BASIC (10-06)

The following are excluded from the SBC provisions.

• Initial determination of a closed period of disability (except adverse reopenings/revisions from an allowance to a closed period of disability).

• Substantial gainful activity (SGA) cessations.

• Whereabouts unknown cessations under Title II. (Title XVI whereabouts unknown is a basis to suspend, but not to terminate Supplemental Security. Income (SSI) payments until the beneficiary is located.) See DI 13015.001 for procedure on processing these cases.

• Failure to follow prescribed treatment cessations.

• Termination of benefits based on failure to cooperate with the field office request for necessary information or evidence needed to complete the continuing disability review. See DI 13015.001C.

• Title II disability determinations made on the basis that a prior favorable determination was obtained by fraud or similar fault.

• Auxiliary filing a claim on the record of a primary beneficiary whose disability has already been ceased (whether SBC is involved with the primary beneficiary’s record or not).

• Medicare Qualified Government Employee (MQGE).

• Termination of continued payments under Section 301. See DI 14505.010G.

NOTE: The cessation and adverse reopening determinations/decisions in Title II cases excluded from SBC require a due process predetermination notice without benefit continuation language. See DI 28080.005.

Goldberg/Kelly procedures apply to Title XVI cessation/adverse reopening cases that are exclusions from SBC. See SI 02301.300.