TN 9 (12-09)
GN 02613.870 Title II Martinez Settlement —Medicare, CDRs, Deceased Beneficiaries Incarceration and Questionable Mailing Addresses
A. Case Processing Issues
In addition to payments, you need to determine if several other issues may apply when processing a Martinez settlement case.
1. Medicare Part B
Martinez class members who lost their Medicare Part B (medical insurance) entitlement were given special enrollment rules under certain conditions. If you receive any inquiries for Medicare entitlement from Title II post-2006 Martinez class members, send the inquiry information via email to the ^Martinez.Settlment mailbox. In the subject line of your email message, state “Martinez Medicare Inquiry.” In the body of your email, explain in detail the circumstances regarding the beneficiary’s request for Medicare entitlement.
2. Missed continuing disability reviews (CDRs) during suspension
The Martinez settlement does not impact our statutory requirement to schedule CDRs at selected intervals. The instructions for the CDR review process are in DI 28001ff.
After we resume monthly benefits, the beneficiary or recipient is added to the pool of cases that can be selected for CDRs during the regular CDR review operation. For information on the CDR diary, see DI 26525.001.
3. Deceased beneficiaries or recipients
Any Martinez payment relief due to deceased SSI recipients (PSY T01) or to deceased RSDI beneficiaries (LAF T1) are paid in accordance with normal processing instructions in SI 02101.003 and GN 02301.030, respectively.
4. Underpayments released to correctional institution addresses
If a correctional institution returns a Martinez resumption check, follow current procedures on Returned Checks located in SM 01315.010 and How to Return a Check to the Department of the Treasury in SM 01315.015.
5. Questionable mailing addresses on the MBR for Martinez Class members
The automated resumption process may not release the retroactive payment because of the prior non-payment LAF status of the beneficiary (e.g., LAF S7, LAF S4, or T8, etc.). Title II Redesign (T2R) generates a Summary Process Alert for program service center (PSC) technician review.
Examine the alert carefully along with the MBR.
Review the beneficiary’s mailing address on the MBR to determine if the address where we will issue the check is questionable. Generally, the beneficiary’s mailing address is the address where he or she resides or his or her own post office (PO) box (or the residence address or PO box of his or her representative payee).
If the address appears questionable (e.g., similar to a correctional institution address you found on the Incarceration Control System (IRCS) database), verify the beneficiary’s mailing address before releasing the retroactive payment. The instruction for developing for a questionable mailing address is in GN 02605.005B.
Release to the beneficiary the underpayment that is in the Special Payment Amount (SPA) field on the Special Payment (SPC PAY) data line on the Master Beneficiary Record (MBR) after reviewing the address information and the other factors affecting continuing eligibility to Social Security benefits that could change this payment. The information about the Summary Process Alert is found in GN 02613.870B.1 of this section.
6. Blank or 9999 Offense Codes on a Fugitive Felon System Control File (FFSCF) warrant
Instructions for processing cases where the warrant information on the FFSCF database shows that an offense code is “blank” or is “9999” and the offense charge symbol shows either “felony” or “probation or parole violation” are found in the chart in GN 02613.875A.1.a. bullet 3.
B. T2R Summary Process Alerts and Processing Limitations
You can view the Summary Process Alerts and Processing Limitations on the Transaction History (THIS) or Display Results In Paperless Project (DRIP).
1. Summary Processing alert for underpayment in the Special Payment Amount (SPA) Field on the Master Beneficiary Record (MBR)
Summary posts the results of netting based on final LAF status. Underpayments are paid as prior month accrual (PMA) payments for all situations except those resulting in LAF-S, U, T1, or X1. If the final LAF is S or T and a SPC PAY underpayment remains, or if the final LAF is T1 and a SPC PAY underpayment of $50 or more remains, Summary generates the A80027 alert for manual review to determine if we should pay the underpayment as a PMA, or if development is necessary. This alert occurs only once, when the T2R system first establishes the underpayment in the SPA field on the Special Payment (SPC PAY) data line on the MBR. You must review the alert to make sure the underpayment amount is accurate and is going to the appropriate address before paying the underpayment. An instruction for reviewing the A80027 alert is in SM 03045.050C.2.b.
2. Summary Processing Limitation for NAD over $49,999.00
PMA amounts that exceed $49,999.00 create a Summary processing limitation code A82600. The Summary processing limitation goes to the PSC technician for review and release of the underpayment via MADCAP. The instruction for processing the Summary processing limitation code of A82600 is in SM 03045.050C.2.
3. Summary Processing Limitation for attorney-fee withholding
Once Summary performs paid versus payable on a monthly basis to determine the retroactive benefits, it generates a processing limitation code A80200 if there is a pre-existing Fee Established for Appointed Representation (FEAR) data field on the MBR. You must manually adjust the attorney fee withholding. The instructions for processing the Summary processing limitation code A80200 are in SM 03045.050.
Increases or decreases in the amount of retroactive benefits after SSA authorizes the representative's fee do not normally affect the amount of the representative's fee under the approved agreement. The instructions for determining if you can use past-due benefits to adjust a prior representative’s fee is in GN 03940.036B.
C. Federal Court Previously Decided Fugitive Felon Status Issue
If you receive information that an individual’s record shows a final federal court disposition about payments due to fugitive felon status, take no action on that case under the Martinez settlement. Refer these cases to The Office of General Counsel (OGC). If OGC confirms a final federal court disposition, remove the special message on the MBR. For the special message, see GN 02613.860C.1.a.