The Appeal Application screens in MAPS or the SSA-1021 (Appeal of Determination for
Help with Medicare Prescription Drug Plan Costs) are used to obtain the following
information:
-
•
Applicant's Name and Social Security Number
-
•
Medicare Number (if different from Social Security Number)
-
•
Spouse's Name (if spouse lives at same address as applicant) and Social Security Number
-
•
Spouse's Medicare Number (if different from Social Security Number)
-
•
The reason for the disagreement
-
•
Whether or not the individual will be submitting additional information
-
•
Whether the individual prefers a case review or a telephone hearing
-
•
Whether individual wants a telephone hearing sooner if scheduling permits (at least
20 days is provided between date of request and date hearing is scheduled). Make it clear that the SAU will schedule the appointment and send the appointment
notice.
-
•
Whether an interpreter is needed and whether individual is hearing impaired
-
•
Whether or not a conference call is needed if the hearing is to be via telephone (i.e.
whether the individual will be represented, or will include another party in the hearing).
-
•
Claimant’s statement explaining good cause for late filing of appeal.
NOTE: When multiple applications are in MAPS, due to a systems limitation, an appeal can
only be established on the most recent application. Establish the appeal on the current
application, include a Report of Contact stating the appeal is established on the
current application due to a systems limitation, show the date of the application being appealed and also state that this is the date that should be used for the appeal determination.
a. Applicant Requests an Appeal via 800# or in FO
The SSA employee will:
-
•
Conduct a brief interview with the individual, or the person acting on his/her behalf.
Make it clear to the individual that the SDR will schedule the appointment (if hearing
by telephone is requested) and send the individual an appointment notice.
-
•
Determine whether the individual is requesting an appeal, requesting an explanation
of a determination, reporting a subsidy changing event (marriage, divorce, death of
spouse, separation, annulment, separated spouses living together again, or spouse
newly enrolls for subsidy) or reporting another event that may change the subsidy
determination. There is more information on subsidy changing events and other reporting
events in HI 03050.025. Also, in HI 03050.025C., there is a chart for handling calls within and outside the appeal period.
-
•
If a request for appeal is mailed to the FO, review the appeal information to make
sure it is complete and readable. Contact the individual to obtain clarification on
any items before entering information on the Appeal screens in MAPS. Make two attempts
to phone the individual before submitting the appeal to the SAU. Document attempts
on the RPOC screen in MAPS (date, time, and phone number).
-
•
Establish the appeal by completing the Appeal Application screens in MAPS. See MSOM
INTRANETMAPS 007.001.
-
•
Document the MAPS Report of Contact screen with additional information. Accept any
reasonable allegation, e.g., lower income due to loss of job. Destroy paper copies
of additional documentation and return original documents to the individual.
-
•
Document the reason for late filing on the Good Cause for Late Filing screen in MAPS.
Accept any reason the individual gives.
-
•
If a recent change of address or phone number is indicated, enter the new address/phone
number on the appeal screens in MAPS. This entry will not update the MBR/POS records,
so you must also enter the new information in POS (see MSOM T2PE 003.001).
-
•
For applicants with foreign addresses, record on the MAPS APIS screen the following
information: the applicant’s mailing address and telephone number, and the field office
code of the office establishing the appeal. This information should be entered in
the section titled “Please explain why you disagree with our decision.”
-
•
Do not ask the caller for two preferences for the date and timeframe (morning or afternoon)
for the hearing appointment and do not enter any preferences to MAPS. Make it clear to the caller that the SAU will schedule the appointment and send an
appointment notice.
-
•
Submit to Subsidy Appeal Unit (SAU).
-
•
For telephone hearing, the SDR schedules the appointment (not the 800 # agent or the
FO) and sends the appointment notice. For case review, the SDR sends the acknowledgment
notice.
b. Applicant Requests an Appeal via Mail to WBDOC
The SSA employee will:
-
•
Establish the appeal in MAPS.
-
•
Attempt two phone contacts with the individual to obtain clarification on any items
that are incomplete or unreadable or to determine the reason for late filing, if applicable.
-
•
Document the RPOC screen or the Good Cause for Late Filing screen in MAPS. Accept
any explanation the individual gives.
-
•
Fax any additional or supporting information that accompanied the appeal request to
the SAU. At the end of each day, batch additional/supporting information and send
to the SAU. Determine SAU by following instructions in TC 24030.030L. Include the
SSN on all supporting information. Document on RPOC, additional information faxed
to (fill-in jurisdictional SAU).
-
•
If a recent change of address is indicated, enter the new address on the appeal screens
in MAPS. This entry will not update the MBR, so you must also enter the new address
in POS (see MSOM T2PE 003.001).
-
•
For applicants with foreign addresses, record on the MAPS APIS screen the following
information: the applicant’s mailing address and telephone number. This information
should be entered in the section titled “Please explain why you disagree with our
decision.”
-
•
Submit to Subsidy Appeal Unit. Once the appeal request has been established, the paper
form may be discarded. Ensure all information has been input in MAPS before destroying
the appeal form.
-
•
For telephone hearing, the SDR schedules the appointment and sends the appointment
notice. For case review, the SDR sends the acknowledgment notice.