Multiple payment situations are also subject to the dollar limitation (b) If all of the multiple payments exceed the applicable dol- (i) Payment will be continued at the rate of the highest of the (ii) If all of the multiple payments exceeded the applicable CROSS-REFERENCES: Claims Manual Section 13300ff. (PPD-27) Disability SSR 78-31 TITLE XVI DISABILITY-APPLICATION OF THE AT APPELLATE LEVELS PURPOSE: To enunciate the policy regarding the applicability of the supplemental security income (SSI) presumptive disability (PD) and presumptive blindness (PB) provision in cases where a prior disability or blindness decision has been made and the applicant appeals the decision or files a subsequent application. CITATIONS (AUTHORITY): Social Security Act, as amended, Section 1631(a)(4) (B), Regulations No. 16, Subpart I, Sections 416.951, 416.952 and 416.953. PERTINENT HISTORY: Both the act and congressional reports contain language relating to the intended purpose of the PD provision. Section 1631(a) (4) (B) of the act states that benefits may be paid "to an individual applying for such benefits on the basis of disability or blindness for a period not exceeding 3 months prior to the determination of such individual's disability or blindness..." (Emphasis added). The congressional committee reports (Senate Report No. 92-1230, page 391; House Report No. 92-231, page 155) pertaining to the provision are substantively identical; the House Report states: "Under this provision, applicants for disability benefits could be paid up to 3 months benefits when a prima facie case for determining that a disability existed had been presented. In order to avoid any interruption of benefits to an eligible disabled person, your committee expects that the Secretary will make the initial determination of disability before the end of the 3month period." POLICY DIRECTIVE STATEMENT: The PD and PB provision may be implemented only when an individual is applying for SSI disability benefits; i.e., filing an initial or subsequent SSI application based on disability or blindness. The history and language of the statute-with the wording "prior to the determination"-clearly indicate that the provision is not to be extended to the situation where the individual is filing a request for an administrative appeal. The language of the committee reports discusses the benefits to be paid strictly in terms of bridging the period from filing to the initial determination of disability. Implementation of the provision is, therefore, precluded in any case at the appellate level, including cases where there is evidence that the applicant's condition is more severe, evidence of an additional impairment that was not previously considered, or cases where the denial was on the basis that the income and resources requirements were not met. Where an individual has previously applied for benefits and been denied, the provision may be implemented upon reapplication if the individual meets the criteria for PD payments and there has been a change in the disability or blindness factor incident to the prior denial which would justify the strong likelihood of an allowance of the subsequent claim. Under these circumstances, a PD or PB benefit is payable even though the individual previously received a PD or PB benefit, and may have a concurrent administrative appeal pending on the prior denial. The provision may also be implemented in cases where the prior denial was on a basis other than disability or blindness and there has been a change in the factor that resulted in the denial. For example, a severely impaired applicant may be denied initially on the grounds that his or her work activity constituted substantial gainful activity. At the time of the request for reconsideration, he or she is no longer working and files a subsequent application. In such a situation, a PD or PB decision can be made on the new application. This reapplication policy recognizes the language and basic thrust of the statute for providing benefits of PD or PB on application for SSI disability or blindness benefits where there is a strong likelihood of eli gibility. To permit implementation of the provision on subsequent application without acknowledgement and consideration of the reason or cause of a prior disallowance, would be contrary to the language and intent of the statute; i.e., that the provision should only be implemented where there is strong evidence of the likelihood of eligibility. Obviously, in an unchanged circumstance which had previously been determined not to meet the SSI disability or blindness requirements, the likelihood is that eligibility based on disability or blindness would not be found on subsequent application. (PPD-9) Appeals SSR 78-32 SUPPLEMENTAL SECURITY INCOME ACTIONS PURPOSE: To enunciate current policy providing that a change in the source of the State supplementary payment included in the Supplemental Security Income (SSI) monthly check is not an initial determination where such change results from the termination of an agreement for Federal administration of the State supplementary payments. In view of the issues arising from the court order in Cardinale v. Mathews, it is necessary to expressly recognize that this is not an adverse action requiring Goldberg v. Kelly due process which includes advance notice, continuation of payments and related initial appeal rights to all affected recipients. While such actions have not been interpreted as initial determinations in the past and are not directly affected by the Cardinale court order, we deem it advisable to clarify SSA's existing policy relating to the termination of an agreement for Federal administration of the State supplementary payments. CITATIONS (AUTHORITY): Sections 1102 and 1616 of the Social Security Act; Section 212 of Public Law 93-66; Regulations No. 16, Section 416.1403. PERTINENT HISTORY: The Secretary of Health, Education, and Welfare may enter into an agreement with a State under which the Secretary will, on behalf of such State, make supplementary payments to all individuals receiving benefits under title XVI and who are eligible for such supplementary payments. These agreements, which may apply to either mandatory or optional supplementary payments, are subject to termination by either party in accordance with the terms specified therein. As a result of such termination, the State will be responsible for making any supplementary payments on its own behalf for months after the month of termination of the agreement and the amount of the Federal SSI check will be adjusted accordingly. In the past when one of these agreements has been terminated, notice (without any appeal rights) has been sent to the recipient explaining that the individual will now be receiving two checks, one from the Social Security Administration for the Federal SSI benefit and a separate check from the State for the State supplementation payment. In those cases where the recipient was only eligible for the supplementation, this notice reflected that the check would now be sent by the State. POLICY DIRECTIVE STATEMENT: The termination of a Federal-State agreement for the Federal administration of the State supplementary payments is an administrative action having no adverse effect on the recipient, and therefore the reduction in the amount of the Federal SSI check does not constitute an initial determination requiring continuation of payments and appeal rights. This policy is currently in effect and will continue in the future. A notice shall be sent to each applicable recipient explaining how the regular monthly check will be affected because of the termination of the agreement. Where the terminated agreement regards the mandatory supplement, the notice will indicate that the State will not assume responsibility for these payments. Because the Social Security Administration cannot commit the State as to the course of action it will take upon assumption of administration of the optional supplement, the notice will reflect that the individual should look to the State for payment of any optional supplementary payment that may be due in the case of termination of an agreement for Federal administration of the optional supplementary payments. FURTHER INFORMATION: An agreement with the State of Illinois has been terminated and the Social Security Administration adhered to the basic policy guides as indicated above in informing the applicable recipients how their regular monthly checks would be affected because of the termination of the agreement. In case any payments would be subsequently reduced or stopped by the State, Goldberg v. Kelly appeal rights would flow from the subsequent action on the part of the State. The U.S. District Court for the District of Columbia issued an order on August 26, 1975, in the case of Cardinale v. Mathews enjoining the Social Security Administration from reducing, suspending, or terminating supplementary security income payments, in all situations except in the case of termination because of the death of the recipient, without following Goldberg v. Kelly procedures of advance written notice, continuation of payment at the previously established rate, and related appeal rights. Citing the U.S. Supreme Court decision in Goldberg v. Kelly, the district court found the Social Security Administration's other exceptions to this advance written notice rule to be unconstitutional deprivations of due process. The Social Security Administration has since negotiated an agreement with the plaintiff's attorney to use two other limited exceptions not here pertinent. The Cardinale court order raises issues regarding the circumstances under which Goldberg v. Kelly advance notice, related initial appeal rights, and continuation of payment must be provided where a determination has been made with respect to an individual's benefits. Therefore, it is necessary to clearly provide that the payment actions resulting from termination of an agreement for Federal administration of the State supplementary payments, as distinguishable from the type of actions addressed in the Cardinale court order, are not initial determinations. CROSS-REFERENCES: Claims Manual Sections 13331(b) and 13608. SECTIONS 1631(c) (42 U.S.C. 1383(c))- SUPPLEMENTAL SECURITY INCOME - HEARINGS AND APPEALS-EFFECT OF ABANDONMENT 20 CFR 416.1423, 416.1450, and 416.1453 SSR 76-43 The claimant filed his application with the State after June 1973 for Aid to the Disabled and was converted to the Federal program in January 1974. Subsequently he was notified he did not meet Federal standards to receive SSI payments based on disability. He requested a reconsideration of the determination; such reconsideration upheld the initial determination. The claimant then requested a hearing and his benefits were continued pending a decision on his claim. He failed to acknowledge receipt of Notice of hearing and did not respond to other attempts to contact him. Held, the claimant's request for hearing is dismissed as abandoned in accordance with Regulations No. 16, section 416.1450. Further held, the reconsideration determination is binding and becomes the final decision of the Secretary of Health, Education and Welfare. The claimant filed his application for Aid to the Disabled with the State after June of 1973. He was determined to be disabled and entitled to disability benefits from the State in October of 1973. On January 1, 1974, claimant was converted from the State to the Federal disability program. On September 1, 1974, the claimant was notified that since he had not received any disability check from the State for any month prior to July 1973 and since it had been determined that he did not meet the Federal standard of disability, then he was not entitled to receive any supplemental security income benefits. He requested a reconsideration of that determination on October 7, 1974. Claimant was advised on or about November 14, 1974, that his original denial had been affirmed and the Social Security Administration terminated his benefits at that time. On May 29, 1975, the claimant was notified that he had been receiving supplemental security income benefits for the months of December 1974 through the date of the notification because the Federal court in the case of Buckles v. Weinberger, 398 F. Supp. 931 (1975), held that the Social Security Administration had used improper procedures to terminate his benefits. Claimant was further instructed that if he still dis |