BASIC (01-01)

A. Introduction

SSA may redetermine eligibility and payment amount by means of a redetermination when:

• A beneficiary (or someone on his or her behalf) reports an event or a change; or

• SSA discovers a change on its own through regularly scheduled redeterminations or information provided by interfaces, matches, other alerts, etc.

B. Policy -- Redeterminations Involving Change in Eligibility or Payment

A redetermination involving eligibility or payment changes can be:

1. An Initial Determination

A redetermination that results in a determination which prospectively changes either a factor of eligibility or payment amount is an “initial determination.” Such redeterminations can later be reopened or revised according to the time limits for reopening specified in VB 02507.010B.1. The time period for reopening is measured from the date of the notice of the initial determination subsequent to the redetermination action.

2. A Revised Determination

If the change made by a redetermination has retroactive effect, it is a revised determination. Revised determinations can be reopened and revised.

NOTE: The 1- or 2-year period for reopening a revised determination is measured from the date of the notice of the initial determination that it revises, not from the date of the notice of the revised determination.

EXAMPLE: Notice of an initial determination of an SVB beneficiary's entitlement and payment amount is dated 2/1/01. The payment amount is subsequently revised, with notice of the revised determination dated 8/1/01. The revised determination itself may be revised for any reason through 2/1/02 (or for good cause through 2/1/03) since the period for reopening under administrative finality is measured from the date of the notice of the initial determination.

3. Determinations that Are Both Initial and Revised

A determination resulting from a redetermination can constitute both an “initial” and a “revised” determination at the same time. Such a determination is “initial” to the extent that it affects future eligibility or payment and “revised” to the extent that it affects retroactive eligibility or payment.

If a redetermination constitutes an initial determination, it can be reopened from the date of the notice of that determination through the time limits specified in VB 02507.010B.1. If the redetermination constitutes a revised determination, it can be reopened from the date of the notice of the initial determination being revised through the time specified in VB 02507.010B.1.

C. Policy — Redeterminations Involving No Change

Redeterminations which result in no change in eligibility or payment amount are not initial determinations for purposes of administrative finality. Therefore, they are not subject to reopening and revision.