DI 33025.075:
Age 18 Redetermination Cases Under P.L. 104-193
Effective Dates: 02/22/2013 - Present- Effective Dates: 12/13/2017 - Present
TN 7 (09-97)- TN 10 (12-17)
- DI 33025.075 Age 18 Redetermination Cases Under P.L. 104-193
A. Background- A. Background – Childhood disability eligibility at attainment of age 18
Pursuant to P.L. 104-193, all childhood disability beneficiaries who were eligible as children in the month before the month in which they attained age 18 must have their eligibility redetermined under the adult standards for initial claims.- Pursuant to Public Law (P.L.) 104-193, all title XVI childhood disability recipients who attained age 18 on or after August 22, 1996, and were eligible as children in the month before the month in which they attained age 18, must have their eligibility redetermined under the adult standards for initial claims.
The disability redeterminations will be done using the adult disability criteria for initial claims, except for the first step of sequential evaluation, substantial gainful activity. The medical improvement review standard will not apply.- Use the adult disability criteria for initial claims to make disability redeterminations, excluding the first step of the sequential evaluation, process, substantial gainful activity (SGA).
B. Policy- NOTE: The medical improvement review standard (MIRS) does not apply in Age 18 redetermination cases.
Claimants found not disabled in an age 18 disability redetermination based on the application of the adult disability criteria may appeal the determinations that they are not disabled. Reconsiderations of the age 18 disability redetermination cases will be conducted under the regulations that govern the disability hearing process. See§§20 C.F.R. 416.1414-416.1418.- B. Policy – Appealing the decision in an age 18 redetermination case
C. Process- Recipients found not disabled in an age 18 redetermination, based on the application of the adult disability criteria, may appeal the determination that they are not disabled. Reconsiderations of the age 18 redetermination cases will be conducted under the regulations that govern the disability hearing process. See 20 CFR §416.1414 through §416.1418.
Except as set out in this section, age 18 redetermination reconsiderations will be conducted according to DI 33001.000.- C. Process for conducting an age 18 redetermination case
- Except as set out in this section, age 18 redetermination reconsiderations will be conducted according to DI 33001.000 Disability Hearing Unit Procedures.
- For example:
* The DDS will first perform a case review to determine whether a fully favorable determination can be issued based on the evidence in the record.* If a fully favorable determination cannot be reached based on the DDS's case review, any residual functional capacity assessment forms (SSA-4734-U8 or SSA-4734-F4) or Psychiatric Review Technique Form (SSA-2506-BK) obtained for the case review will be marked “Advisory.”* The DDS or DHU will prepare a Summary of Evidence (SSA-887).* The DHU will send the claimant or his or her representative, if any, notice of the time and place of the disability hearing at least 20 days before the date of the hearing.* The claimant or his or her representative, if any, should be encouraged to review the evidence in the case file on the date of the hearing or at an earlier time.* If, for any reason, additional evidence is obtained after a hearing, and all evidence, taken together, supports an unfavorable determination, the claimant is notified, in writing, and given an opportunity to review and comment on the additional evidence within 10 days of the date the notice is received, unless there is good cause found for granting additional time.- * If the disability determination services (DDS) could not reach a fully favorable determination, any residual functional capacity assessment forms, including SSA-416 (Medical Evaluation), SSA-4734-BK (Physical Residual Functional Capacity), or SSA-2506-BK (Psychiatric Review Technique), obtained for the case review, will be marked, “Advisory.”
- * The DDS or the disability hearing unit (DHU) will prepare an SSA-887 (Summary of Evidence).
- * The DHU will send the recipient, and his or her representative, if any, notice of the time and place of the disability hearing at least 20 days before the date of the hearing.
- * The recipient and his or her representative, if any, should be encouraged to review the evidence in the case folder on the date of the hearing or at an earlier time.
- If, for any reason, additional evidence is obtained after a hearing, and all evidence, taken together, supports an unfavorable decision, the recipient is notified, in writing, and given an opportunity to review and comment on the additional evidence within 10 days of the date the notice is received, unless there is good cause found for granting additional time.
- D. Procedure - preparing the disability hearing officer’s report of disability hearing
During the hearing, complete an SSA-1205-BK (Disability Hearing Officer's Report of Disability Hearing) to record the proceeding. In conducting the hearing and completing the SSA-1205-BK, delete or cross-out any reference to to the comparison point date (CPD) or the medical improvement review standard (MIRS). These concepts are not applicable in age 18 redetermination cases.- While conducting the hearing, complete an SSA-1205-BK (Disability Hearing Officer's Report of Disability Hearing) to record the proceeding. Because comparison point decision (CPD) and the MIRS do not apply in age 18 redeterminations, annotate the SSA-1205-BK to show you did not use these concepts. Delete, cross out, or make remarks about any reference to the CPD or the MIRS. Examples of remarks to use in appropriate items include “not applicable” or “The medical improvement standard does not apply.”
- E. Procedure - fully favorable age 18 redetermination case
- 1. Completing the form SSA-1207-BK-OP1
- Complete an SSA-1207-BK-OP1 to document a fully favorable determination. Concisely discuss the evidence and provide a rationale that explains the basis of the decision.
- 2. Completing the form SSA-832
- Complete an SSA-832 in every case with a decision. Enter in the remarks section, “This decision is based on the hearing held on (date of hearing).” For special coding instructions, see DI 23570.025 Processing Childhood and Age 18 Disability Redeterminations.
- DHO cover notice
- Prepare and release the DHO cover notice with the DHO decision.
- Refer to DI 33015.025 and DI 33095.100 for a sample Notice of Reconsideration without benefit continuation. Do not use any fill-in that refers to medical improvement. For a fully favorable decision – Notice of Reconsideration with benefit continuation, suggested language follows:
- Suggested Language for a Fully Favorable Decision
-
- Social Security Administration
- Supplemental Security
E. Procedure - fully favorable age 18 redetermination cases- Notice of Reconsideration
1. SSA-1207 or SSA-4268-U4/C4- Date:
Complete an SSA-1207-BK-OP1 or SSA-4268-U4/C4 to document a fully favorable determination. Regardless of which form the DHO uses, concisely discuss the evidence and provide a rationale that explains the basis of the determination. If the determination is documented on an SSA-4268-U4/C4, the SSA-4268-U4/C4 should contain the information similar to that which would have been entered in the “Analysis of Evidence and Findings of Fact” section of the SSA-1207-BK-OP1.- Name
2. SSA-832- Address
Complete an SSA-832 in every case in which a determination is reached. Enter in the remarks section, “This determination is based on the hearing held on (date of hearing) .” See DI 23570.025 for special coding instructions.- City, State, and Zip Code
- We are writing to let you know that we have made our disability hearing decision on your case.
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- Our Decision
- We find that your disability began (insert date of disability here).
- We have attached the hearing decision to this letter. Our decision deals only with whether you are disabled. If our decision causes a change in your benefits, you will receive a separate letter.
- If you agree with our decision, you do not have to do anything.
-
- If you Disagree with The Decision
- If you disagree with the decision, you have the right to ask for a hearing. At the hearing, a person who has not seen your case before will review your case again. That person is an Administrative Law Judge (ALJ). In this review, the ALJ will consider any new facts you have.
- * You will have 60 days to ask for a hearing
- * The 60 days start the day after you receive this letter. We assume you will receive this letter within five (5) days after the date that appears above, unless you can show us that you did not receive the letter within five days.
- * You must provide a good reason for a delay if you wait more than 60 days to ask for a hearing.
- * Your request for a hearing must be in writing. We will ask you to sign Form SSA-501, called a ‘Request for a Hearing.’ Contact the nearest Social Security Administration office for a copy of this form and if you need help.
- Enclosures:
- Hearing Decision
- F. Procedure - partially or fully unfavorable age 18 redetermination cases
1. SSA-1207–BK-OP1- 1. Completing the form SSA-1207–BK-OP1
- Complete an SSA-1207-BK-OP1 to document a partially or fully unfavorable determination.
2. SSA-832- 2. Completing the form SSA-832
- Complete an SSA-832 in every case with a decision. Enter in the remarks section, “This decision is based on the hearing held on (date of hearing).”
- 3. DHO cover notice
Complete an SSA-832 in every case in which a determination is reached. Enter in the remarks section, “This determination is based on the hearing held on (date of hearing) .”- Prepare and release the DHO cover notice with the DHO decision.
- * Unfavorable decision and benefit continuation not offered -- SSA-L1674
- * Unfavorable decision and benefit continuation is offered – SSA-L1680
G. DHO cover notice- See:
- * DI 33015.025 Preparing the Notice of the Disability Hearing Officer's Decision
- * DI 33095.116 SSA-L1680— Disability Hearing Decision Cover Letter — Payment Continuation Elected at Reconsideration and Offered Again at ALJ Hearing Level
Prepare and release the DHO cover notice with the DHO decision. See DI 33015.025, and DI 33095.100-DI 33095.116. Do not use a fill-in that refers to medical improvement. In most cases, the appropriate fill-in will be, “We find that you are no longer eligible for payments.”- Do not use a fill-in that refers to medical improvement. In most cases, the appropriate fill-in will be, “We find that you are no longer eligible for payments.”
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