SI 02007.001: Interim Benefits in Cases of Delayed Final Decisions - SSI

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~~Effective Dates: 04/26/2013 - Present~~
Effective Dates: 01/11/2018 - Present
TN 3 (11-05)
SI 02007.001 Interim Benefits in Cases of Delayed Final Decisions - SSI
~~Citations: Section 1631(a)(8) of the Social Security Act; 20 CFR 416.1469(d)~~
Citations:
Section 1631(a)(8) of the Social Security Act;
20 CFR 416.1469(d)
A. Policy
When an administrative law judge (ALJ) makes a favorable disability or blindness decision on a case, the Appeals Council (AC) may decide on its own motion to review the decision or reopen the decision. It may do this because an office protests the ALJ's decision to the AC, or because quality assurance sampling of ALJ decisions causes the AC to question the ALJ's decision. When the AC decides to review or reopen a decision, the claimant receives a notice that tells him/her about the favorable ALJ decision, that the decision is being reviewed/reopened, and that benefits will be delayed while the case is under review/reopening. The notice also tells the claimant that there is a limit to how long benefits can be delayed.
The law (section 1631(a)(8) of the Social Security Act) requires SSA to pay monthly Federal benefits prospectively if a final decision is not made by the Commissioner within 110 calendar days after the date of the ALJ decision. These “interim benefits” start with the month in which the 110th day falls, and end with the month in which the final decision is made.
The law also provides that any interim benefits paid will not be considered overpayments, unless fraudulently obtained.
These requirements apply to both title II and SSI. Both title II and SSI can be paid as interim benefits. For SSI, only Federal SSI money is paid as interim benefits. Federally administered State supplementary payments are not paid as interim benefits.
If a field office (FO) has effectuated the favorable ALJ decision before the AC took action to review or reopen the case, then interim benefits are not an issue.
Interim benefits are also not payable when the ALJ has made a favorable decision, a long period of time has gone by while the FO is completing preeffectuation review development for SSI, but the AC own motion review is not involved. The FO must complete effectuation of the ALJ's decision and pay regular benefits as soon as possible.
Following are two examples of interim benefit cases:
EXAMPLE 1:
* The ALJ issued a favorable disability decision on June 21, 2004.
* The AC decided to review the case on its own motion.
* The claimant began receiving SSI interim benefits starting with October 2004, because 110 days from June 21 is in October.
* The AC reverses the favorable ALJ decision in February 2005, and the FO stops interim benefits in March 2005. The payments for October 2004 through March 2005 are SSI interim benefits.
EXAMPLE 2:
* The ALJ issued a favorable disability decision on June 21, 2004.
* The AC decided to review the case on its own motion.
* The claimant began receiving SSI interim benefits starting with October 2004, because 110 days from June 21 is in October.
* The AC remanded the case to the ALJ for further proceedings and a new decision.
* The ALJ held a new hearing and issued a subsequent unfavorable decision.
* The claimant filed a request for review of the unfavorable ALJ decision with the AC.
* The AC denies the request for review.
* The FO stops the interim benefits.
B. Policy - Related Policies
1. Interim Benefits in Cases of Delayed Final Decisions - Title II
See DI 42010.205. These sections state the policies and procedures for interim benefits under title II.
2. Nondisability Requirements
A person must meet all nondisability requirements for SSI eligibility to receive interim benefits (e.g., limitations on income and resources, and the requirement to file for other benefits.) See SI 00501.001.
3. Interim Assistance Reimbursement (IAR)
Interim benefits are not payable to the State for reimbursement. See SI 02003.001A.3.a.
4. Overpayments
Interim benefits are not overpayments unless fraudulently obtained. Unless interim benefits were fraudulently obtained, do not take any overpayment recovery action. See GN 04101.010 regarding “SSA Program Integrity Responsibilities”. Also see SI 02201.005 regarding SSI overpayments.
5. Reporting Responsibilities/Changes in Benefits Due/Appeal Rights
All SSI posteligibility rules apply to SSI interim benefit cases, except the rule about overpayments stated in SI 02007.001B.4. See SI 02007.015 for notice requirements.
For example:
* Claimants receiving SSI interim benefits have the same reporting responsibilities as other SSI recipients;
* Changes in nondisability factors can increase or decrease the monthly interim benefits due or cause interim benefits to stop;
* Some changes in nondisability factors require the FO to conduct unscheduled redeterminations;
* Due process requirements apply, including the requirement to provide an advance notice (Goldberg v. Kelly) before reducing or stopping interim benefits for nondisability reasons. (See SI 02301.001)
6. Windfall Offset
The rules for windfall offset apply to interim benefits. See GN 02610.005.
EXAMPLE:
Facts about the interim benefits:
* The claimant applies for SSI and title II benefits in January 2004.
* Based on the alleged date of disability onset, the first month in which title II benefits could be due is February 2004.
* The ALJ issues favorable disability decisions on June 21, 2004.
* The AC decides to review the case on its own motion.
* The claimant begins receiving SSI and title II interim benefits starting in October 2004, because 110 days from June 21 is in October.
* The AC affirms the favorable ALJ decision in February 2005.
* The claimant continues to receive monthly SSI and title II benefits.
* The claimant receives retroactive SSI benefits.
The windfall offset computation
* The retroactive title II benefits would have been paid in February 2004 through September 2004.
* The offset period begins February 2004, the first month title II benefits could affect SSI if paid when due.
* The offset period ends November 2004, 2 months after the last month in which the retroactive title II would have been paid.
C. Procedure - Starting Interim Benefits
Step
Action
1
The ALJ makes a favorable disability/blindness decision
2
The Appeals Council decides on its own motion to review the ALJ's decision or decides to reopen the decision.
3
About 100 days after the ALJ decision, the Office of Appellate Operations (OAO) in the Office of Disability Adjudication and Review (ODAR) will send the servicing FO and/or the processing center with jurisdiction an information sheet titled “Potential Interim Benefit Case”. This information sheet gives detailed information about the case. See SI 02007.010A. for an exhibit of the sheet.
About 100 days after the ALJ decision, the Office of Appellate Operations (OAO) in the Office of Hearings Operations (OHO) will send the servicing FO and/or the processing center with jurisdiction an information sheet titled “Potential Interim Benefit Case”. This information sheet gives detailed information about the case. See SI 02007.010A. for an exhibit of the sheet.
* If there are potential title II interim benefits, OAO will fax the information sheet to the appropriate Processing Center (PC);
* If there are potential SSI interim benefits, OAO will e-mail the information sheet to the servicing FO with the required information;
* If there are potential title II and SSI interim benefits (concurrent cases), OAO will e-mail the information sheet to the FO and fax the information sheet to the PC.
4
The FO conducts a Preeffectuation Review Contact (PERC), to determine eligibility and payment based on nondisability factors. See SI 00603.030. Interim benefits begin with the month in which the 110th day falls; therefore, you do not have to establish the payment amount for all months, only for the beginning month of interim benefits forward.
* Attempt to complete processing within 10 working days of receiving the e-mail from OAO.
* Compute payments using the “transitional computation cycle” (TCC). See SI02005.005. The month in which the 110th day falls is the first month of the TCC. There is no “E02” month. There is no “proration” of benefits based on the 110th day; the person is due unprorated benefits for the month in which the 110th day falls.
* If the claimant is ineligible for SSI benefits for the first month for which interim benefits could be made (the month in which the 110th day falls), find the first month after the month the 110th day falls and which the person could be paid and proceed from there.
* Do not pay federally administered State supplementary payments.
* Include in countable income any title II interim benefits. See DI 42010.210C.3.h.; this section describes the procedures the PC follows to coordinate the generation of title II interim benefits with SSI interim benefits.
* The person may be eligible for income and resources exclusions related to disability/blindness, such as the exclusion for blind work expenses, and the exclusion of income or resources for a plan for self-support.
5
The FO follows these steps:
* Stop the interim benefit payment from going to the State as interim assistance reimbursement (IAR). Check the supplemental security record (SSR) for a pending IAR indicator (a grant reimbursement code (GRC) of R or F). For active MSSICS cases, delete the indicator via the CMSC screen. For non-MSSICS cases, delete the indicator via PR9 per SM 01005.623.
* Pay SSI interim benefits through the force due (M02) process per MSOM BUSSR 002.006.
* Enter a FORCE DUE BEGIN DATE on the Force Due Control (UFDC) screen equal to the first month in the computation history to ensure that an erroneous underpayment is not released. See MSOM BUSSR 002.004.
* On the Collect Force Due Amounts (UFDU) screen, enter zero Federal and State due amounts for months prior to the first month of interim benefits. Enter the Federal SSI due amount and a zero State due amount for the first month of interim benefits. The system will continue to pay monthly benefits until the record is terminated or the due amount is reduced to zero. See MSOM BUSSR 002.005.
* On the REMARKS section of the SSR, add the following language: M02 REQ’D INTERIM BENEFIT PAYMENTS EFFECTIVE XX/XX/XXXX (date payments will start) UNTIL FINAL ALJ DECISION MADE//UNIT CODE-FO CODE-XX/XX/XXXX (date the remark is added).
6
The FO sends a notice. If interim benefits are payable, see SI 02007.015B. for notice language. If interim benefits are not payable, see SI 02007.015C. for notice language.
D. Procedure - Stopping Interim Benefits
Step
Action
1
When a final disability/blindness decision is made, OAO will notify the PC and/or the servicing FO indicating the final decision using the information sheet entitled “Potential Interim Benefit Case.”
* If there were potential title II interim benefits, OAO will fax the information sheet to the PC.
* If there were potential SSI interim benefits, OAO sends an e-mail with the information sheet to the servicing FO;
* If there were potential title II and SSI interim benefits (concurrent cases), OAO will fax the information sheet to the PC and e-mail the information sheet to the FO.
2
If the final decision is favorable, the FO pays the person all additional benefits he/she is due from the month of application forward.
* If IAR applies, send the first check for the past-due benefits to the State or local subdivision by adding the GR field information to the SSR before changing the force due amounts. For MSSICS cases, add the GR field information via the CMSC screen. For non-MSSICS cases, add the GR field and SOST field information via PR9; see SM 01005.623.
* Issue underpayments to the person:
* Use “M02” to issue underpayments by changing any due amount for months in the retroactive period. Follow the rules for issuance of underpayments by installment; see SI 02101.020. Once all underpayments are issued on the “M02” record, terminate this record and establish a new start date record. See MSOM MSSICS 007.001.; OR
* Terminate the “M02” record, and establish a new start date record. See MSOM MSSICS 007.001. Then issue the underpayments by one-time payments (OTPs). Post the OTPs to the terminated record, not the new record. The instructions for posting an OTP to a terminated record are in SM 01901.130.
(This might be your choice if the underpayments must be paid in installments, and you do not want to keep the “M02” record active for a long period.)
* Send an SSA-L8025-U2, SSI Notice of Award; see NL 00802.010 and NL 00802.015. Explain the recovery of interim benefits from the retroactive benefits that are due; see NL 00804.115 (choose paragraph 1480 or 1484.)
If the final decision on the interim benefit case is an unfavorable decision, the FO:
* Stops the interim benefits. Stop payment effective with the earliest payment that can be stopped.
* Sends no notice, because the ODAR (AC or ALJ) notice explains why the claimant is not eligible for SSI and the appeal rights.
* Sends no notice, because the OHO (AC or ALJ) notice explains why the claimant is not eligible for SSI and the appeal rights.

POMS Reference

SI 02007.001: Interim Benefits in Cases of Delayed Final Decisions - SSI