Current through Register 1531, September 27, 2024
(A)
Requirements.
(1) For
a parent to be considered disabled for TAFDC purposes, his or her medical
impairment must meet or equal the Social Security Disability standards in
accordance with 20 CFR Part 416 , Subpart I (the Social Security Disability
standard), or meet or equal the Social Security Disability standard except that
the medical impairment must only have lasted or is expected to last for a
continuous period between 90 days and 12 months.
(2) The applicant or client must apply for
Social Security Disability benefits in accordance with
106
CMR 702.710: SSI and SSP
Benefits: SSI Benefits and appeal any denials at the Social Security
Administration, if requested to by the Department.
(B)
Disability Determination
Process. The determination of whether a parent meets the
definition of disability as defined above shall be made by the agency or
organization under contract/agreement with the Department to provide disability
evaluation services (hereafter referred to as the Department's
agent).
(C)
Cooperation
in the Disability Determination Process.
(1) An applicant or client is responsible for
establishing that he or she is disabled.The Department shall assist the
applicant or client in obtaining the necessary information and may require the
applicant or client to attend an exam by the Department's agent.
(a) The applicant or client must provide the
Department with:
1. a description of his or
her impairments and a list of his or her medical providers; and
2. information regarding the vocational
factors used in determining the Social Security Disability standard.
(b) If an applicant or client,
without good cause, does not appear for a scheduled medical examination, does
not provide required medical releases, or otherwise does not cooperate in the
disability determination process, the Department's agent shall make a
determination of disability based only on the information received from the
applicant or client and other available sources.
Religious or personal reasons opposing medical examinations or
tests do not constitute good cause.
(2) The Department and, if applicable, its
agents, shall take reasonable steps to assist applicants and clients in
obtaining information necessary to make a determination.
(a) The worker and/or agent of the Department
is responsible for assisting the applicant or client in completing the
Disability Supplement when, after inquiry by the worker, such assistance is
requested.
(b) The Department's
agent is responsible for:
1. gathering the
information needed to make a disability determination by contacting any
physician, psychologist, and/or hospital identified by the applicant or client,
to obtain information on any impairment that may potentially affect the
applicant's or client's ability to work provided such impairments have been
identified by the applicant or recipient or is otherwise evident in the record;
and
2. arranging for a competent
medical authority (see
106 CMR
701.600: Definition of
Terms) to examine the applicant or client for additional information
or tests, as necessary, to clarify incomplete or ambiguous information
submitted to the Department by a competent medical authority as defined in
106 CMR
701.600.
(D) When the Department's agent must make a
determination, it shall determine whether the applicant or client has an
impairment or combination of impairments that meets or is equivalent to the
disability standards found at 106 CMR 703.190.
(E) The Department's agent shall make a
determination that an applicant or client is not disabled only if:
(1) the agent has considered all clinical or
vocational evidence submitted by the applicant or client or obtained by the
Department. The Department shall consider a test and diagnosis done more than
30 days prior to the completion of the applicant's or client's Disability
Supplement if it is still relevant to the applicant's or client's current
impairments; and
(2) the clinical
information available establishes that one or more of the findings needed to
meet the applicable medical standard is not satisfied and additional clinical
information would not enable the applicant or client to meet the medical
standard.
(F) When an
applicant or client makes a first claim for a disability exemption
(see
106 CMR
703.100) within a continuous 60-month period,
disability is presumed. The applicant or client will be considered exempt until
the Department's agent makes its determination. If the agent finds that the
applicant or client is not disabled, the exemption will end.
(G) When an applicant, who has previously
been denied by the Department's agent, makes another claim of disability within
a continuous 60-month period; and
(1) the
applicant has used 24 months of time-limited benefits (
see
106 CMR
703.120) , eligibility must be established
using the verification described in
106 CMR
701.380(B)(7).
(a) If the applicant is requesting a
time-limited benefits extension (see
106 CMR
703.130) , the verification described in
106 CMR 701.380(B)(7)
may also be used to excuse the applicant
from meeting the work activities related to qualifying for a time-limited
benefits extension.
(b) If the
applicant is not requesting a time-limited benefits extension, the verification
described in
106 CMR 701.380(B)(7)
may be used to excuse the applicant from
meeting the work program requirement (see
106 CMR
703.150) , if applicable;
(2) the applicant has not used 24
months of time-limited benefits, the verification at
106 CMR 701.380(B)(7)
may be used to excuse the applicant from
meeting the work program requirement (
see
106 CMR
703.150) , if applicable.
If the verification described in
106 CMR 701.380(B)(7)
is provided, eligibility for TAFDC will be
presumed but the applicant will not be considered exempt under
106 CMR
703.100. The final disability determination
will be made by the Department's agent. The length of this good cause period
will be determined by the specified verification until the final disability
determination is made by the Department's agent.
(H) When a client, who has been previously
denied by the Department's agent, makes another claim of disability within a
continuous 60-month period (see
106 CMR
703.120); and
(1) the client has used 24 months of
time-limited benefits (see
106 CMR
703.130) , the verification described in
106 CMR 701.380(B)(7)
may be used to excuse the client from
meeting the work activities related to qualifying for a time-limited benefits
extension; or
(2) the client has
not used 24 months of time-limited benefits (
see
106 CMR
703.120) , the verification described in
106 CMR 701.380(B)(7)
may be used to excuse the client from
meeting the work program requirement, if applicable.
If the verification described in
106 CMR 701.380(B)(7)
is provided, eligibility for TAFDC will be
presumed but the applicant will not be considered exempt under
106 CMR
703.100. The final disability determination
will be made by the Department's agent. The length of this good cause period
will be determined by the specified verification until the final disability
determination is made by the Department's agent.
(I) The decision of the Department's agent as
to whether an applicant or client is disabled shall also be the decision of the
Department. A Department hearings referee may affirm, modify or reverse the
finding of the agency or organization providing disability evaluation
services.
