TN 3 (05-92)
NL 00803.210 Notice of Waiver Decision - Waiver Denied
You must always issue a manual notice when you cannot waive the entire overpayment.
B. WHEN TO USE
Use the following chart to choose the correct Overpayment Information notice to send overpaid individuals when you deny a waiver request.
|IF THE RECIPIENT IS IN....||AND||THEN USE FORM....|
|current pay ||does not reside in an institution where Medicaid pays more than half the cost of care ||SSA-L8173-U3 proposing recovery by full refund or adjustment rate that is lesser of 10 percent total monthly income or full SSI check. |
|current pay||resides in an institution where Medicaid pays more than half the cost ||SSA-L8174-U3 proposing recovery by full refund or refund by installments. |
|nonpay ||resides anywhere ||SSA-L8174-U3 proposing recovery by full refund or refund by installments. |
C. DESCRIPTION OF THE SSA-L8173-U3 AND SSA-L8174-U3
Besides providing information about overpayment recovery per B. above, the SSA-L8173-U3 and SSA-L8174-U3 tell overpaid individuals:
The amount of the overpayment;
The reason for denial of the waiver request; and
The right to appeal the waiver determination.