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DI 12027.060: Appeals Council (AC) Remand Medical Cessation Cases – Statutory Benefit Continuation (SBC) - Title II

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  • Effective Dates: 10/16/2006 - Present
  • Effective Dates: 05/20/2018 - Present
  • BASIC (10-06)
  • DI 12027.060 Appeals Council (AC) Remand Medical Cessation Cases – Statutory Benefit Continuation (SBC) - Title II
  • A. Policy - AC Remand Medical Cessation Cases – SBC - Title II
  • 1. General – AC Remand Cases as They Pertain to SBC
  • SBC applies to medical cessation appeal cases remanded by the AC to an Administrative Law Judge (ALJ) for further action, including court remands not covered by Section 2(d) of P.L. 98-460.
  • 2. SBC Elected at Prior ALJ Level
  • If SBC was elected at a prior ALJ level, reinstate SBC without a new election statement (SSA-795), retroactive to the first month of non-payment resulting from the now vacated prior ALJ decision.
  • 3. SBC Not Elected at Prior ALJ Level
  • * If SBC was not elected at the prior level, the claimant will have the opportunity to elect or decline SBC pending a new ALJ decision.
  • * If SBC was elected pending a new ALJ decision, reinstate SBC payment effective the month of the AC remand order.
  • B. Process
  • The Office of Disability Adjudication and Review/Hearing Office (ODAR/HO) will notify the field office (FO) by telephone of the remand and provide the Social Security Number (SSN), beneficiary name and date of the vacated ALJ hearing decision.
  • The Hearing Office (HO) will notify the field office (FO) by telephone of the remand and provide the Social Security Number (SSN), beneficiary name and date of the vacated ALJ hearing decision.
  • The HO will follow with a memorandum notifying the FO of the ALJ decision. See DI 12095.172 for exhibit of memorandum.
  • The FO will notify the primary beneficiary (and auxiliaries) when SBC benefits are being reinstated pending a new ALJ decision.
  • C. Procedure
  • 1. SBC Reinstatement
  • To reinstate SBC after AC remand:
  • * Obtain Master Beneficiary Record (MBR) to verify status after contact from the HO.
  • * Initiate SBC via Critical Payment System (CPS) following SM 00614.000.
  • * Do not withhold any benefits for possible attorney fees.
  • * Input special processing code C34.
  • * Show ALJ level appeal code and the date of remand as the date of the appeal request in remarks.
  • 2. Development for Suspension, Deduction and Termination Events
  • To develop for suspension, deduction and termination events:
  • * Contact beneficiary (and auxiliaries) after SBC reinstatement to determine if any payment adjustment is required due to any suspension, deduction or termination event.
  • * Send advance (due process) notice before making adjustment if an adverse payment adjustment is needed. (See Notices Required Before and After Taking a Title II Adverse Action, GN 03001.015 and Notice Requirements for Title II Due Process Actions, GN 03001.005.)
  • * Follow DI 12027.050C. and DI 12027.050D. if substantial gainful activity (SGA) development is involved.
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