The Subsidy Determination Reviewer (SDR) will review the information considered in making the initial determination including the information in records available to SSA and any additional information provided and make the decision based on this information. The decision will be recorded on CPMS (Case Processing and Management System) using identifying information (last name, first initial, last 4 digits of SSN) for easy access in event of court review, and updated to the Medicare database. If the individual objects to the telephone hearing being recorded, document in Remarks in CPMS, conduct a case review and issue a decision without the telephone hearing.

If it appears that the SDR can make a fully favorable decision based on available information and the individual agrees, a telephone hearing need not be held. The SDR will document his or her actions and issue the fully favorable decision.

The SDR will input the Determination Effective Date in MAPS which will determine the appeal decision effective date that is passed to the subsidy determination process in all cases other than dismissals.

The SDR decision is binding unless the individual requests judicial review by filing an action in Federal district court.

NOTE: Where the SDR is deciding a new issue, the notice of decision issued by the SDR will include appeal rights.

All decision notices will include a list of exhibits, i.e., a minimum of MAPS systems data, a copy of the initial determination notice and other notices as appropriate, and information submitted as displayed on the Development Worksheet in MAPS.

The SDR is responsible for issuing notices in the Document Generation System (DGS). A written notice of the decision will be mailed to the individual at his/her last known address. Generally, we will not send a notice if the premium subsidy stops because of death or if the initial determination is a redetermination that results in no change.

All notices will be stored on the Online Retrieval System (ORS).

The written notice that we send will explain the procedural history and issues of the case:

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  What our decision is;

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  The reasons for our decision; and

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  The effect of our decision on the subsidy

When notices are returned as undeliverable, the SAU will try to locate the individual. Document efforts to locate the individual on the Report of Contact screen in MAPS; e.g., use of local resources. If a new address is uncovered, remail the notice, enter the new address on the appeal screens in MAPS. This entry will not update the MBR, so you must also enter the new information in POS (see MS 06302.003).

See GN 02605.055 for guidance on undeliverable notices.