B-8430 Special Reviews

Revision 10-1; Effective March 1, 2010

A special review occurs between the annual review cycles to evaluate one or more eligibility elements without completing the annual review. The annual review (redetermination) packet is not required for a special review.

The need for a special review is based on policy, a reported change or the eligibility specialist's judgment.

Examples of when special reviews are needed for follow-up:

On the person's action for applying for potential benefits. An initial 30-calendar day special review is required to evaluate if the person made application after the person has been notified to do so. This may occur before the application is completed. Another special review will be needed to follow up to see if the recipient continues to be eligible.

When variable income and/or incurred medical expenses are averaged and projected. Special reviews are required at least every six months unless documentation substantiates an exception.

Within a 90-day time frame when the total countable income is within $10 of the income limit.

Within a 90-day time frame when the total countable resources are within $100 of the resource limit.

When any change is anticipated to occur.

For special reviews, document clearly the detailed reason(s) for the special review. Documentation must include:

specific information regarding the reason a special review is set;

the name of the individual who is affected; and

the eligibility area(s) subject to the review.

Include this information on correspondence sent to the person to request information concerning the special review. No redetermination packet is required.

For example, if someone has a private pension and the pension amount is anticipated to increase in the future, set a special review for the anticipated change. The eligibility area will be income. Documentation must specify pension information that will need to be verified at the special review. Include the:

date on which the anticipated change is to occur;

type of pension;

source of pension; and

frequency of payment of pension that will need to be verified at the special review.

Form H1020 , Request for Information or Action , and Form H1020-A , Sources of Proof , are used to request information from the person or authorized representative. Include the due date on Form H1020 or H1020-A. If the recipient calls with questions, follow Appendix XVI , Documentation and Verification Guide , for acceptable verification sources.

Example:

George Black called this morning saying he received a letter requesting verification that he had applied for Veterans Affairs (VA) benefits. He stated that he had applied and was told that it would take at least six months to hear anything.

Document what Mr. Black said. Recipient declaration is acceptable verification that he has applied for additional benefits. Be sure to tell Mr. Black to call and report if he hears anything about his eligibility from the VA.