PM 03-09-05-a.

If a client responds to Form 2509AC or Form 157C by stating that an appeal is pending at the reconsideration or ALJ level, review SDX information. SDX provides the appeal date, appeal code, appeal decision code and appeal decision date. If SDX does not confirm the client's statement, request proof from the client. A written statement from SSA verifying the pending appeal must be dated within the previous 90 days. Upon receipt of proof that an appeal is pending, restore the P3 assistance.

Resumptions

If the case is in suspension, resume with TA 13/TAR 74. Resume assistance retroactive to the date of suspension.

With the FCRC entry of TA 13, Item 80 code 373 RESUM is centrally entered. The AMOUNT field of code 373 will contain the month and year of the resumption. Code 373 identifies the case as a P3 client with an SSI appeal pending. Matching federal funds for medical assistance are not available when the case is coded with code 373.

Once entered, code 373 will remain on Form 552 throughout any subsequent suspensions/resumptions. Code 373 cannot be deleted by the Family Community Resource Center. When the case is canceled or changed to category 03 or 93 assistance, code 373 is centrally deleted.

Restoring Assistance

P3 assistance was centrally canceled if SDX shows that the client did not file an appeal within 65 days of the SSI denial date. If the client provides proof that an appeal is pending at the reconsideration or ALJ level, the case was canceled in error. Restore assistance effective the date of cancellation.

Use TA 12 to restore. Enter code 373 RESUM in Item 80. Enter the 4-digit date representing the month and year the case was restored in the AMOUNT field of code 373. Matching federal funds for the medical assistance are not available when the case is coded with code 373.

Discrepancy Referral (Form 1925)

When the client provides proof that an appeal is pending at the reconsideration or ALJ level and the appeal status is not reflected in the SDX Appeal Code field within 4 weeks of the date the appeal was filed, complete Discrepancy Referral (Form 1925).

Forward Form 1925 and a copy of the proof provided by SSA to the SSA Programs Control Unit of the Bureau of Operations Support. The SDX Appeal Code field is centrally updated to reflect the client's actual appeal status.