TN 55 (08-96)

A. Introduction

For title XVI cases, the PAYMENT PERIOD and the onset date that the DDS will show on the SSA-831 are not necessarily related. Rather, the onset will usually be an administrative onset, selected to permit payment in the first month of the PAYMENT PERIOD. (See DI 12586.001, item 8.).

B. Policy -- PAYMENT PERIOD

The PAYMENT PERIOD in title XVI cases is generally the 48-month period immediately preceding 12/91 (i.e., 12/87 through 11/91). However, if eligibility and disability continue, benefits may continue beyond the “PAYMENT PERIOD.” Certain exclusions listed below will affect the PAYMENT PERIOD.

The FO is responsible for computing the PAYMENT PERIOD and potential onset prior to sending the case to the DDS. The PAYMENT PERIOD will be computed using the DEVELOPMENT/PAYMENT PERIOD Worksheet (DI 12586.095, Exhibit 10), or the PC program, if available in the FO.

C. Procedure

1. Computing Title XVI Payment Period

When computing the title XVI PAYMENT PERIOD, start with the 48-month period from 12/87 through 11/91, but go back further, as necessary, to exclude:

• months the class member was already entitled to title II “A” (reduced or unreduced), “HA”, CDB or DWB benefits;

• months of title XVI eligibility including nonpayment months that occur during a period of title XVI eligibility;

• months of potential eligibility to title XVI payments based on a pending claim;

• months covered by a non-New York medical denial or cessation decision;

• months the class member would not be eligible for a title XVI payment due to institutionalization (SI 00520.001FF);

• months the class member would not be eligible for title XVI payment because he/she was out of the U.S. (SI 00501.400).

IMPORTANT: In no case may payment be made for any period prior to the first day of potential eligibility on the earliest title XVI claim finally adjudicated in the Stieberger period; 10/1/81 through 7/2/ 92, inclusive.

2. Documentation

File DEVELOPMENT/PAYMENT PERIOD Worksheet on the right side of the DIB folder, just beneath the SSA-831.

EXAMPLES:

1. A title XVI only claim, filed 7/22/83, was denied by the NY DDS at reconsideration on 3/10/84.

   The PAYMENT PERIOD is 12/87 through 11/91 (see B., above).

2. The same facts as in a., except the class member was institutionalized, resulting in title XVI ineligibility throughout the months of 10/88-6/89.

   The PAYMENT PERIOD cannot include the period of institutionalization (10 /88-6/89).

   The PAYMENT PERIOD is 7/89-11/91 (see B., above), and 3/87-9/88.

3. The earliest Stieberger claim was filed on 6/12/87, and was denied at the ALJ level on 2/16/89. The class member became eligible for AI benefits on 3/31/90.

   The PAYMENT PERIOD cannot include months of eligibility to title XVI, so begin counting back with 2/90. Forty-eight full months would be 3/86; BUT, in no case may payment be made for any period prior to the first possible day of eligibility on the earliest Stieberger claim. Since the date of filing of the earliest claim is 6/12/87, the first possible date of eligibility is 6/12/87.

   The PAYMENT PERIOD is 6/12/87 through 2/90.

D. POLICY -- STIEBERGER ONSET

The Stieberger ONSET date is established to permit payment to start with the first day of the first month of the PAYMENT PERIOD. Unless the DDS must adjust the onset based on its development (see DI 12586.065, item 2.), ONSET in title XVI cases is the first day of the first month of the PAYMENT PERIOD.