Background

This transmittal amends section I-2-1-40 of the Hearings, Appeals, and Litigation Law (HALLEX) manual to add a separate “Homeless” case category to the critical case designations that the Office of Hearings Operations uses to determine which cases require special processing. Under the new Homeless category, we adopted the definition of a homeless individual used in POMS DI 11005.004, which is based on the Federal definition of a homeless individual. See 42 U.S.C. § 11302. Previously, for critical case purposes, homelessness was covered under the Dire Need category in HALLEX I-2-1-40 A, which remains in the revised subsection A as a separate case designation.

This transmittal also amends section I-2-1-94 and archives section I-2-1-95.

Explanation of Content and Changes

This transmittal revises HALLEX I-2-1-40 as follows:

I-2-1-40 – We retitled this section to “Critical Case Procedures.”

I-2-1-40 A. – We updated the title of this section to “Situations that Require Expedited Processing.”

I-2-1-40 A.1 – We added an instruction to staff to complete form SSA-2200 when adding a “TERI Case” flag at the hearings level and to add the completed SSA-2200 to the file in eView.

I-2-1-40 A.2 – We removed a note that stated that expedited processing of continuing disability review claims was not required for cases identified as having a Veterans 100 Percent Permanent and Total (VPAT).

I-2-1-40 A.5 – We added a separate critical case designation for individuals who are experiencing homelessness that adopts the definition of homeless used in POMS DI 11005.004. The definition used in POMS is based on the Federal definition of a homeless individual, as defined in 42 U.S.C. § 11302. For situations where a claimant calls the hearing office to report that they are experiencing homelessness, we included an instruction to HO staff to verify that the contact information we have for the claimant is correct and to update the claimant's information in our systems if needed. We also added an instruction to review cases identified in eView with an “Eviction” flag to determine if the case fits the Homeless category.

1-2-1-40 A.6 – We moved the Dire Need critical case category definition formerly in subsection A.5 to subsection A.6. We removed references to homelessness from the Dire Need category because homelessness is now covered under the newly created Homeless case designation. We revised one of the examples of a Dire Need case and specified that if there is an allegation that the claimant lacks basic utilities at their home (heat, potable water, or electricity) and the claimant does not have the resources to have the service(s) turned on, we should designate the case as a critical Dire Need case. We added language stating that a dire need situation may also exists bases on allegations the non-receipt or interruption of benefit payments has caused the claimant a financial hardship for consistency with POMS DI 23020.030. We added language noting that staff may designate a case dire need, based not only on allegations, but also on the evidence in the record. We also added an instruction to review cases identified in eView with an “Eviction” flag to determine if the case fits in the Dire Need category.

1-2-1-40 A.7 – We moved the definition of a Potentially Violent critical case designation formerly in subsection A.6 to subsection A.7.

I-2-1-40 C.1 – We removed an instruction that directed staff to use the Critical Request Evaluation Sheet to document critical case requests and replaced it with directions to use a Report of Contact to document critical case requests. We also instructed staff to use “Referrals” in the Hearings and Appeals Case Processing System (HACPS) and “To Do” items in the Case Processing and Management System (CPMS) to route critical case requests to the appropriate staff person for review.

I-2-1-40 C.2 – We added the case characteristic for an individual who is experiencing homelessness (HMLS) to the list of case characteristics to be added to critical cases in CPMS and noted that the “Homeless” critical case flag in HACPS should be used for Homeless critical cases.

We included a direction to add a summary of why a case was made critical in HACPS case notes or CPMS remarks.

We clarified that multiple critical case characteristics and case flags may be added to a case in the Office of Hearings Operations' case processing systems (HACPS and CPMS) and that staff should add all critical characteristics and flags that apply to a case.

We removed instructions related to reviewing cases for case flags that do not have a corresponding characteristic or flag at the hearings level.

Additionally, we updated HALLEX I-2-1-40 C.2 to clarify that there is a special flag to be used on paper 100% P&T cases.

I-2-1-40 C.3 – We removed instructions related to paper case processing and noted that staff will check the representative's availability and expert availability, if applicable, when scheduling critical cases.

I-2-1-40 C.4 – We removed instructions related to paper case processing.

I-2-1-40 C.5 – We updated the address information for the Office of Disability Operations.

We also made minor editorial changes throughout this HALLEX section.

I-2-1-94 – We renamed the sheet “Critical Case” and included a space on the sheet to designate the case as Compassionate Allowance, Homeless, Dire Need, or Homicidal/Potentially Violent.

I-2-1-95 – We archived this section because we discontinued the use of the Critical Case Evaluation Sheet.

Date: August 6, 2024