SSR 78-25: Supplemental Security Income Suspensions and Terminations—Exceptions to Continuation of Payment Procedure
To provide an explanation of due process considerations relating to reduction, suspension, and termination of SSI payments.
Sections 416.1336 and 416.1337 of Subpart M, Regulations No. 16; Civil Action No. 74-930 Catherine Cardinale v. David Mathews, U.S. District Court for the District of Columbia.
On August 26, 1975, the U.S. District Court for the District of Columbia issued an order in the case of Cardinale v. Mathews which, in effect, defined the SSI beneficiary's right to procedural due process under the Fifth Amendment to the U.S. Constitution in the area of reduction, suspension, and termination of SSI payments. The court order validated all exceptions to advance notice and continuation of payment procedures except where the Social Security Administration has factual information confirming the death of the beneficiary. Two exceptions to procedures involving continuation of payment at the previously established level are allowable under the order, however. These are applicable when: (1) the SSA has established that the payment amount exceeds the level of payment possible under the law, and (2) the SSA has determined that an SSI beneficiary is receiving multiple payments.
POLICY DIRECTIVE STATEMENT:
Under the revised regulations, SSA will provide advance notice and continuation of payment until the initial appellate decision in all cases before reduction, suspension, or termination of SSI payments in all circumstances except those involving the death of the beneficiary. Continuation of payment is available to beneficiaries who appeal within 10 days of notice. In addition, there will be two exceptions to continuation of SSI payments at the established rate pending the initial appellate decision on the merits. Both continuation of payment exceptions cover situations in which there is no doubt that the continued payment would be incorrect.
1. Dollar Limitations
(a) Under the first exception, monthly payment limitations for three categories of recipients are set. Continuation of payment in excess of such limitations pending the initial appellate decision is not required.
(i) Recipients Eligible for Federal SSI Benefits Only
A payment ceiling of $200 per month is placed on this category. This figure insures that payments exceeding the statutory maximum for Federal SSI payments by any substantial amount will not have to be continued at an obviously incorrect level in the event of an appeal.
(ii) Recipients Eligible for Federal SSI Benefit and Optional State Supplementation or Optional State Supplementation Only
A payment ceiling of $700 per month is placed on this category since the highest possible benefit involving optional supplementation is less than this amount.
(iii) Recipients Eligible for Federal SSI Benefits and Mandatory or Other Supplementation or Mandatory Supplementation Only
A payment ceiling of $2,000 per month is set since this amount covers a correct payment situation which could occur involving the types of payments listed above.
(b) The dollar limitations apply in the following manner. If a payment is generated which exceeds the particular dollar limitations, initially a 10-day notice of planned action will be generated and payment for the next month will be correctly computed as reflected in the notice. If the individual appeals within the 10-day period and the appeal cannot be disposed of prior to the first of the next month, then the following rules will apply in determining the amount of the continuing payment:
(i) Generally, a payment will be issued for the actual amount paid in the month immediately preceding the month in which the incorrect payment was first made;
(ii) If an intervening action or event would have increased the benefit amount for the month in which the incorrect payment was made, the recipient will be paid the intervening higher payment rather than the amount paid for the prior month;
(iii) If, in the month prior to the month in which the limitation is first exceeded the individual was in suspense status, SSA will pay the amount which actually was due the recipient for the amount in which the payment limitation was exceeded. For example, if a person in suspense in 4/76 is due to receive a Federal SSI payment only of $157.70 in 5/76 but is incorrectly paid $1,577, the payment continuation upon appeal would be limited to $157.70;
(iv) If the individual should have remained in suspense status, but was incorrectly paid a benefit which exceeded the dollar limitation, payment will not be continued to him or her during an appeal and the 10-day appeal information will not be given in the notice.
2. Multiple Payments
Under the second exception, if SSA determines that the recipient has received two or more regular monthly payments in one month, a determination as to the correct amount of benefits for the next month will be made; at the same time, a notice will be sent to the recipient. This advance notice explains:
(a) That multiple payments have been made;
(b) The correct amount of benefits payable to the recipient;
(c) The recipient's appeal rights.
If the recipient appeals within 10 days of receipt of notice of the action, the highest of the multiple check amounts (or the correct amount, if higher) will be paid until the initial appellate decision is made.
In order for SSA to determine that multiple checks are being sent to the same individual, all of the following factors must be present:
(a) Two or more checks are being sent to individuals with the same name or a similar name (i.e., a common, logical spelling variation of the name);
(b) The checks contain the same social security number, or one contains a pseudo number;
(c) The checks go to the same address;
(d) The recipients are of the same sex;
(e) The recipients have the same date of birth.
If all these factors are present, the multiple payment exception may be used. If any one of the factors is not present, the usual due process procedures regarding continuation of payment must be followed.
Multiple payment situations are also subject to the dollar limitation provision. Where one or more of the checks, separately, exceed one of the dollar limitations, the rules for determining the continuing payment under the dollar limitation provision will apply in the following manner:
(a) If one or more, but not all, of the multiple payments exceed the applicable dollar limitation, payments will be continued at the rate of the highest of the multiple payments that falls within the dollar limitation, or the amount determined to be correct, if higher;
(b) If all of the multiple payments exceed the applicable dollar limitations:
(i) Payment will be continued at the rate of the highest of the payments that did not exceed the applicable dollar limitation, or at the amount determined to be correct, if higher, in the latest prior month in which all multiple payments did not exceed the dollar limitation;
(ii) If all the multiple payments exceeded the applicable dollar limitation, both currently and for all prior months, the amount determined to be correct will be paid.
Claims Manual Section 13300ff.