When OGC transfers the court remand to the SAU, the Subsidy Determination Reviewer
(SDR) will review the case based on instructions by the court and OGC. The SDR will
undertake further development which may include a new hearing or case review and changes
to eligibility criteria in Medicare Application Processing System (MAPS). Any notices
that are issued will come from Document Generation System (DGS) and the determination
process, as appropriate. A hearing is required unless waived by the claimant, see
HI 03040.001C.2., or unless the SDR can make a fully favorable decision, i.e., full subsidy, without
a hearing.
Starting January 1,2024, the Inflation Reduction Act (IRA) provides full subsidy to
all Extra Help beneficiaries. A partial subsidy determination can only be made on
an Extra Help case that has a coverage start date before January 1, 2024.
The court will either retain jurisdiction or return jurisdiction to SSA.
If the court retains jurisdiction, the DGS notice will explain in the appeal paragraph
that the individual has 10 days to let us know if they disagree with the decision
before we will file a certified copy of the administrative record with the court.
Where the court does not retain jurisdiction, the DGS notice will explain that the
court order returning the case back to the Commissioner ends the court’s review. If
the individual disagrees with the notice of decision issued by the SAU upon remand,
the individual must file a new civil action.
There is a timeframe for continuing the appeal process. Individuals may file an action
in Federal district court within 60 days after the date the individual receives notice
of the decision. If the individual requests an extension of time, the SDR will determine
whether the individual has good cause, document the reason(s), and send appropriate
DGS notice. For more information about reviewing and processing good cause requests,
see HI 03040.001 and GN 03101.020.