TN 2 (04-08)

HI 01140.003 Appeals Dispositions for the Income-Related Monthly Adjustment Amount ( IRMAA)

A. Policy

The disposition codes related to the IRMAA appeals are not the same for all levels of the appeal. Dispositions of “abandon” and “remand” are not appropriate for reconsiderations. All dispositions for reconsiderations, other than dismissals, are determined by the information presented on the IRMAA PCOM system for the premium year being appealed. The disposition determination is effectuated on the IRMAA PCOM screens and must be recorded on the IRMAA Appeals Tracking System. The notice that is generated for a reconsideration is based on the disposition determination in the IRMAA PCOM screens. See MSOM T2PE 008.003.

B. List of Dispositions

1. Fully Favorable Reversal

A fully favorable reversal would result from an appeal that reverses SSA’s original determination resulting in the complete removal of the IRMAA for the premium year being appealed.

2. Partially Favorable Reversal

A partially favorable reversal would result from an appeal that partially reverses SSA’s original determination resulting in a reduction of the IRMAA being charged but does not completely remove the IRMAA for the premium year being appealed.

3. Dismissal

SSA will dismiss a reconsideration in only two situations:

  • A reconsideration is filed outside of the appropriate time frame and no good cause is found, or

  • The beneficiary insists on filing a reconsideration based on IRS information being incorrect or amended and has no proof of the error or amendment.

A dismissal of a request for reconsideration does not have appeal rights. Inputs to the IRMAA PCOM screens will generate a dismissal notice for these situations.

If the OMHA or MAC dismisses an appeal, the OMHA or MAC will notify the beneficiary and send information about its action to the SEPSC.

4. Affirmation

An affirmation decision upholds SSA’s decision that is being appealed. An affirmation is appropriate when new information is received but does not change the IRMAA, an appeal is filed based on a non-qualifying event or the individual wants to protest the constitutionality of imposing IRMAA. Inputs to the IRMAA PCOM screens will generate affirmation notices for these situations.

If OMHA or MAC affirms a decision, OMHA or MAC will issue the affirmation notice to the beneficiary and send information about its action to the SEPSC.

All affirmations notices include appeal rights and inform the beneficiary of how to appeal the decision.

5. Withdrawal

A beneficiary or his representative has the option to withdraw an appeal. If a beneficiary decides not to pursue a reconsideration and requests that we withdraw the reconsideration, the appropriate disposition would be a withdrawal.

Requests for withdrawal of a hearing or MAC review received by a field office should be forwarded to SEPSC who will send them to the servicing OMHA or MAC office. The servicing OMHA or MAC office will issue a notice to the beneficiary about the withdrawal.

6. Abandon

When a beneficiary or his representative fails to pursue a request for appeal, the appropriate disposition selection would be “abandon”. A reconsideration decision cannot be abandoned. Once a reconsideration request is received it should be processed to completion and a decision should be posted.

7. Remand

An OMHA ALJ, Medicare Appeals Council and a Federal Court Judge are the only authorities who can remand a case. A remand back to SSA will allow SSA to revise the decision. A remand decision is only appropriate for cases that are received back from HHS or Federal Court by SSA. The SEPSC will process all remands. All remands will result in an affirmation, fully favorable reversal or partially favorable determination.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601140003
HI 01140.003 - Appeals Dispositions for the Income-Related Monthly Adjustment Amount ( IRMAA) - 11/10/2016