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This change was made on Mar 22, 2018. See latest version.
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DI 25235.005: Medical Diary Criteria for Certain Title XVI Disabled Infants

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  • Effective Dates: 06/11/2015 - Present
  • Effective Dates: 03/22/2018 - Present
  • TN 1 (12-05)
  • DI 25235.005 Medical Diary Criteria for Certain Title XVI Disabled Infants
  • A. Policy
  • The general diary policies in DI 26525.001 and DI 26525.025B. apply to title XVI disabled child cases. However, additional criteria for medical diaries apply for certain infants. The basic principle for setting diaries is: Set a MIE diary for the date the infant is expected to be found no longer disabled; otherwise, set a MIP or MINE diary as appropriate to the evidence in the case.
  • B. Procedure
  • 1. Diary Date for Infants with Congenital Organ Dysfunction – Functional Equivalence Example 6 (DI 25225.060)
  • 1. Diary Date for Infants with Congenital Organ Dysfunction – Functional Equivalence Example 5 (DI 25225.060)
  • Example 6 in DI 25225.060 says we will find an infant disabled until attainment of age 1 if the: “Child has a major congenital organ dysfunction which could be expected to result in death within the first year of life without surgical correction, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both)….”
  • Example 5 in DI 25225.060 says we will find an infant disabled until attainment of age 1 if the: “Child has a major congenital organ dysfunction which could be expected to result in death within the first year of life without surgical correction, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both)….”
  • a. When To Set Diary at Age 1
  • Set the diary date at age 1, unless the child is expected to be still disabled at that date. Use MIE Reason Code C, per DI 26525.025B.2.
  • b. When To Set Later Diary Date
  • If the child is expected to remain disabled at age 1, set a later MIE diary date based on the evidence in the case record and on clinical judgment regarding when it is expected that the child’s impairment(s) will no longer be disabling. If appropriate to the evidence, set a MIP or MINE diary. Consider all evidence about the child’s impairment that is available at time of adjudication. Guidelines for establishing MIE, MIP, and MINE diaries are in DI 26525.025, DI 26525.035, and DI 26525.045, respectively.
  • 2. Low Birth Weight Infants
  • See DI 25235.006 for LBW diary guidelines.
  • 3. Systems Limitations Affecting Diary Date
  • If systems limitations preclude a diary for the child’s first birthday, or for the date by which medical improvement is expected to have occurred, set the diary for the earliest date allowed by the system (i.e., 6 months following the date of adjudication).
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