR close-out notice (see DI 13050.015 and DI 13050.105). Tell the individual that he/she must return the signed forms before provisional payments can be paid.
- 3. Eligible spouse
If there is a previously eligible spouse, the spouse could also be reinstated if he or she requests reinstatement and meets the EXR requirements. * If the spouse is blind or disabled, worked, and meets EXR screening requirements in DI 13050.050A., complete a SSA-372 for the spouse. * Complete a medical package for the spouse (SSA-454, SSA-827, etc.).
- 4. Aged spouse
- If there is an aged spouse, obtain an initial application for SSI Aged and establish entitlement using normal requirements for entitlement.
5. Request the prior file Request the prior claim folder that contains the comparison point medical records (CPD folder) the DDS will need to make the medical determination. Follow the instructions for retrieving a folder in the medical CDR instructions, see DI 13015.030 through DI 13015.250 and DI 40525.020 through DI 40525.150. If the CPD folder is not found, follow the procedures in DI 13015.080 and DI 13015.090. 6. Representative payee If, during the interview you determine that the individual is incapable of managing his or her own provisional payments, develop for a representative payee. If the individual had a representative payee in the previous entitlement period, determine if a representative payee is still needed. See DI 13050.075 for more instructions about payee development. 7. Provisional payments Initiate provisional payments when appropriate, see DI 13050.030, and forward the EXR package(s) to the servicing DDS for a medical determination per DI 13050.055. C. Procedure - workflow outline The following is an outline of the application and award processing procedures for title XVI EXR cases. These instructions are discussed more fully in POMS DI 13050.005 to DI 13050.095. 1. Title XVI - initial development * FO will screen for eligibility and take EXR request for eligible individual (or couple) and establish the EXR request on the DCF. Develop for payee as appropriate. * Initiate Provisional Payments per DI 13050.030I. * Send EXR case-file to DDS for medical determination with folder flag (see DI 13050.105, Exhibit 4). Transfer jurisdiction to the DDS on the DCF and create an EXR issue on the DCF development worksheet (CDRW screen) to control for return of the case. * DDS will receipt case per DI 28057.010B, make the MIRS determination and complete the SSA-832. See DI 28057.020F for instructions on completing the SSA-832. * DDS faxes EXR approval to FO so that the FO can initiate necessary non-medical development (see DI 11010.340). * DDS returns EXR case-file to FO. 2. Title XVI - after medical allowance * FO receives folder from the DDS with a completed SSA-832 and personalized explanation. * Transfer jurisdiction of the EXR event back to the FO on the DCF and complete needed non-medical development, including PERC. Terminate provisional benefits and complete systems input to initiate reinstated benefits (start date procedures), issue notice, and clear the EXR event in the DCF as a continuance. See SM 01701.080. D. Policy - technical denial - FO responsibilities If, after going through the screening process in DI 13050.050A, or at a later date, you determine the individual is not eligible to expedited reinstatement (EXR) because he does not meet the requirements (see DI 13050.001B.), a denial notice must be issued to the individual and any appropriate third party, provisional benefits must be stopped as per DI 13050.030J and the individual must be contacted to: * Explain the basis for non-eligibility, and * Inform the individual that he or she has the option of filing a new application for disability payments, requesting a reconsideration of the EXR decision, or filing a new EXR application. Discuss the merits of each option to help the individual determine which option would be most advantageous. The request for reinstatement can be used as a protective filing for a new application if the individual chooses to file a new claim. Process the EXR action based upon the individual's decision per DI 13050.020. E. Procedure - technical denial - Title XVI 1. Individual files initial claim If the individual files a new claim instead of requesting EXR, document the basis for EXR ineligibility in the MSSICS claim or a SSA-5002 if a paper application is taken. Closeout the existing EXR protective writing through normal closeout procedures (include a closeout statement in the claimants remarks on the initial claim application, etc.) 2. Individual requests EXR * Obtain form SSA-372, Request for Reinstatement for title XVI, SSA-372 * Establish an EXR event within the DCF per DI 13010.610. * Document the basis for EXR ineligibility on a SSA-553, Special Determination, or an SSA-5002, Report of Contact and annotate the Remarks (IRMK) screen of the DCF. * Retain supporting documentation with the above forms in a brown folder. * Process the denial per DI 13050.050C. Post payment status code N07 to the SSR. See SM 01701.080 and SM 01305.001P.6. * Close the EXR event in the DCF using the SSR/MBR/OTHER CONDITIONS – STOP CDR option per DI 13010.620. 3. Provisional benefits paid Terminate provisional benefits, if started. See SM 01701.080. 4. Notice Send an EXR denial notice to the claimant and any appropriate third party. Retain a copy of the notice for the file. T16 EXR notices must be manually prepared at this time.
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